1. Sustaining change: Reflections including the role of regional networks and NQICAN and using Patient and Public Involvement / Patient Leaders
Kat Young MA
Senior Quality Improvement Lead, Royal Berkshire NHS Foundation Trust
Chair, National Quality Improvement and Clinical Audit Network
Member, National Advisory Group for Clinical Audit and Enquiries
Member, Faculty Medical Leadership and Management
Twitter: Clin_Q

2. The change cycle Define a problem Implement change
measure
Implement change
Analyze causes
Identifying feasible solutions
Develop and implement action plan
Re-audit / Sustained?
Sensible? Effective?

3. Model for Improvement

4. Run Charts

5. What to measure?
Only collect the data you need to answer the questions – link to aim/objectives
Outcomes measure
Are we fulfilling our aim?
Measures of the customer (patient, family)
Process measure
Things we think will lead to improvement in outcome
Measures of the workings of the system
Balancing measure –
What is the risk?
Is something else being affected by our changes (good or bad)?”
Measures of the other parts of the system

6. Run charts Keep measuring What change works? Measure little and often
Process,
Outcome
Balancing measure
Keep measuring
Is it still working?
Make results visible
Ward to Board
Patient/user friendly

7. Sustainability from the start…
© Royal Berkshire NHS FT 2013
Employers felt 55% of change management initiatives met initial objectives, but only 25% felt gains were sustained over time
felt gains were sustained over time.

8. IPPs Ideas Measure Plan RoI Organise Vital Behaviours Evaluate
RBFT
QIPP
Programme
IPPs
The Quality Improvement Approach: IMPROVE
Ideas
Measure
Plan
RoI
Organise
Vital Behaviours
Evaluate
… do we want to improve?
… good are we and how do we know?
… do we make the changes?
… do we prioritise?
…do we reduce waste?
… do we demonstrate it’s worth it
… do we make it happen
… will our behaviours support the change
… will we know we have made a difference, and how do we keep improving?
How…
Brainstorm
Process Map
Model for Improvement
Spaghetti Diagram
RAG Study
Benchmark
Audit
Historical analysis
Baselines
Lean
Pareto
Staff +Patient Engagement
5 D’s
PDSA
PMO Docs
Human / Financial cost and saving
SPC
Business Cases
Project Plan
Owners
Timescales
Rapid Improvement Events
Six Sigma
Open to change
See the benefit or bigger picture
Engagement
Review performance
Communicate change
Ensure sustainability
Celebrate Success
Methodology

9. Testing for sustainability
“Quality is impossible without an honest conversationDeming
Preferences, attitudes and behaviours
Appetite for improvement
Motivation / desire
To individual as well as organisation
Ability / skills
Ownership
Objectives
Leadership
Visibility of results
***KEEP CHECKING!
Picture: © Paul Souders/Corbis

10. Testing sustainability
Questions to ask
Are they aware?
Do they care?
Is it fair?
will they do it?
Can they do it?
Anything they need in order to do it?
Is it primary or secondary to role?

11. Sustaining continuous improvement: Communication
Timely, frequent communication
Articulate key messages and benefits and results
Celebrate great work / achievements – focus on the positives
Highly visible
Make it fun, be creative
Multiple stakeholders / channels
Engage those doing the doing
Organisation
Staff
Patients

12. Winning hearts and minds
Does it connect? Continue to connect?
Hard facts/ numbers + emotion / story
Patient and Public Involvement
Patient Leaders

13. Ways of Working
SMARTER not harder
Behaviour and values
Listen and understand negativity
Find the positives, find ways to share the positives, build energy and momentum
Build capability and capacity
Support networks / Champions

14. Role of Networks Create energy, enthusiasm and skills
Provides support – we know it can be tough
Advice and guidance
Shared learning
What works / what doesn’t work

15. NQICAN and Regional Clinical Audit Networks
@nqican

16. 15 Regional Clinical Audit Networks
@nqican
NQICAN Website to be launched at HQIP Conference

17. Summary… Know what works – Measure measure measure: little and often
Change involves people
Vision / Purpose / Fulfilling work
Positive experience
Involve patients
Work together, support each other, network
Test:
Organisational commitment
Leadership
Financial
Visibility of key messages and communication
Work together
Use your Network

18. Thank you for listening Questions? Discussion…