Improving the quality & safety of your service
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The document emphasizes the importance of effective change management and improvement in health services, recommending a structured approach using the Plan-Do-Study-Act cycle. It highlights the need to define clear aims, engage the right stakeholders, and measure outcomes to ensure changes lead to genuine improvements. Additionally, it discusses different communication styles necessary for conveying ideas and managing teams in the context of change.
Improving the quality & safety of your service
- 1. Improving the Quality and Safety of your Service Carol Marley - Improvement Manager Improving health outcomes across England by providing improvement and change expertise
- 2. Take a few minutes to think about something you would like to change have a chat to the person next to you about your idea
- 3. “Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way… if only he could stop bumping for a moment and think of it!” A. A. Milne
- 4. • Improvement work is not difficult • It’s not necessary to start from scratch • It’s pointless to just tell people to work harder; it’s better to try and work differently • If you don’t do things differently, things won’t change and are unlikely to improve Time out
- 6. “Every system is perfectly designed to get the results it achieves” Paul Batalden Dartmouth Medical School, New Hampshire, USA.
- 7. The NHS Change Model 8 components
- 8. Aims Measurements Change ideas The Improvement Guide Langley et al (1996) Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in the improvements that we seek ? Act Plan Study Do Testing ideas before implementing changes
- 9. The ‘Plan, Do, Study, Act’ cycle
- 10. What are you trying to accomplish? First define your aim…
- 11. We all know what we are doing… • Can you picture…
- 13. Why does defining your aim matter? • If you don’t know where you are going, you are likely to end up somewhere else… • How do we know what to measure if we don’t know what we are trying to achieve? • Focus on the problem and the gap – what do you need to tackle and what will it change? • It’s not about the solution!
- 14. Getting the right people involved and supporting the process of change
- 15. How you feel about change?
- 16. Attitudes to change differ… Proportionate enthusiasm Healthy scepticism Annoying evangelism Irrational obstructionism Moderate interest
- 17. How do you feel if your not told about changes? How do you feel if you’re the last to know?
- 18. Have you got the right people involved? • Psychiatrists, nurses, managers, care staff, pharmacists, patients, carers, families, commissioners, trust service improvement / project management office, communications team, chief executive, schools …
- 19. Attitudes to change differ… Proportionate enthusiasm Healthy scepticism Annoying evangelism Irrational obstructionism Moderate interest
- 20. Attitudes to change Proportionate enthusiasm Healthy scepticism Annoying evangelism Irrational obstructionism Moderate interest Calming down Keeping in real world Perspective Focussing ? Support Direction Feedback Motivating Exploring Evidence of benefit “Unpacking” Debate (argument) Selling
- 21. What are you going to tell them and how??
- 22. ADD Grief loss model
- 23. We all respond differently • Analyst • Amiable • Social (Expressive) • Driver
- 24. Analyst Amiable Expressive Driver Analytical Patient Verbal Action-orientated Controlled Loyal Motivating Decisive Orderly Sympathetic Enthusiastic Problem solver Precise Team person Gregarious Direct Disciplined Relaxed Convincing Assertive Deliberate Mature Impulsive Demanding Cautious Supportive Generous Risk-taker Diplomatic Stable Influential Forceful Accurate Considerate Charming Competitive Conscientious Empathetic Confident Independent Fact finder Persevering Inspiring Determined Systematic Trusting Dramatic Results-orientated Logical Congenial Optimistic Conventional Animated
- 25. The Analyst: Technical Specialist May be perceived positively as May be perceived negatively as How to work better with analysts • accurate • critical • tell how first • conscientious • picky • list pros & cons • serious • moralistic • be accurate & logical • persistent • stuffy • provide evidence • organised • stubborn • provide deadlines • deliberate • indecisive • give them time • cautious • don’t rush or surprise
- 26. The Analyst • Interested in, and places an high value on, facts, figures, data and reason • Others may describe them as analytical, systematic or methodical • They tend to follow an orderly approach when tackling tasks • Well organised and thorough • Sometimes seen as too cautious, overly structured and does things ‘by the book’ • They analyse, consider and project • They view time in a linear (sequential) fashion
- 27. Communicating with an Analyst • They want facts, figures and data in the message • It should be presented in an orderly fashion, with supporting documentation • Give them time to examine reports etc Written communications will be quite formal and precise, listing key points. They may use and outline style, with sub-headings and numbered sections. Tables and appendices, with facts and figures will also be included.
- 28. The Amiable: Relationship Specialist May be perceived positively as May be perceived negatively as How to work better with amiables • patient • hesitant • tell why & who first • respectful • ‘wishy-washy’ • ask instead of telling • willing • pliant • draw out their opinions • agreeable • conforming • chat about their life • dependable • dependent • define expectations • concerned • unsure • strive for harmony • relaxed • laid back • organised • mature • empathetic
- 29. The Amiable • Interested in, & places a high value on, relationships, feelings, interactions and affiliation with others • Often described as warm and sensitive to feelings of others, and a loyal & supportive friend • May be viewed as too emotional/ sentimental and too easily swayed by others • Will often make reference to past events and their relationships over a period of time
- 30. Communicating with an Amiable • Make sure the human dimensions of the situation are included • Include how others may feel about the matter • Let them know who else will be involved • Include past experiences in a similar situation Written communications will be quite informal, chatty and friendly. They may inject names and make reference to others and to past events
- 31. The Expressive: Social Specialist May be perceived positively as May be perceived negatively as How to work better with expressives • verbal • a talker • tell who first • inspiring • overly dramatic • be enthusiastic • ambitious • impulsive • allow for fun • enthusiastic • undisciplined • support their creativity & intuition • energetic • excitable • talk about people & goals • confident • egotistical • value feelings & opinions • friendly • flaky • keep fast paced • influential • manipulating • be flexible
- 32. The Expressive • Interested in taking people with them, enthusing them with optimism and energy • Tend to be open with people and willing to make a personal investment • Generally very good with people • Can frighten people by being over-dominant • May feel personally let down by people or left out • They tend to be poor with detail • Their hunches can go wrong
- 33. Communicating with an Expressive • They will be looking for the new and the exciting aspects of the message • Include some kind of innovation to hook the expressive Written communications can tend to be rather vague and abstract. They are inclined to be idea orientated and are often quite lengthy in making a point.
- 34. The Driver: Command Specialist May be perceived positively as May be perceived negatively as How to work better with drivers • decisive • pushy • tell what & when first • independent • one man show • keep fast paced • practical • tough • don’t waste time • determined • demanding • be business like • efficient • dominating • give some freedom • assertive • an agitator • talk results • risk-taker • cuts corners • find shortcuts • direct • insensitive • a problem solver
- 35. The Driver • Places great emphasis on action and results • Often viewed as decisive, direct and pragmatic • They view time as here and now, like to get things done and hate spinning things out • They translate ideas into action, and are dynamic & resourceful • Sometimes accused of only seeing the short term, and neglecting long-range implications • Can be seen as too impulsive, simplistic, and acting before they think
- 36. Communicating with a Driver • They will want to know ‘what are we going to do’? • ‘How soon we are going to do it’ is also very important to them Written communications will be brief, sketchy and crisp. They may resent having to take the time to write and will often scribble a reply on the senders original message and return it to them.
- 37. Measurement for Improvement “All improvement will require change, but not all change will result in improvement”
- 38. Aims Measurements Change ideas The Improvement Guide Langley et al (1996) Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in the improvements that we seek ? Act Plan Study Do Testing ideas before implementing changes
- 39. “It feels like…” or “I think …” just isn’t enough
- 40. If you don’t measure, you wont know… • If the changes we make have actually made a difference • If it is an improvement • How much difference the change has made • If the improvement has stayed in place? • Measurement can show: – How well the current testing is performing – Whether you have reached your aim – How much variation there is in the data/process – Small test of change – Whether the changes have resulted in improvement – Whether a change has been sustained
- 41. Top tips when starting to measure: • Seek usefulness not perfection • Measure the minimum. • Remember the goal is improvement and not a new measurement system. • Aim to make measurement part of the daily routine. • Don’t let measure issues delay the start of your PDSA cycles.
- 42. Why Baseline? • To understand current position • Development of a hypothesis • Enables teams to define success • For evaluation purposes • Before and After comparisons • Assessment • ??How much data??
- 43. Where can we get data from?
- 44. Project Metrics • Don’t forget to baseline • Measure times between patient journey steps A B • Measure the demand on the service • Measure your capacity • • Number on caseload
- 45. Got the data… what next? Understanding the information Root Cause Analysis Problem Solving
- 46. Tools to help people through the change process •Communicate communicate communicate •Be inclusive •What’s in it for me •Deal with conflict as it occurs •Don’t tolerate bad behaviour •Be honest •Manage expectations •Be aspirational/accountable/disciplined •Don’t impose solutions baste on emotion/opinion •Be part of the action plan