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The Quality Improvement Guide Introduction The Model for Improvement Measurement & Reliability Teamwork & Leadership

The Quality Improvement Guide Engaging your audience Summary Discussion time!

The Quality Improvement Guide Introduction The first question: “How should we set about making this improvement?”

The Quality Improvement Guide Introduction Will – we must want to improve Ideas – we must know what to try Execution – we must know how to change

The Quality Improvement Guide Introduction - examples 1 ~ reducing risk in primary care (Based on work done in the 1960s/70s) 2 ~ preventing deaths and injuries due to road traffic (non-healthcare example) 3 ~ improving stroke care

The Quality Improvement Guide The Model for Improvement Based on three key questions: 1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What change can we make that will result in improvement?

The Quality Improvement Guide The Model for Improvement

The Quality Improvement Guide 1 ~ What are we trying to accomplish?

The Quality Improvement Guide 2. How will we know that a change is an improvement? desired outcome identified need to identify standard to measure the outcome against

The Quality Improvement Guide 2. How will we know that a change is an improvement? Use a measure which is: well defined allows comparison between sites and over time already in use, if possible specific and sensitive enough to identify and monitor outcomes can be applied to the whole community, population or system

The Quality Improvement Guide 2. How will we know that a change is an improvement? Remember: Improvement work can go ahead WITHOUT there being a good outcome measure, and BEFORE monitoring is stable

The Quality Improvement Guide

3. What changes can be made that will result in improvement? Must link outcome measures to ‘interventions’ – the systems and processes that achieve the desired outcome Two parts to this question – “What is wrong with the system now?” “What works?”

The Quality Improvement Guide What is wrong with the system now? What will deliver the biggest benefit? What will affect the things that are done most often or the area where most waste is incurred. What do typical cases tell us about the system? Are demand and need understood properly? (How much demand is repeat work or work caused by another part of the service?)

The Quality Improvement Guide What is wrong with the system now? What is the high-value part of the system (the part that delivers real benefit)? - Is it the same as the part which has the highest costs? What can simplify the process? How can we use the knowledge of service users and people in other parts of the process?

The Quality Improvement Guide What works? Need to gather evidence of how a good system should work. Don’t need to go into too much detail. Successful change is most likely to be achieved using simple steps Use evidence gathered to produce driver diagrams to show desired outcomes and ways to achieve them

The Quality Improvement Guide Driver Diagrams First column – ‘Aim’ – shows desired outcome (the simpler the better) Second column – ‘Drivers’ – shows factors that affect the outcome Third column – ‘Interventions’ – shows actions that have been shown to make a difference and bring about improvements

The Quality Improvement Guide Aim Driver Intervention

The Quality Improvement Guide How do we introduce changes to processes? Plan Do Study Act

The Quality Improvement Guide PDSA - Plan Plan what you are going to do differently Who What Where When

The Quality Improvement Guide PDSA - Do Carry out the plan and collect information on what worked well and what issues need tackling

The Quality Improvement Guide PDSA - Study What is the information telling us? What worked and what didn’t? What should be adopted, adapted, or abandoned?

The Quality Improvement Guide PDSA - Act Use this new knowledge to plan the next test. Agree changes / amend outcome measures if necessary Continue testing, refining the procedure or technique

The Quality Improvement Guide Measurement & Reliability Use a spreadsheet to count all critical parts in the process. Use “process mapping” to convert process into visual, step-by-step diagram

The Quality Improvement Guide The 7 Steps to Measurement

The Quality Improvement Guide The 7 Steps to Measurement ~ Collect information (step 4) ~ Analyse it and convert it into useful information (step 5) ~ Review the information to see what decisions need to be made (step 6) The Collect-Analyse-Review cycle then starts all over again (step 7) Steps 4 to 6 form the ‘Collect-Analyse-Review’ cycle.

The Quality Improvement Guide Measurement best practice Use run charts to spot variation Frequent measures show reliability of new processes Measure for improvement not judgement

The Quality Improvement Guide Teamwork & Leadership Leadership at an organisational level Clinical or technical expertise Frontline leadership The 3 types of leadership you need

The Quality Improvement Guide Teamwork & Leadership Using information to define and solve the problem, Gathering ‘enthusiasts’ Appointing a local specialist or ‘process owner’ Setting up ‘sub-teams’ if there are several areas to be covered or specific areas of expertise are needed Attract and keep excellent team members by...

The Quality Improvement Guide Teamwork & Leadership Changing practice often requires a change in the organisation’s culture (the beliefs and assumptions people have about ‘the way things are round here’).

The Quality Improvement Guide Teamwork & Leadership Setting clear improvement aims Monitoring and communicating progress Generating and spreading new ideas – encouraging front line teams to come up with ideas and share them Encouragement, praise, celebrating success The tasks of leaders

The Quality Improvement Guide Engaging your audience Develop language which wins ‘hearts and minds’ Communicate the improvements and the involvement of those delivering them Develop tools which allow frontline staff and leaders to understand what needs to be done Report on involvement and success Maintain momentum to make sure new ways of working are spread throughout and across organisations.

The Quality Improvement Guide Engaging your audience – how! Identify your audiences and their perspectives Craft a key message to convey the work in a short, memorable statement Focus on frontline staff – their views, their success stories – to encourage more people to get involved Develop a ‘brand’ beyond just a logo – consider the ‘tone’ and emotional impact Provide resources for others to spread the message

The Quality Improvement Guide Summary The Model for Improvement provides a framework for change Consult evidence to select the best interventions to achieve your aims Measurements will help you understand the problem and see whether your solution is having an effect

The Quality Improvement Guide Summary Teamwork and leadership are both vital The commitment to change often requires a change in culture An emphasis on engaging people with a coherent and urgent key message will enable change to happen

The Quality Improvement Guide More information Available to download at The Quality Improvement Guide