1. What changes do we think will result in improvement?

2. EYC is one!

3. Mothercare Award for Maternity Service of the Year NHS Forth Valley Philips AVENT Award for Innovation in Midwifery Maternity telehealth Sheona Brown and Dorothy Finlay NHS Greater Glasgow and Clyde Pregnacare Award for Excellence in Maternity Care Vulnerable Families Maternity Team Elaine Moore and Mary Garven NHS Ayrshire and Arran The RCM Award for Partnership Working Early Years Assessment Team Rebecca Wade and Linda Davidson NHS Borders and Scottish Borders Council The President’s Award for Supervisors of Midwives Supervisor of Midwives Team NHS Lanarkshire and University of the West of Scotland NMSF Award for Bereavement Care Bereavement care: maintaining a gold standard Family room organisation and update Emma Campbell NHS Lothian Pregnacare Award for Excellence in Maternity Care Vulnerable Families Maternity Team Elaine Moore and Mary Garven NHS Ayrshire and Arran Scotland Johnson's Baby Mums' Midwife of the Year winner Laura Main NHS Grampian

4. Early Years Collaborative -9 months to 1 year 1 year to 30 months 30 months to Primary school 5 – 8 years Leadership Scotland – the best place in the world to grow up

5. Stretch Aims 1.Positive pregnancies which result in the birth of more healthy babies by end 2015 15% in the rates of stillbirths and infant mortality 2.85% of all children reached all of the expected developmental milestones at the time of the child’s 27 ‐ 30 month child health review, by end ‐ 2016 3.90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end ‐ 2017 4.90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021

6. 1.Positive pregnancies which result in the birth of more healthy babies by end 2015 15% in the rates of stillbirths and infant mortality 2.85% of all children reached all of the expected developmental milestones at the time of the child’s 27 ‐ 30 month child health review, by end ‐ 2016 3.90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end ‐ 2017 4.90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021 Stretch Aims

7. One year in… ‘Superior results in certain locations do not spread to other sites’ WHO/IHI Key Changes Learning Session 4 January 2014

8. Key changes Develop and package interventions for optimal adoption across the EYC In alignment with the EYTF expectations and the agreed Single Outcome Agreements. Describe the relative advantage over current practice ‘Trialability’ and ‘Observability’ Small pockets of activity (islands of excellence) Make it compelling!

12. Key changes Focus Breakthrough items Big tickets Concentrated effort But don’t stop other stuff!

13. Activity to date Key Changes event Engage those not in the room Develop a menu of key changes by work stream Paper to EYTF December 2013 Learning session 4 – ‘Key Changes’

14. Activity today Your work today – develop and refine the proposed Key Changes Consider the evidence base Consider your population Apply your improvement science learning Consider your ‘Pioneer’ sites Share your data…

15. BECOMING A “PIONEER SITE” IN THIS AREA A Pioneer Site is an area (specific geographical location, nursery, clinic, school, community centre etc.) that has: 1.The local will and interest to work on this important issue with their community. 2.Leadership support to be the CPP’s Pioneer Site for this issue. 3.Adequate resourcing to do the work required for testing in this area. 4.Some existing work in this area. 5.Willingness to share their data and learning with the Collaborative, warts and all!

16. Key changes Cross cutting Workstream 1 Workstream 2 Workstream 3 Workstream 4 Workstream 5

17. In 1601, James Lancaster successfully conducted an experiment to illustrate the effectiveness of lemon juice to prevent scurvy. When did the British Fleet adopt this treatment? 1.1602 2.1689 3.1757 4.1796 5.1865

18. 264 years....

19. 19 Controlling Scurvy 1601 Captain James Lancaster experimented with lemon juice to prevent scurvy 1747 James Lind, another experiment on HMS Salisbury 1795 British Navy adopts innovative prevention on all ships 1865 prevention was adopted across the British Merchant Marine

20. “Strong evidence for an innovation is necessary but not sufficient to result in its adoption” Mark Freeman, 2012, The International Journal of Management Education

21. Source: Based on Ryan and Gross (1943) The “Diffusion Curve”: Reaching the Tipping Point Number of Adopters of Hybrid Seed Corn in Two Iowa Communities Tipping Point

22. Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press. Roger’s Adopter Categories

23. Jason’s preferences…

24. Roger’s Adoption Attributes Rate of Adoption Relative Advantage Compatibility Complexity Trialability Visibility

25. “Up to 70% of improvement projects never spread” Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable Company. MIT Sloan Management Review 2012; 53(4): 43-50.

26. With thanks to Carol Haraden

27. 1. Start with a large pilot

28. 2. Find one person to do it all

29. 3. Be assured…vigilance and hard work will solve the problems

30. 4. Do one small test and then spread everywhere ????

31. 5. Get the pilot team to spread the improvement system-wide

32. 6. Only look at the process/quality measures on a quarterly basis (or less frequently)

33. 7. Expect marked improvement in outcomes early on without attention to process reliability Memo issued to all staff Must do this! Memo clearly worked – job done!

34. Commitme nt Testing and Implementing a Change Idea Cost of failure Belief in idea What factors influence the decision?

35. BELIEF Low degree of belief that change idea will lead to improvement High degree of belief that change idea will lead to improvement commitment Current commitment within organisation No commitment Some commitment Strong commitment COST OF FAILURE large Cost of failure large small Cost of failure small large Cost of failure large small Cost of failure small Very small scale test Small scale test Very small scale test Small scale test Large scale test Small scale test Very small scale test Implement Large scale test Testing and Implementing a Change Idea

36. @jasonleitch