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What changes do we think will result in improvement?

What changes do we think will result in improvement?. EYC is one!. Mothercare Award for Maternity Service of the Year NHS Forth Valley. The President’s Award for Supervisors of Midwives Supervisor of Midwives Team NHS Lanarkshire and University of the West of Scotland.

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What changes do we think will result in improvement?

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  1. What changes do we think will result in improvement?

  2. EYC is one!

  3. Mothercare Award for Maternity Service of the Year NHS Forth Valley The President’s Award for Supervisors of Midwives Supervisor of Midwives TeamNHS Lanarkshire and University of the West of Scotland Philips AVENT Award for Innovation in MidwiferyMaternity telehealthSheona Brown and Dorothy FinlayNHS Greater Glasgow and Clyde Scotland Johnson's Baby Mums' Midwife of the Year winner Laura Main NHS Grampian The RCM Award for Partnership Working Early Years Assessment TeamRebecca Wade and Linda DavidsonNHS Borders and Scottish Borders Council Congratulations everyone! Pregnacare Award for Excellence in Maternity Care Vulnerable Families Maternity TeamElaine Moore and Mary GarvenNHS Ayrshire and Arran Pregnacare Award for Excellence in Maternity Care Vulnerable Families Maternity TeamElaine Moore and Mary GarvenNHS Ayrshire and Arran NMSF Award for Bereavement Care Bereavement care: maintaining a gold standardFamily room organisation and updateEmma CampbellNHS Lothian

  4. Early Years Collaborative

  5. Stretch Aims • Positive pregnancies which result in the birth of more healthy babies by end 2015 • 15% in the rates of stillbirths and infant mortality • 85% of all children reached all of the expected developmental milestones at the time of the child’s 27‐30 month child health review, by end‐2016 • 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end‐2017 • 90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021

  6. Stretch Aims • Positive pregnancies which result in the birth of more healthy babies by end 2015 • 15% in the rates of stillbirths and infant mortality • 85% of all children reached all of the expected developmental milestones at the time of the child’s 27‐30 month child health review, by end‐2016 • 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end‐2017 • 90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021

  7. Learning Session 4 January 2014 • One year in… • ‘Superior results in certain locations do not spread to other sites’ WHO/IHI • Key Changes

  8. Key changes • Develop and package interventions for optimal adoption across the EYC • In alignment with the EYTF expectations and the agreed Single Outcome Agreements. • Describe the relative advantage over current practice • ‘Trialability’ and ‘Observability’   • Small pockets of activity (islands of excellence) • Make it compelling!

  9. Key changes Focus Breakthrough items Big tickets Concentrated effort But don’t stop other stuff!

  10. Activity to date • Key Changes event • Engage those not in the room • Develop a menu of key changes by work stream • Paper to EYTF December 2013 • Learning session 4 – ‘Key Changes’

  11. Activity today • Your work today – develop and refine the proposed Key Changes • Consider the evidence base • Consider your population • Apply your improvement science learning • Consider your ‘Pioneer’ sites • Share your data…

  12. Becoming a “Pioneer Site” in this area • A Pioneer Site is an area (specific geographical location, nursery, clinic, school, community centre etc.) that has: • The local will and interest to work on this important issue with their community. • Leadership support to be the CPP’s Pioneer Site for this issue. • Adequate resourcing to do the work required for testing in this area. • Some existing work in this area. • Willingness to share their data and learning with the Collaborative, warts and all!

  13. Key changes • Cross cutting • Workstream 1 • Workstream 2 • Workstream 3 • Workstream 4 • Workstream 5

  14. In 1601, James Lancaster successfully conducted an experiment to illustrate the effectiveness of lemon juice to prevent scurvy. When did the British Fleet adopt this treatment? • 1602 • 1689 • 1757 • 1796 • 1865

  15. 264 years....

  16. Controlling Scurvy 1601 Captain James Lancaster experimented with lemon juice to prevent scurvy 1747 James Lind, another experiment on HMS Salisbury 1795 British Navy adopts innovative prevention on all ships 1865 prevention was adopted across the British Merchant Marine

  17. “Strong evidence for an innovation is necessary but not sufficient to result in its adoption”Mark Freeman, 2012, The International Journal of Management Education

  18. The “Diffusion Curve”:Reaching the Tipping Point Tipping Point Number of Adopters of Hybrid Seed Corn in Two Iowa Communities Source: Based on Ryan and Gross (1943)

  19. Roger’s Adopter Categories Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.

  20. Jason’s preferences…

  21. Roger’s Adoption Attributes

  22. “Up to 70% of improvement projects never spread” Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable Company. MIT Sloan Management Review 2012; 53(4): 43-50.

  23. With thanks to Carol Haraden

  24. 1. Start with a large pilot

  25. 2. Find one person to do it all

  26. 3. Be assured…vigilance and hard work will solve the problems

  27. 4. Do one small test and then spread everywhere ???? ????

  28. 5. Get the pilot team to spread the improvement system-wide

  29. 6. Only look at the process/quality measures on a quarterly basis (or less frequently)

  30. 7. Expect marked improvement in outcomes early on without attention to process reliability Memo clearly worked – job done! Memo issued to all staff Must do this!

  31. Testing and Implementing a Change Idea Belief in idea Cost of failure Commitment What factors influence the decision? Scope of test

  32. Testing and Implementing a Change Idea Very small scale test Very small scale test Very small scale test Very small scale test Small scale test Very small scale test Large scale test Very small scale test Small scale test Implement Small scale test Large scale test

  33. @jasonleitch

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