Address the complexity in a Structured way The lens through which an Improver looks at a problem The System Variation Theories of why/what Human Behaviour

“The First Law of Improvement” Every system is perfectly designed to achieve exactly the results it gets.

Red Sweets Factory Three willing workers One performance manager Each worker uses a spoon to take skittles from a bag three time and count the red skittle. Put score on the board Each worker in turn. Dropped Skittles of any colour are subtracted from red skittle total Lesson no amount to effort, shouting, fear or punishment can improvement the randomness of the count

Worker 1 Worker2 Worker 3 Run 1 Run 2 Run 3 TOTAL Worker Performance 15/9/2016 Worker 1 Worker2 Worker 3 Run 1 Run 2 Run 3 TOTAL

Building Reliable Systems

Doing Quality Improvement Define Diagnose Treat Sustain Spread

Define a problem

Drill down beyond the Symptoms to the Root Causes of the Problem Diagnosis - 5 Why’s analysis What is it? The Five Why’s is an interview technique that is used to drill down to the problem, rather than accept action around a symptom. When to use it? When you want to solve a problem, and not a symptom. Before initiating an action without a clearly understood outcome. To focus limited resources on the most effective action. The approach focuses on the identification of a problem, not its solution. WHY…? Drill down beyond the Symptoms to the Root Causes of the Problem

Now start to think of solutions... Five Why Analysis Carry out 5-why and determine the ROOT CAUSE causing the machine to stop Q: WHY has Photocopier stopped ? A: Fault Occurred! Q: WHY has a fault occurred ? A: Paper Jammed! Q: WHY Is paper jammed ? A: Stuck in the compartment! Q: WHY has it got stuck ? A: Paper was damaged! 4 Q: WHY is the paper damaged ? A: Box was dropped! Root-cause Now start to think of solutions... 5 3 2 1

Diagnose the Problem – Process Mapping

Process mapping: Why process map?

Treating – Agree an ‘Aim’ and Generate Solutions With a clear aim solutions need to be generated which will achieve that vision. What should be considered when generating solutions? Outcome of problem diagnosis Change ideas developed by team Insight from Voice of the Customer work Insight from work done in other trusts International best practice Published thinking such as ‘The Productive Series’ Initial understanding of high-level cost/benefit analysis Then, you could use a workshop format to: Consolidate these solutions Brainstorm further solutions Group the solutions (affinity diagram)

Why is it important to understand customer needs?

Prioritise solutions Example prioritisation matrix There may be a large number of potential solutions, which cannot all be achieved in the timescales available. A prioritisation matrix is a great tool to help agree which solutions should be taken forward and can also identify quick wins. Include any elements which are relevant, such as: Ease of implementation Impact of the solution You can also use this method to evaluate opportunities or solutions using categories, such as: Clinical risk Cost to implement Level of external engagement required

Plan, Do, Study, Act (PDSA) The four stages of the PDSA cycle:

The Model for Improvement

Detail Design Self Care Support Delivery System Design Decision Using Multiple “Ramps” over time: Chronic Disease Care Detail Design A P S D Self Care Support Delivery System Design Decision Clinical Information Systems

Test and Measure Improvement

*Graphical display of data plotted in some order, often time order. Reminder: Run Charts*, with annotations, provide you with specific insights and can help you from fooling yourself (and others *Graphical display of data plotted in some order, often time order.

Run Chart

Anyone for Tennis?

The Model for Improvement

Number of Change Type of Change Time Baseline   1 2 3 4 5

Implement and Sustain Key Requirements for success in quality improvement

Spreading Best Practices   Dissemination Diffusion Definition Spread of innovation is planned, formal, centralised and occurs through vertical hierarchies Spread of innovation is unplanned, informal, decentralised and largely horizontal or peer-mediated Methods Wide range of methods: presentation in conferences and seminar, leaflets, peer-reviewed publications, formal dissemination programmes, websites, etc Word of mouth through existing professional and social networks. Use of opinion leaders, champions and boundary spanners can accelerate the diffusion of innovation. Strengths The message and means of communication used can be tailored depending on the target audience Fewer resources required, as it happens more naturally and organically. Effective if influential key people buy into the idea Weaknesses It usually attracts early adopters only. Often the initial will of early adopters fades away before any action has been taken. No control of the message and its reach. https://www.youtube.com/watch?v=_VHXRYXzEVU

How many times can you win in 1 minute? EXTREME – THUMB WARS! 1,2,3,4…. I declare a thumb war! How many times can you win in 1 minute?