striking the balance: approaches to accountability and quality improvement to achieve results
TRANSCRIPT
Striking the Balance: Approaches to Accountability and Quality
Improvement to Achieve Results
Helen Bevan Chief Transformation Officer
Horizons, NHS England
Christina KrauseExecutive Director
BC Patient Safety & Quality Council
@helenbevan @ck4q #qfA9 #quality2016
Speed Networking
“When do you feel most engaged and energized at work?”
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Three ways to enhance quality
Qualityplanning
Qualityimprovement
Qualitycontrol Source:
Juran quality trilogy
All three are necessary for
quality outcomes
All three need to be aligned
QP
QCQI
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Three ways to enhance quality
Source of model: Juran quality trilogy
Identify the needs of population, create aims & metrics for outcomes & set out a series of
steps for meeting our aims
Ensuring high quality care through
monitoring, inspecting, accrediting, regulating
& include corrective responses
Achieve better outcomes through a systematic change
approach with strong leadership, adaptive
culture and people who are skilled in QI
methods.
QP
QCQI
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TRIZ: Theory of Inventive
Problem solving
Stopping counter-productive
activities and behaviours
“Every act of creation is first an act of destruction”Pablo Picasso
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ww
w.liberatingstructures.com
Our TRIZ topic…
How can we deliberately create a health care system that favours quality assurance over quality
improvement as a strategy for improving care?
TRIZ
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Step 1
As a table group make a list of “to-dos” on the first paper sheet in response to this task:How can we deliberately create a health care system that favours
quality assurance over quality improvement as a strategy for improving care?
• Go wild!• 5 minutes
TRIZ@helenbevan @ck4q #qfA9 #quality2016
Step 2As a table group, go down your first list and ask:– Is there anything that we are currently doing that in
any way, shape or form resembles any of the items on list one?
– Is there an element of truth in here?• Cross out anything that you do not currently do,
circle those that do – Be unforgiving about these items and talk about their
impact• 5 minutes
TRIZ@helenbevan @ck4q #qfA9 #quality2016
Step 3As a table group, for each one you circled ask:
“what are the first steps that will help us stop getting undesirable results?”
• Make a list of actions on a new sheet • Be prepared to share some of your content
from lists 2 and 3 with the wider group• 5 minutes
TRIZ@helenbevan @ck4q #qfA9 #quality2016
Intrinsic motivators
build energy and creativity
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Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
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Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity create focus &
momentum for delivery
Drivers of extrinsic motivation
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Drivers of extrinsic motivation
create focus & momentum for delivery
Intrinsic motivators • connecting to shared purpose
• engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
•System drivers & incentives•Payment by results•Performance management•Measurement for accountability
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Internal motivators
• connecting to shared purpose
•engaging, mobilising and calling to action
• motivational leadership
build energy and creativity
Drivers of extrinsicmotivation
•System drivers & incentives•Performance management•Measurement for accountability
create & focus momentum for delivery
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The power of extrinsic drivers
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Three types of levers for large scale change
‘Prod mechanisms’ targets
performance management
price & payment incentives regulation
competition
‘Proactive support’
relies on building ‘intrinsic motivation’ in
staff to make the right changes to
improve
‘People focused’ education and training
national contractsprofessional regulation
clinical quality standards
Type one:
Type two: Type three:
Source: Health Foundation Constructive comfort: accelerating change in the NHS 2015
@helenbevan @ck4q #qfA9 #quality2016
Three types of levers for large scale change
‘Prod mechanisms’ targets
performance management
price & payment incentives regulation
competition
‘Proactive support’
relies on building ‘intrinsic motivation’ in
staff to make the right changes to
improve
‘People focused’ education and training
national contractsprofessional regulation
clinical quality standards
Type one:
Type two: Type three:
Source: Health Foundation Constructive comfort: accelerating change in the NHS 2015
Less than 10%of the potential
for improvement
at system level can be
delivered through type one change
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“I have some Key Performance
Indicatorsfor you”
or
“I have a dream”
Source: @RobertVarnam
@helenbevan @ck4q #qfA9 #quality2016
@helenbevan @ck4q #qfA9 #quality2016
https://www.youtube.com/watch?v=DKK-yFn7e_0
@helenbevan @ck4q #qfA9 #quality2016
https://www.youtube.com/watch?v=DKK-yFn7e_0
@helenbevan @ck4q #qfA9 #quality2016
@helenbevan @ck4q #qfA9 #quality2016
@helenbevan @ck4q #qfA9 #quality2016
What Is the Balance in Your System?
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Adapted from the Danish national quality strategy
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@helenbevan @ck4q #qfA9 #quality2016
What Is the Balance in Your System?
Table Discussion
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@helenbevan @ck4q #qfA9 #quality2016
Examples of Polarities to Manage
Old power ANDTransactional AND
Micro ANDCollaborative learner AND
Customizing ANDWholeness AND
Complex AND
New powerTransformationalMacroExpert advisorStandardizingLinearSimple
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#qfA9
Positive results of focus on this left pole
Negative results of over-focus on the left pole to the neglect of the right pole
Negative results of over-focus on the right pole to the neglect of the left pole
Deeper Fear from lack of balance
Greater Purpose Statement - why balance this polarity?*
and
Adapted from the Polarity Management map, Polarity Associates
Polarity MapAction stepsHow will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures?
Action StepsHow will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures?
Early Warnings Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole.
Early WarningsMeasurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole.
Positive results of focus on this right pole
At Your Tables …
An opportunity to dive deeper on quality assurance and quality improvement through polarity mapping.
Using the worksheet on your table – explore the concepts of:
Accountability AND Improvement
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Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA
old power new power
Currency
Held by a few
Pushed down
Commanded
Closed
Transaction
Current
Made by many
Pulled in
Shared
Open
Relationship
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So what does this mean for us in the room today?
• Striking the balance … both/and, not either/or• Understanding and applying within our own
contexts • Turn to your neighbour …
What does it mean for you back home?
@helenbevan @ck4q #qfA9 #quality2016
Thank you!
Helen Bevan @helenbevan
Christina Krause@ck4q
@helenbevan @ck4q #qfA9 #quality2016