2. 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

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

5. 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

6. 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

7. Building Reliable Systems

8. Doing Quality Improvement
Define
Diagnose
Treat
Sustain
Spread

9. Define a problem

10. 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

11. 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

12. Diagnose the Problem – Process Mapping

13. Process mapping: Why process map?

14. 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)

15. Why is it important to understand customer needs?

16. 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

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

18. The Model for Improvement

19. 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

20. Test and Measure Improvement

21. *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.

22. Run Chart

23. Anyone for Tennis?

24. The Model for Improvement

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

26. Implement and Sustain
Key Requirements for success in quality improvement

28. 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.

31. 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?