Transcript Sustaining change Tips for sustaining and evidencing

Sustaining change: Reflections
including the role of regional networks and NQICAN
and using Patient and Public Involvement / Patient
Leaders
Kat Young MA
Senior Quality Improvement Lead, Royal Berkshire NHS Foundation Trust
Chair, National Quality Improvement and Clinical Audit Network
Member, National Advisory Group for Clinical Audit and Enquiries
Member, 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
What change works?
Make results visible
Ward to Board
Patient/user friendly
• Measure little
and often
• Process,
• Outcome
• Balancing
measure
Is it still working?
• Keep measuring
Sustainability from the start…
© Royal Berkshire NHS FT 2013
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.
RBFT
QIPP
Programme
The Quality Improvement Approach: IMPROVE
Ideas
Measure
Plan
RoI
Organise
Vital
Evaluate
How…
Behaviours
… do we
want to
improve?
… good are
we and how
do we know?
Methodology
RAG Study
Brainstorm
Process Map
Model for
Improvement
Spaghetti
Diagram
… do we
make the
changes?
… do we
prioritise?
Pareto
…do we
reduce
waste?
… do we
demonstrate
it’s worth it
Project Plan
Audit
Staff +Patient
Engagement
Human /
Financial cost
and saving
Historical
analysis
5 D’s
SPC
PDSA
Business
Cases
Benchmark
Baselines
Lean
PMO Docs
… do we
make it
happen
Owners
Timescales
Rapid
Improvement
Events
Six Sigma
… will our
behaviours
support the
change
Open to
change
See the
benefit or
bigger
picture
Engagement
… will we
know we
have made a
difference,
and how do
we keep
improving?
Review
performance
Communicate
change
Ensure
sustainability
Celebrate
Success
Testing for sustainability
• Preferences, attitudes and behaviours
• Appetite for improvement
– Motivation / desire
– To individual as well as organisation
• Ability / skills
• Ownership
“Quality is
impossible
without an
honest
conversation
Deming
– Objectives
• Leadership
• Visibility of results
***KEEP CHECKING!
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
Multiple
stakeholders /
channels
Engage those doing
the doing
• Organisation
• Staff
• Patients
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
NQICAN and Regional Clinical Audit
Networks
[email protected]
@nqican
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…