sustaining change: reflections including the role of regional networks and nqican and using patient...
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Sustaining change: Reflectionsincluding the role of regional networks and NQICAN and using Patient and Public Involvement / Patient
Leaders
Kat Young MASenior Quality Improvement Lead, Royal Berkshire NHS Foundation TrustChair, National Quality Improvement and Clinical Audit NetworkMember, National Advisory Group for Clinical Audit and EnquiriesMember, Faculty Medical Leadership and Management Twitter: Clin_Q Email [email protected]
The change cycle
• Define a problem – measure
• Implement change – Analyze causes– Identifying feasible solutions– Develop and implement action
plan• Re-audit / Sustained?
Sensible? Effective?
Model for Improvement
Run Charts
What to measure?• Only collect the data you need to answer the questions – link to
aim/objectives• Outcomes measure – Are we fulfilling our aim?– Measures of the customer (patient, family)
• Process measure – Things we think will lead to improvement in outcome– Measures of the workings of the system
• Balancing measure – – What is the risk? – Is something else being affected by our changes (good or bad)?”– Measures of the other parts of the system
Run charts
• Measure little and often• Process,• Outcome • Balancing measure
What change works?
• Keep measuringIs it still working?Make results visible
Ward to BoardPatient/user friendly
Sustainability from the start…
Employers felt 55% of change management initiatives met initial objectives, but only 25% felt gains were sustained over time http://www.towerswatson.com/en/Press/2013/08/Only-One-Quarter-of-Employers-Are-Sustaining-Gains-From-Change-Management felt gains were sustained over time.
© Royal Berkshire NHS FT 2013
Ideas Measure Plan RoI Organise Vital Behaviours
Evaluate
How
…RBFT QIPP
Programme
Met
hodo
logy
… do we want to
improve?
… good are we and how do we know?
… do we make the changes?
… do we prioritise?
…do we reduce waste?
… do we demonstrate it’s worth it
… do we make it happen
… will our behaviours support the
change
… will we know we
have made a difference,
and how do we keep
improving?
Brainstorm
Process Map
Model for Improvement
Spaghetti Diagram
RAG Study
Benchmark
Audit
Historical analysis
Baselines
Lean
Pareto
Staff +Patient Engagement
5 D’s
PDSA
PMO Docs
Human / Financial cost
and saving
SPC
Business Cases
Project Plan
Owners
Timescales
Rapid Improvement
Events
Six Sigma
Open to change
See the benefit or
bigger picture
Engagement
Review performance
Communicate change
Ensure sustainability
Celebrate Success
The Quality Improvement Approach: IMPROVE
Testing for sustainability
• Preferences, attitudes and behaviours• Appetite for improvement – Motivation / desire– To individual as well as organisation
• Ability / skills• Ownership – Objectives
• Leadership• Visibility of results
***KEEP CHECKING!
“Quality is impossible without an
honest conversatio
nDeming
Picture: © Paul Souders/Corbis
Testing sustainability
Questions to ask • Are they aware?• Do they care? – Is it fair?– will they do it?
• Can they do it?• Anything they need in order to do it? • Is it primary or secondary to role?
Sustaining continuous improvement: Communication
• Timely, frequent communication
• Articulate key messages and benefits and results
• Celebrate great work / achievements – focus on the positives
• Highly visible• Make it fun, be creative
• Organisation• Staff • Patients
Multiple stakeholders / channelsEngage those doing the doing
Winning hearts and minds
–Does it connect? Continue to connect?–Hard facts/
numbers + emotion / story–Patient and Public
Involvement –Patient Leaders
Ways of Working
• SMARTER not harder• Behaviour and values • Listen and understand negativity• Find the positives, find ways to share
the positives, build energy and momentum• Build capability and capacity –Support networks / Champions
Role of Networks
• Create energy, enthusiasm and skills • Provides support – we know it can be tough• Advice and guidance• Shared learning– What works / what doesn’t work
15 Regional Clinical Audit Networks
[email protected] @nqican NQICAN Website to be launched at HQIP Conference
Summary… • Know what works – Measure measure
measure: little and often• Change involves people– Vision / Purpose / Fulfilling work– Positive experience – Involve patients– Work together, support each other,
network• Test: – Organisational commitment– Leadership– Financial – Visibility of key messages and
communication
Work together Use your Network
Thank you for listening Questions? Discussion…