Clearing the barriers to improvement Mandy Smith & Liz Smith Quality Improvement Facilitators Taking Action to Improve Quality Birmingham 25 th March 2014

Achieving successful change requires.. VISIONSKILLSINCENTIVES RESOURCES ACTION PLANCHANGE SKILLSINCENTIVES RESOURCES ACTION PLANCONFUSION VISIONINCENTIVES RESOURCES ACTION PLANANXIETY VISIONSKILLS RESOURCES ACTION PLAN NO CHANGE VISIONSKILLSINCENTIVES ACTION PLANFRUSTRATION VISIONSKILLSINCENTIVES RESOURCES FALSE STARTS

Promoting the vision The vision is care which complies with standards, because this delivers the best outcomes Do all the clinical team and stakeholders agree? Is the audit focussed on clinical priorities? Will the audit design provide convincing evidence for change? Does it aim at quality improvement?

Aims and objectives Setting the correct AIM and OBJECTIVES is key. WEAK aims: Audit compliance with guidelines Evaluate care of STRONG aims: Improve compliance with guidelines by... Increase patient safety by... Practical exercise

Developing skills Do front line staff lack skills in clinical audit and managing change? Access to audit facilitators and practical support Do audit facilitators understand their role? The importance of clinician leads Support from senior management Good audit governance – not bureaucracy

Developing skills Do front line staff have the skills to implement new working practices? Identify the needs for training and support Don’t train people to do what they already know how to do but can’t do for reasons other than lack of knowledge – i.e. lack of resources, faulty systems and processes. Identify and address the underlying causes for lack of compliance.

Identify your strengths Are these skills already available in your organisation? Identify who else in your organisation has change management skills & experience. Where can skills be shared or transferred? Who has the power and influence to lead change? How do the clinical audits you are working on relate to other QI activities?

Maximising incentives Incentives fall into two main categories: Incentives for organisations Incentives for healthcare professionals acknowledgement professional pride motivation outcomes satisfaction

Maximising incentives For organisations: reputation and publicity high –level assurance evidence for commissioners service improvement and development

Maximising incentives For healthcare professionals: professional pride and reputation personal development, revalidation reduction in complaints improved services

Finding the resources Resources may include time, money, people and equipment Remember - clinically effective services are more cost effective Engage budget holders Engagement with commissioners

Finding the resources Audit data can provide powerful evidence for a business case Developing a business case: A proposal seeking authorisation for the allocation of resources Required whenever expenditure has to be justified Follow the prescribed format used in your organisation

Contents of a business case Executive summary Background including current position & proposed development Quantifiable benefits so impact can be assessed Project management arrangements including timelines, procurement strategy etc. Financial analysis – consult your finance colleagues Risk analysis Summary of proposals

Planning for action Poor or inadequate action planning is worse than none at all Do you understand the fundamental reasons for the shortfalls identified by the audit? Are the actions SMART? Specific, Measurable, Assignable, Realistic and Time-related Using the ‘AIMS’ tool

Three types of Measure Outcome measures: Voice of the 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 a different angle. What happened to the system as we improved the outcome and process measures? e.g. unanticipated consequences, other factors influencing outcomes – a holistic view.

Balancing Measures Reduce length of stay Decrease post op ventilation time Increase VTE treatment 4 hour A&E waiting time readmission rate re-intubation rates bleeding / HIT !

Planning for action Do the front line staff who will be implementing the actions actually believe they will be effective? Using the CAST system to prioritise actions WEAK ACTIONSSTRONG ACTIONS Raise staff awarenessRemove barriers to doing the work effectively Remind staffRedesign the work Provide trainingSupervise, monitor and feed back Write a new policyUse IT or technological solutions

Acting on the plan Taking action is a process and the action plan documents and supports the process Monitor consequences and address barriers Go with the willing to build the evidence base for change Celebrate achievements and build on success Report, review and learn from failures

In summary Share the vision with all the key stakeholders Support staff in developing new skills Provide incentives that matter to your colleagues Work with stakeholders to identify the resources Plan for action and follow the plan through to successful change VISIONSKILLSINCENTIVES RESOURCES ACTION PLANCHANGE