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Improvement Next Steps

Improvement Next Steps . Susan Hannah Pat O’Connor. Purpose of this session. Current position of the work so far… life in the fast lane Revisit the Science of Improvement Consider your local work through the Lens of Profound K nowledge

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Improvement Next Steps

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  1. Improvement Next Steps Susan Hannah Pat O’Connor

  2. Purpose of this session Current position of the work so far… life in the fast lane Revisit the Science of Improvement Consider your local work through the Lens of Profound Knowledge What is your data telling you… your measures sampling and groups of work (segments) are crucial Bringing it all together on the driver diagram Next steps

  3. Back at the Ranch Early years work is not the only game in town Outside the SECC life goes on Where are your bright spots and how does everyone know about them Discuss at your table and find out one new connection or a piece of work that is going well (5 mins)

  4. Aim Measures Changes Testing & Implementation The Improvement Guide, API

  5.  Plan  Do  Study  Act “What will happen if we try something different?” “What’s next? ” “Did it work?” “Let’s try it!”

  6. Cycles of Tests Build Confidence Changes that will result in improvement Learning from data Proposals, theories, hunches, intuition

  7. Act Plan Study Do Sequence for improvement Make part of routine operations Sustain & spread a change to other locations Test under a variety of conditions Implement a change Theory & prediction Test a change Support with data and consideration of people Develop a change

  8. StartSmall • 1 client • 1 day • 1 case • 1 worker • Move to 3,5,7…. as confidence grows

  9. Smaller Scale Tests: Shrink It!rapid cycles of learning Years Quarters Months Weeks Days Hours Minutes Drop down next “two levels” to plan test cycle!

  10. Subject Matter Knowledge Profound Knowledge Subject Matter Knowledge: Specialist knowledge and skills required to be a good practitioner Improvement Profound Knowledge: The interaction of the theories of systems, variation, knowledge and psychology.

  11. Viewing the System to plan for Quality Improvement Macro – systems : e.g. Local Authority localities, Health Boards The CPPs Meso – system : e.g. Education Dept, Social Work Service Primary Care Service Micro- system : e.g. Nursery School, Local Social Work Team Health Visiting Team

  12. The Science of Improvement Appreciation of a system Theory of Knowledge Psychology Understanding Variation Values “The aim of this chapter is to provide an outside view – a lens – that I call a System of Profound Knowledge. It provides a map of theory by which to understand the organisationsthat we work in.”

  13. People unclear on the concept of a system! I’m sure glad the hole is not in our end!

  14. What insights might be obtained by looking through the Lens of Profound Knowledge? • Appreciation for a System • Interdependence of sub systems • Processes and interactions • System must have an aim and plan for improvement • Whole is greater than sum of the parts • Theory of Knowledge • Learning from theory and experience • Operational definitions • Expert prediction • MFI / PDSAfor learning and • improvement • Psychology • Interaction between people • Motivation • Values, beliefs, assumptions • Will to change • Understanding Variation • Knowledge of baseline • Variation is to be expected • Common or special causes • Reliability

  15. How does the Lens of Profound Knowledge look in your system?

  16. INPUTS FOR PLANING • Purpose of the Organisation • Market Analysis • Customer Research • Supplier Input • Technology Information • Economic Forecasts • Business needs • Regulations Human Resources Planning Training Planning Strategic Planning Process Future Scenarios Operations Planning Product/Service Development Planning Project Planning Department and Functional Planning Market Planning A System for Planning: Integrate Planning for Improvement with Other Organisation Planning Processes Developing Operating Budget Financial Planning Developing Capital Budget Annually 1 to 5 years Plan to Improve Business Planning Process Plan to Operate Operate and improve the Organisation Quarterly 1 to 5 years Annually • Key measures of the system • Customer feedback • Employee suggestions • Status of plans

  17. Setting Priorities: Process Condition and Strategic Impact Diagram 6 5 4 3 2 1 21 High leverage processes: develop improvement charters to address these 15 14 9 18 1 7 Process Condition 8 4 2 5 3 19 11 10 12 6 16 0 5 10 15 Strategic Impact (total rating)

  18. Thanks to Edinburgh

  19. Use System Theory to Improve OutcomesMeasurement for Improvement “If I had to reduce my message … to just a few words, I’d say it all had to do with reducing variation.”Dr. W. Edwards Deming

  20. Why Do You Need Data and Information? To plan for improvement For testing change For tracking compliance For determining outcomes For monitoring long term progress To tell their story

  21. Three Types of Measures • Outcome Measures: Voice of the customer or patient. How is the system performing? What is the result? • Process Measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned? • Balancing Measures: Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures? (e.g. unanticipated consequences, other factors influencing outcome)

  22. Fundamental Questions for Measurement • How can we monitor the real-time behavior of the system of care, steer it to avoid crashes, and maintain it’s operational reliability? • Over time, where are the gaps in practice that indicate a need for system change (i.e. improvement)? • In our efforts to improve, what’s working? What changes are improvements? Are we on track to meet our aims?

  23. Look at the Relationships % high CO women referred to Smoking Cessation services Rate of pregnant women smokers Cessation intervention delivered Clinical attendance

  24. Speak to your neighbour • Where are you in relation to your testing plans in each of the work stream areas? • Where are you in relation to data and results? • What are the prevailing challenges you are facing?

  25. What could a family of measures for WS2 look like?

  26. What could a family of measures look like for your area of workCan you link your activity and potential measures to a driver diagram?

  27. Summary Improvement links to the big aims (driver diagrams) Data and measurement – dashboard of measures Use of run charts Annotations Integration Local support structure Leadership removing barriers

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