1. Presentation title: 32pt Arial Regular, black Recommended maximum length: 1 line Service Improvement in the NHS Presented by Maggie Morgan Cooke

2. NHS Context Need to harness learning and move on in support of next stage of NHS reform Future challenges will need new approaches that are proven to work Need for a culture of continuous improvement Need for more rapid adoption of new products and technologies Need for improvement and increased efficiency and to contribute to overall efficiency and cost reduction targets

3. The Vision of the Institute Capture worldwide best practice Focus on agreed priorities Create high impact solutions Identify changes to enable the NHS to meet the big future challenges Support local capability development Support rapid dissemination and commercialisation of product and technology innovations from within and outside the NHS Support rapid adoption and spread through networks, guidance, tools and facilitation Anticipate the challenges of tomorrow and deliver the solutions today

4. Overall Reform Agenda NHS Institute & Wider System NHS Institute Work Process Within the Wider System NHS Institute & Wider System STAKEHOLDER ENGAGEMENT / MARKETING KNOWLEDGE MOBILISATION EVALUATION AND MEASUREMENT PROGRAMME / PROJECT MANAGEMENT RESOURCE PLANNING AND MANAGEMENT LOGISTICS

5. Using technology to support improvement NHS Collaborate A Social Networking tool for the Practice Partner Network What is social networking? Developing online social networks for people who share interests and activities – in this case, the PPN and improvement Communication through blogging, discussion forums, sharing resources and collaborative working

6. Connecting For Health Background and introduction The NHS is changing the way it works. Its vision for the future is to have a more modern, efficient, patient-led health service and to give patients more choice and control over their own health and care. Key Facts Better, safer care to patients Enable clinicians to increase efficiency and effectiveness Give healthcare professionals access to patient information safely, securely and easily NHS Connecting for Health, which came into operation on 1 April 2005, is an agency of the Department of Health. Our purpose is to support the NHS to deliver better, safer care to patients, via new computer systems and services, that link GPs and community services to hospitals, and to maintain the national critical business systems previously provided by the former NHS Information Authority.came into operation on 1 April 2005Department of Health Accurate information is crucial if patients are to have choice and receive the right care at the right time. A key aim of the National Programme for IT in the NHS is to give healthcare professionals access to patient information safely, securely and easily, whenever and wherever it is needed. The National Programme for IT is creating a multi-billion pound infrastructure, which will improve patient care by enabling clinicians and other NHS staff to increase their efficiency and effectiveness. It is doing this by: creating an NHS Care Records Service to improve the sharing of patients' records across the NHS with their consentNHS Care Records Service making it easier and faster for GPs and other primary care staff to choose and book hospital appointments for patientschoose and book hospital appointments providing a system for the electronic transmission of prescriptionselectronic transmission of prescriptions ensuring that the IT infrastructure can meet NHS needs now and in the future.IT infrastructure

7. Central truths of improvement Every system is perfectly designed to get the results that it gets If we want different performance, we must change the system To change the system, we must think in fundamentally different ways

8. There is massive fatigue and frustration with the current system: How can we use this to catalyse positive change? The NHS has an abundance of knowledge, skills and techniques used in limited ways to varying degrees of success: How can we optimise and build on this? Staff at every level trying to make service improvements repeatedly stumble across the same obstacles: What underpinning new ways of thinking could circumvent this and accelerate us forward? Organisations struggle to harness organisational energy around shared goals What ideas, strategies and tools could help? What is currently in the way of widespread transformation?

9. Drivers of efficiency and quality benchmarks benchmarks learning from best practice learning from best practice patient experience patient experience Foundation Trust status Foundation Trust status Community Enterprise status Community Enterprise status partnership working with the wider partnership working with the wider health and social care community health and social care community performance targets Payment by Results NICE / quality / NSF standards Patient Choice contestability commissioning / PBC Consultant and GP contracts Agenda for Change adverse events service reconfiguration ambition beyond national targets ambition beyond national targets leadership systems leadership systems clinical leadership and engagement clinical leadership and engagement patient partnership patient partnership internal improvement methods internal improvement methods investment in training / development investment in training / development culture of innovation culture of innovation performance management performance management internal patient safety standards internal patient safety standards measurement systems measurement systems clinical standardisation clinical standardisation clinical pathways clinical pathways financial control financial control voluntary compelled external internal

10. Meeting Patient’s Expectations

11. What are we trying to Accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? ActPlan StudyDo The Model for Improvement

12. Building and Using the Evidence Evaluation & Implementation

13. The 8 planet operational definition

14. Ambition Aim for perfection Build ambition around clinical values Provide space for interpretation at team level “Targets give you permission to stop once you’ve hit them, ambition keeps you to striving to constantly improve”

15. Framing Goal alignment, collective commitment to vision, value based connections Who I am and how I influence Self-efficacy, confidence, self belief and sense of personal responsibility How I can make a difference Personal branding, making new connections, influence and power Mobilisation Why people join up, optimism and hope, intent to impact Motivating and inspiring Connect with intrinsic motivators, engaging for change, positive affect Change is my mission Positive challenge, proactive involvement, active leadership Individual Organisation Sustainability Why people stay, why people leave Positive energy to respond to NHS challenges and opportunities “Only 26% of employees consider themselves actively engaged in their work.” (Gallup) Strategies and tools

16. A leadership for performance improvement mindset From focus on sorting “poor performers” select for “remedial action” or reward manage the volume of patients fire-fight - acute problems To focus on processes and systems change the performance of the overall system manage variability in the system deal with the chronic problems that underpin poor performance

17. Transformation requires... Leaders creating an energised context Individual, team and organisational belief and know-how Knowledge and great ideas Techniques for application (eg Lean) Power people up to accelerate and spread NHS improvement and provide best patient care

18. What are our ambitions for our system and our patients? How do we mobilise change to achieve this? How do we sustain these changes? How do we liberate the latent energy and creativity of our staff to make things better for patients? Questions for leaders at every level

19. Any Questions? Maggie.morgan-cooke@institute.nhs.uk