Posted by: ayrshirehealth | December 21, 2012

The twelve days of Christmas by @jasonleitch

It’s Christmas. Santa, holly, carol singers and general festivities. santa hatIt is both the happiest time of the year for many and saddest time for some. An opportunity to reflect and to look forward.

Almost everyone will have had some healthcare experience since last Christmas. Ranging from a GP visit to a transplant with months of recuperation. Many will have continued their regular chronic disease management in partnership with the healthcare system.

‘the best at getting better’

Jim Anderson, the former CEO of Cincinnati Children’s Hospital chose an unusual mission statement for his hospital. It wasn’t ‘to be the best children’s hospital in the world’. It was ‘to be the best at getting better’.

24-7Jim recognised that the improvement and quality mission is never done.

It is a twenty four hour a day, seven day a week, 365 day a year job. It will be forever. We must strive every day to get better at getting better.  What does this mean in practical terms?

What should those passionate about healthcare improvement get from Santa for Christmas.

I have a few suggestions.

It is traditionally thought that the three wise men from the East (not from Portobello…further East than that) followed a star and took twelve days to reach Jesus. The traditional Christmas carol suggests a gift for each of these twelve days. “On the first day of Christmas….etc”

So I offer a special healthcare quality version of the twelve days. Some we already have, some I think we should seek in 2013. You don’t have to sing it.

  • Twelve hours of managed family visiting a day as the norm in wards and ICUsclock
  • Eleven percent reduction in mortality across the whole country. (11.4% to be more accurate but that doesn’t fit the Carol.)
  • Ten out of ten theatres using the surgical checklist every day, for every operation
  • Nine SPSP fellows get inspired to make radical transformation in their context
  • Eight improvement advisors teach others how to measure for improvement
  • Seven days a week of reliable person-centred care, evidenced by unrelenting compassion
  • Six intensive care units in Glasgow with no central line infections for 300 days or more
  • Five family members of the Scottish Patient Safety Programme – acute, maternity, mental health, primary care and paediatrics all delivering their how much by when aims.SPSP Logo
  • Four elements in the ventilator pneumonia bundle delivered reliably everywhere
  • Three handovers a day using SBAR as the communication tool in every healthcare setting
  • Two Cabinet Secretaries in one year who both believe quality is the number one priority
  • One Early Years Collaborative.

It fits if you try hard enough ..

It doesn’t have quite the rhythmic quality of pipers piping and ladies dancing but you get the point.  If you wish a version to sing to, how about this:

12 SBAR forms filled          musical notes

musical notes

11 site visits done

10 leader walkrounds

9 response calls answered

8 PVCs pulled


6 surgical pauses

5 medicines reconciled

4 warning scoresQuality strategy

3 bundles done

2 hands washed

And a Quality Strategy

It takes a bit of imagination but it fits.

The Christmas Index

The ‘Christmas Index’ calculates each year what the traditional twelve day’s gifts cost. In 1984 it was £9000, in 2012 it was £67,000, a seven fold increase. Not withstanding the fact it seems impossible to price maids-a-milking and lords-a-leaping, it is getting more expensive. The real prize in healthcare quality is that delivery of this list makes healthcare cheaper each year…Merry Christmas.

screen-capture-11@jasonleitch is the Clinical Director,

The Quality Unit,  Scottish Government

and an Institute for Healthcare Improvement Fellow


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