1. Insert name of presentation on Master Slide Improving quality by changing the service

2. Students need to … www.1000livesplus.wales.nhs.uk Really listen – understanding what it feels like to be a patient/service user Understand the systems Small changes can make big improvements Test improvement ideas – by using Plan, Do, Study, Act (PDSA) Cycles Measurement is vital – not all changes are improvements Work as a team – inter-professional working Others will see things differently to you – value the differences Everyone has a responsibility for improvement

3. Students need to … do it in reality while on placement in a clinical setting www.1000livesplus.wales.nhs.uk They must at least … –Identify an issue for improvement –Process map it –Plan a change (the P of PDSA)

4. www.1000livesplus.wales.nhs.uk Most people would like to ‘do something about quality’ but don't have the time. They are too busy dealing with complaints, correcting mistakes, doing the wrong things right and doing what they do twice. paraphrased from Øvretveit (1992)

5. Listen to the Story www.1000livesplus.wales.nhs.uk –How does listening to the story make you feel from a personal point of view? –If you had this situation presented to you, what would you do about it?

6. www.1000livesplus.wales.nhs.uk drunk There are 2,231 words meaning drunk … quality but only one word for quality

7. www.1000livesplus.wales.nhs.uk What is quality?

8. www.1000livesplus.wales.nhs.uk Quality does not necessarily mean excellence … Quality means: fit for the purpose fit for the purpose.

9. www.1000livesplus.wales.nhs.uk The Model for Providing Care Access System AssessDiagnoseTreat Follow-up Clinical Outcomes Functional Health Status Total Costs Patient with needs Balanced measure of care Satisfaction against need

10. www.1000livesplus.wales.nhs.uk 1. Access 2. Relevance to need 3. Effectiveness 4. Equity 5. Acceptability 6. Efficiency (Maxwell 1984) (Lister’s 7 th component of Quality) 7. Humanity 6 components of Quality

11. www.1000livesplus.wales.nhs.uk It is the system … Every system is perfectly designed to produce the outcome it achieves! paraphrased from Berwick (1996)

12. www.1000livesplus.wales.nhs.uk These are the same – what turns your input (the ingredients) into your outcome (the cake) is what you do to them – the process … the system. If there is something wrong with your outcome shouting at your ingredients won’t make it better!

13. www.1000livesplus.wales.nhs.uk Process mapping … Select a process Map the process

14. www.1000livesplus.wales.nhs.uk Map the process

15. www.1000livesplus.wales.nhs.uk Process mapping … Select a process Analyse the current situation Map the process

16. Analyse the current situation www.1000livesplus.wales.nhs.uk Lots of steps delays bottlenecks Reworked loops

17. www.1000livesplus.wales.nhs.uk Process mapping … Identify opportunities to improve Select a process Analyse the current situation Map the process

18. www.1000livesplus.wales.nhs.uk

19. Identify opportunities to improve With as few steps as possible Each step must add value to the process.

20. www.1000livesplus.wales.nhs.uk The health service has many heroes. The staff who - work harder - predict problems and compensate for short comings. Heroic thoroughness may make patients lives a little safer, but a real improvement in the quality of care provided to patients is not created by heroes who compensate for the flawed processes. The real heroes are those who change the system to remove the flaws!

21. www.1000livesplus.wales.nhs.uk Workshop activity In groups of about 6 and to go back to the original people that are stuck on the post-it notes around the room and as a group pick 1 to work on. Attempt to process map the system that the person was in If you don’t have enough information on the actual system you can process map what you think should happen (as opposed to what went wrong).

22. The tribal wisdom of the Dakota Indians, passed from generation to generation, states that when you discover that you are riding a dead horse the best strategy is to dismount. However modern management best practice within government and large organisations has developed other strategies, including the following: Change Riders. Say things like “this the way we always ride horses” Appoint a committee to study the horse. Arrange to visit other sites to see how they ride dead horses. Hold training sessions to improve dead horse riding ability. Compare the state of dead horses in today’s environment. www.1000livesplus.wales.nhs.uk

23. Re-classify the dead horse as “living, impaired”. Pass legislation declaring that “this horse is not dead” Harness several dead horses together for increased the speed Do a cost analysis study to see if contractors can ride it cheaper Offer the horse career counselling and the option of a transfer to a less stressful position of equivalent status Check with IT Support to see if the whole network is down, or if it is just the horse Promote the dead horse to a Senior Management position www.1000livesplus.wales.nhs.uk