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HI3 Launch 23 August 2018

Guest Blogger Audrey Henderson is an Information Analyst for the Information Services Division (ISD) of NHS. She works for the Local Intelligence Support Team (LIST); providing data support to Health and Social Care Partnerships and GP clusters for Improvement work across Highland, Orkney and Shetland. She and her local colleagues are hosted by NHS Highland Public Health and are based in Inverness.

There was a definite buzz of anticipation and excitement when I arrived at the Centre for Health Sciences in Inverness for the launch of The Highlands and Islands Improvement Institute - HI3. I was attending as an NHS intelligence analyst (aka health data enthusiast); and although I knew that the institute was to be a formal collaboration between NHS Highland and the University of the Highlands and Islands (UHI) in relation to quality improvement, I still wasn’t really sure what that meant.

It didn’t take long for pennies to start dropping as Prof Elaine Mead (Chief Executive of NHS Highland) kicked off the event and introduced us to HI3 (it’s called “Hi-cubed”, she encouraged us to repeat until it was ingrained). HI3 is a true collaborative of Research, Education, and Practice, she told us. A place where professionals can connect, share, learn and innovate together through Quality Improvement (QI) science. The day progressed with numerous examples of how this is already happening across Highland and it became clear how necessary HI3 is to harness all this fantastic work and share it not only across Highland but also beyond.


Did you know that the current most read article in the BMJ Open Quality journal is a paper written by colleagues from UHI and NHS Highland? (As at time of writing, Aug 2018). The paper, “Improving wait time from referral to opiate replacement therapy in a drug recovery service”, can be accessed here, and with HI3 there will be more opportunities for papers like this. UHI plans to dramatically increase the number of research academic staff in the coming years, explained Prof Crichton Lang (Deputy Principal for UHI). This means that there will be more opportunities for colleagues working across NHS Highland and UHI to write up, publish and share their findings from quality improvement projects. Publishing is an important step because it allows others to learn from existing working and so the improvement cycle continues.


And how do we learn Quality Improvement techniques? NHS Highland has a unique approach to Quality Improvement with an embedded ethos of "better health, better care and better value”. Dr Cameron Stark (Consultant in Public Health) talked us through their in-house training programme illustrating how any staff member can undertake training to become a Quality Improvement practitioner, and develop further to become QI leaders or even coaches. With HI3 there is opportunity to formalise some of this training and extend its reach. Prof Lang introduced us to the PgCert in Healthcare Quality Improvement. A new programme offered by UHI, developed in partnership with NHS Highland (and already fully subscribed!) which can offer staff and others, a formal qualification in Quality Improvement. HI3 will also provide a platform for staff across both organisations to share their skills externally, with other health and social care providers, third sector organisations and beyond, as was explained during the morning panel discussion.

HI3 is not a theoretical institute though. It has strong groundings in Quality Improvement science, but as Dr Michelle Beattie (Lecturer in Nursing, UHI) explained, we learn Quality Improvement by doing Quality Improvement. This is exemplified by the nursing curriculum at UHI, which is the only one in Scotland to include a mandatory practicum for all student nurses to undertake a quality improvement project. Dr Beattie explained that the practicum has been extremely successful, with students quoting it as an enjoyable experience, and a unique skill, giving them an advantage in the job market. The NHS has benefited too with placement mentors deciding to continue or extend some of the initiatives set in place by students. Most important, QI skills are being embedded further into the workforce ensuring a continuous and growing drive to improve the quality of health and social care.


During lunch time we had the chance to visit a market place of stalls and I visited Kay Cordiner (Senior Charge Nurse) to learn about the Value Management Programme in NHS Highland, which uses QI tools and techniques to empower frontline staff to manage cost and quality in real time. She showed me how endoscopy staff had saved costs and improved service delivery by eliminating late starts in theatres – all by sharing and engaging with data.

During the afternoon session Professor Angus Watson (Colorectal Surgeon and Professor of Surgery) inspired us all by sharing examples of local but far reaching innovations coming out of the Highland region. This included the pill cam, a capsule sized camera that takes 1000s of pictures as it passes through the digestive system. The pill cam which is being piloted for the first time in Scotland in Ullapool is an alternative to diagnostic endoscopy, allowing patients to be assessed more comfortably from home. If successful, it could be rolled out across Highland saving patients travel time and discomfort.

Finally, to round off the day we had an opportunity to see examples of quality improvement in practice. I chose to visit the Orthopaedic ward where they had introduced a Kanban inventory system. This is a highly organised method of stock inventory which doesn’t sound very exciting, but it looked extremely neat, a place for everything and everything in its place. Lisa Kenley (Plaster Room Specialist) explained how they had not only reduced waste but also saved staff time; and eliminated the dread and worry around the chore of re-ordering stock. This meant happier staff with more time for patients.

Final Thoughts

Since relocating to Inverness a year ago I’ve been impressed with the strong culture of Quality Improvement which permeates NHS Highland but with the launch of HI3 it is clear that this is just the beginning. We’re on the cusp of something really exciting. HI3 provides and international platform for professionals to learn, practice, evaluate and share Quality Improvement techniques. As academics and practitioners come together with such willingness to innovate and do better; the benefits can only be greater and further-reaching. I left the day poised to do better myself and proud to be part of a region with such foresight.