Implementing Solutions Patients need Proof the NHS can be trusted to stop this happening again.

The RCA Process Getting Started Gathering Information & Mapping the Incident Identifying Care & Service Delivery Problems Analysing Problems & Identifying CFs and RCs Generating Solutions & Recommendations Implementing Solutions Writing the Report

Successful implementation is a process not an event Communication Diffusion Dissemination Adoption Spread and sustainability Terms Diffusion and dissemination are the processes by which the guidance or safer practice is communicated Adoption is the decision by others to adopt the guidance Implement is to carry out an action or put into effect a plan or procedure Implementer is someone who carries out that action Implementation is when new ways of working are acted upon and changes are made to behaviour and or practice Embedding is when the new ideas or practice are spread within organisations or between organisations to enable sustainable change i.e. the new ways of working and improved outcomes become the norm, and part of everyday practice Guidance is something that guides Safer practice is the habitual practice, habit or custom which makes things safer Director is a person that directs, the person who is responsible for the interpretive aspects of a procedure, who then supervises the integration of all the elements

Implementation = Making change a part of the day-to-day operation of the system To test whether it has been achieved - Ask yourself… would the change persist even if its champion were to leave the organisation?

Set achievable goals WWW What by When by Who

Make the Important Measurable Measure, Measure, Measure Some is not a number Soon is not a time IHI Orlando NPSF conference Make the Important Measurable Then make the Measurable Important How do we know we have improved... Need to measure stuff e.g. Some = 100,00 lives Soon = 14.6.06 9am

Action Planning www.npsa.nhs.uk/rca Incident No: Action 1 ê Action 2 ê Root CAUSE / Lesson learned   EFFECT on patient/service Recommendation(s) to address root cause (or rationale, if no action or recommendation is set). Action(s) to achieve recommendations Level for action (organisation, directorate, team etc) Implementation by whom:- Implementation by when:- Resource required (time) Resource required (money) Resource required (other) Evidence of completion Monitoring & evaluation arrangements Sign-off by:- www.npsa.nhs.uk/rca

Common mistakes in Action Planning... Using change already underway for others reason. (May appear handy but often not relevant or robust) Listing consideration or reviews as solutions (Activity ≠ Change) Assuming Change = Improvement

Consider... How will the action plan be - drawn up? - monitored? ....Busy people who need to prioritise often ensure they cover what is measured/monitored

What It Takes To Improve Will to change the current system Strong positive leadership and a realistic appraisal of resources and barriers Ideas about changes that will improve the system And a theory that links changes to outcomes Execution of the ideas And a way to distinguish successful from unsuccessful changes

Application of Science Plan – What we are going to try out Do – (or JDI) Study – Just enough results for learning Act – Adopt, Adapt, Abandon

Plan Sustainability & Spread When new ways of working and improved outcomes become the norm. (Thinking and attitudes have shifted) Spread The extent to which learning and change has been adopted in other areas that could benefit from them

Implementing change Apostles – Lead. +ve even when things are bad Friends – Biggest group Cynics – Need to win their hearts The dead – Not for or against! (Apathy) Hostages – Saboteurs (Dangerous)

Cascade training Role models  Make use of role models +champions Paint run - likened to cascade training - Cascade training is limited/hard/slow technique ?

Key Points – Implementation Take a simple approach and start small Get people on board Never assume we are doing what we think we are doing ... Measure, Measure, Measure