Clearing the barriers to improvement

Mandy Smith & Liz Smith Quality Improvement Facilitators Taking Action to Improve Quality Birmingham 25 th March 2014 www.hqip.org.uk

VISION VISION VISION VISION VISION

Achieving successful change requires . .

SKILLS INCENTIVES RESOURCES ACTION PLAN CHANGE SKILLS SKILLS SKILLS SKILLS INCENTIVES INCENTIVES INCENTIVES INCENTIVES RESOURCES ACTION PLAN CONFUSION RESOURCES RESOURCES RESOURCES ACTION PLAN ACTION PLAN ACTION PLAN ANXIETY NO CHANGE FRUSTRATION FALSE STARTS

Promoting the vision

• The vision is care which complies with standards, because this delivers the best outcomes • Do all the clinical team and stakeholders agree?

• Is the audit focussed on clinical priorities?

• Will the audit design provide convincing evidence for change?

• Does it aim at quality improvement?

Aims and objectives

• Setting the correct AIM and OBJECTIVES is key.

• WEAK aims: • Audit compliance with guidelines • Evaluate care of .......

• STRONG aims: • Improve compliance with guidelines by . . .

• Increase patient safety by . . .

• Practical exercise

Developing skills

• Do front line staff lack skills in clinical audit and managing change?

• Access to audit facilitators and practical support • Do audit facilitators understand their role?

• The importance of clinician leads • Support from senior management • Good audit governance – not bureaucracy

Developing skills

• Do front line staff have the skills to implement new working practices?

• Identify the needs for training and support • Don’t train people to do what they already know how to do but can’t do for reasons other than lack of knowledge – i.e. lack of resources, faulty systems and processes.

• Identify and address the underlying causes for lack of compliance.

Identify your strengths

• Are these skills already available in your organisation?

• Identify who else in your organisation has change management skills & experience. • Where can skills be shared or transferred? • Who has the power and influence to lead change?

• How do the clinical audits you are working on relate to other QI activities?

Maximising incentives

• Incentives fall into two main categories: • Incentives for organisations • Incentives for healthcare professionals

Maximising incentives

For organisations: • reputation and publicity • high –level assurance • evidence for commissioners • service improvement and development

Maximising incentives

For healthcare professionals: • professional pride and reputation • personal development, revalidation • reduction in complaints • improved services

Finding the resources

• Resources may include time, money, people and equipment • Remember - clinically effective services are more cost effective • Engage budget holders • Engagement with commissioners

Finding the resources

• Audit data can provide powerful evidence for a business case • Developing a business case: • A proposal seeking authorisation for the allocation of resources • Required whenever expenditure has to be justified • Follow the prescribed format used in your organisation

Contents of a business case

• Executive summary • Background including current position & proposed development • Quantifiable benefits so impact can be assessed • Project management arrangements including timelines, procurement strategy etc.

• Financial analysis – consult your finance colleagues • Risk analysis • Summary of proposals

Planning for action

• Poor or inadequate action planning is worse than none at all • Do you understand the fundamental reasons for the shortfalls identified by the audit?

• Are the actions SMART? • Specific, Measurable, Assignable, Realistic and

Time-related

• Using the ‘AIMS’ tool

Three types of Measure

• • • Outcome measures : Voice of the patient. How is the system performing? What is the result?

Process measures as planned?

: Voice of the workings of the system. Are the parts/steps in the system performing Balancing measures : Looking at a system from a different angle. What happened to the system as we improved the outcome and process measures? e.g. unanticipated consequences, other factors influencing outcomes – a holistic view.

Reduce length of stay Decrease post op ventilation time Increase VTE treatment 4 hour A&E waiting time

Balancing Measures

readmission rate re-intubation rates bleeding / HIT .....................!

Planning for action

• Do the front line staff who will be implementing the actions actually believe they will be effective?

WEAK ACTIONS

Raise staff awareness Remind staff Provide training Write a new policy

STRONG ACTIONS

Remove barriers to doing the work effectively Redesign the work Supervise, monitor and feed back Use IT or technological solutions • Using the CAST system to prioritise actions

Acting on the plan

• Taking action is a process and the action plan documents and supports the process • Monitor consequences and address barriers • Go with the willing to build the evidence base for change • Celebrate achievements and build on success • Report, review and learn from failures

VISION SKILLS INCENTIVES RESOURCES

In summary

ACTION PLAN CHANGE

• Share the vision with all the key stakeholders • Support staff in developing new skills • Provide incentives that matter to your colleagues • Work with stakeholders to identify the resources • Plan for action and follow the plan through to successful change