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Scottish Improvement Skills Workshop 1 Day 1

Join our 1-day workshop to learn about improvement science methods and apply them to improve the safety and quality of services. Develop effective interventions, measurement plans, and communication strategies.

michellethompson
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Scottish Improvement Skills Workshop 1 Day 1

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  1. Scottish Improvement Skills Workshop 1 Day 1

  2. Housekeeping

  3. Getting started • Work context • Quality challenges • Strengths for improvement

  4. SIS Objectives • To select appropriate improvement science methods and apply them to improve the safety and quality of services. • Design effective interventions • Construct measurement plans • Use key measurement tools • Communicate about project work to others

  5. Ground Rules

  6. Day 1 • Quality Improvement and why it matters • Improvement principles • Focussing your aim • Project charters • Developing theories for change • Leading local change

  7. Quality Improvement and why it matters • By the end of this session you will be able to: • outline the policy context for Quality Improvement in Scotland • describe how your improvement project aligns with this policy context.

  8. NHS Scotland 20:20 Vision Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting.

  9. Route map to the 20:20 Vision

  10. Aims: To deliver the highest quality healthcare services to the people of Scotland. For NHSScotland to be recognised as world-leading in the quality of healthcare it provides.

  11. Quality Ambitions Person-centred:Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making. Effective: The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated. Safe: There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

  12. Six dimensions of quality

  13. “... the Quality Strategy will be the means by which we ensure that these longer-term transformational challenges are addressed.”

  14. Transformational change A definition: • A change that is not merely an extension or improvement over the past, but astate change.  • This state change in social systems can bepersonal and/or organisational. • Achieving this state change requires altering and expanding the limiting mindset in which the individual/the organisation operates.

  15. Achieving that change • Before the fact the new level of performance envisioned is audacious. It calls for a new way to do the work with a new level of fearlessness, of innovation and collaboration. • After the fact, you will say that we have more than a large improvement, we have a different person or organization, a state-change, a transformation.

  16. William A. Foster 1941 "Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”

  17. Quality Improvement and why it matters: summary • Quality Strategy • Six dimensions of quality • 20:20 Vision • Route map to the 20:20 vision • Transformational change

  18. Improvement principles • By the end of this session you will be able to: • explain Deming’s System of Profound Knowledge • apply the System of Profound Knowledge to assist an understanding of complexity in your local context.

  19. Quality Improvement is defined as the application of: “a systematic approach that uses specific techniques to improve quality.” What is Quality Improvement? Health Foundation 2013

  20. All approaches have the following in common

  21. System of Profound Knowledge Deming 2000

  22. System of Profound Knowledge • https://www.youtube.com/watch?v=xKv--YA8XJE • Deming’s System of Profound Knowledge 1

  23. System of Profound Knowledge Deming 2000

  24. Appreciation for a system • A common purpose • What’s in a system: structures, processes, culture • Interdependence, interactions • Whole is greater than the sum of its parts

  25. Appreciation of a System “Dividing an elephant in half does not produce two small elephants.” Senge 1992

  26. What is a system? “A system is a set of interrelated parts that work together to achieve a common aim” Deming 2000 “A group of items, people or processes working together toward a common purpose” Improvement Guide p77-79

  27. Characteristics of a System • Has aim or purpose • Series of factors leading to outcomes that have value to stakeholders • Structures, processes, people, cultures • It is dynamic • To improve outcomes need to understand system dynamics

  28. Characteristics of a System Structure + Process = Outcome Donabedian (1966)

  29. Complexity Simple Complicated Complex

  30. Appreciation for a system: a personal example • Structures • Processes • People • Culture • Interdependencies

  31. Theory of Knowledge • Current knowledge is expressed as theory • Change involves prediction • We learn by testing theory and finding our if our prediction succeeds or fails

  32. The typical approach Conference Room APPROVE DESIGN DESIGN DESIGN DESIGN Real World IMPLEMENT

  33. The Quality Improvement approach Conference Room APPROVE IF NECESSARY DESIGN Real World START TO IMPLEMENT TEST & MODIFY TEST & MODIFY TEST & MODIFY

  34. Model for Improvement The Improvement Guide Langley J et al 2009

  35. Theory of Knowledge: a personal example • What do we think we know? • What do we think stops us getting the outcomes we want? • What could we do differently, and what do we predict would be the result of that change?

  36. Understanding variation • Random variation – affects everyone, over all outcomes and over time • Non-random variation – arises because of specific circumstances does not affect everyone or all parts of the system all the time

  37. Variation: Random or Non-random?

  38. Variation: Random or Non-random?

  39. Displaying variation in data (1)

  40. Displaying variation in data (2)

  41. Understanding variation: a personal example • What measures might be useful? • For each measure, Is variation in the data collected random or non-random? • If non-random, what is the cause of the variation?

  42. Psychology • Interactions between people • Motivation (intrinsic, extrinsic) • Beliefs • Assumptions • Will to engage with and adopt a change.

  43. Psychology: soft or hard?

  44. Psychology

  45. Psychology: a personal example • Interactions between people • Motivation (intrinsic, extrinsic) • Beliefs • Assumptions • Will to engage with and adopt a change.

  46. System of Profound Knowledge Deming 2000

  47. System of Profound Knowledge Deming 2000

  48. Model for Improvement The Improvement Guide Langley J et al 2009

  49. Three questions • What are we trying to accomplish? • How will we know that a change is an improvement? • What change can we make that will result in improvement?

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