1. Taking the tool forward: Service Improvement Author: Ali Ewing, Principal Lecturer Learning and Teaching July 2011 The University of Northampton Park Campus, Boughton Green Road NORTHAMPTON, UK. NN2 7AL

2. What is service improvement? Improvement is ‘the combined and unceasing efforts of everyone,…to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)’ (Batalden and Davidoff 2007)

3. Seeing the bigger picture Adapted from 'The Blind Man and the Elephant' by John Godfrey Saxe (1816 – 1887) cited by Paul Luvera Journal at http://www.paulluvera.com/weblog/2007/03/truth_the_poem_.html

4. Four Parts to Improvement (Clarke et al 2004)  Stakeholder involvement:  listening and understanding  Personal and organisational development:  Recognising different cultures and people  Process and systems thinking  Effects of different practices and procedures  Initiating, delivering and sustaining improvement:  Plan and measure effects of improvement

5. Tools for service Improvement  What is the problem?  Process mapping: What is the current process?  How long does each part of the process take?  What is your demand?  What is your capacity?  What are your potential constraints?  Where are potential for improvement?

6. Three key questions  What are we trying to achieve?  How will we know that a change is an improvement?  What changes can we make that will result in the improvements that we seek?

7. PDSA Cycle Plan, Do, Study Act (PDSA) cycle is a way of testing an idea by putting a change into effect on a temporary basis and learning from its potential impact. Different from traditional approach where often new ideas are introduced without sufficient testing.

8. PDSA Cycle Plan: agree change to be tested or implemented Do: carry out the test or change and measure the impact Study : study data before and after the change and reflect on what was learnt Act : plan the next change cycle or plan implementation

9. Construct (simple) practical solutions PDSA For further information on this see the NHS Institute for Innovation and Improvement ‘Plan, Do, Study, Act (PDSA)’. http://www.institute.nhs.uk/quality_and_servic e_improvement_tools/quality_and_service_i mprovement_tools/plan_do_study_act.html [accessed 01.09.11]

10. Why test before implementing?  Less time money and risk involved  Process is a powerful tool for learning, and much can be learned from ideas that do not work as well as those that do  Less disruption for everyone  After involvement if development and testing often greater enthusiasm for implementaion.

11. What might your obstacles be?  The human dimensions – comfort zone  The organisation – current systems  Over complicate the process  Time!  Change!

12. References Batalden P, and Davidoff F,. (2007) What is ‘quality improvement’ and how can it transform healthcare, Quality and Safety in Health Care, 16, 2-3 Clarke C, Reed J, Wainwright D, McClelland S, Swallow V, Harden J, Walton G, and Walsh A,.(2004) The discipline of improvement: something old, something new, Journal of Nursing Management, 12, 85-96 NHS Institute for Innovation and Improvement www.institute.nhs.uk

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