Value Management Approach to Quality Improvement in the Intensive Care Unit, University Hospital Crosshouse, NHS Ayrshire & Arran

Critically ill patients will often need the help and support of intensive care. We are able to provide help and assistance to patients if their body is not able to cope with overwhelming sickness or injury. Common interventions include connecting patients to breathing machines or kidney dialysis amongst others. As the population grows and gets older the demand for intensive care services is likely to increase. Our intensive care unit has a proactive improvement plan where we attempt to continually introduce small changes in the care we deliver to patients and families. These changes come from the latest medical research and recommendations, from patient, family and staff feedback and from any other areas of improvement we are made aware of. Recently we introduced a system, called the Value Management Approach (VMA), as a means to co-ordinate our projects into a meaningful strategy. VMA is a new collaborative that supports clinical, care and finance teams to apply quality improvement methods with combined cost and quality to deliver improved patient outcomes, experience and value. Already tested within in NHS Highland, we have seen firsthand the benefit for our intended purpose.

We classify potential improvement projects under one of four headings or pillars, namely, Quality, Service, People and Finance. Considering staff, patient and family feedback we prioritise projects in each of the four areas based on what is likely to be of most value and realise the greatest improvement. This strategy encourages staff engagement and allows patients and families an opportunity to influence change. Focussing on finance as a pillar has enabled the department to legitimately feel that we can tackle improvement for the sole purpose of cost saving and reducing waste without compromising decision-making or care.

Pivotal to the system is regular feedback and report-out of the ongoing results to determine whether any change results in improvement or not. A weekly report-out consists of verbal presentations of progress in each of the four areas in front of the multi-disciplinary team. Hurdles and success are both discussed and celebrated. Once complete, projects are progressed along the priority list.

The Value Management Approach has allowed us to ask “What matters to…….” staff, patients, families and finances.   Combined with a weekly report-out of results we are seeing improvements in real time and communicated to staff at all levels.