2. Format for Workstreams sessions Introductions at your table Improvement Bootcamp overview and other improvement journeys Components of a learning system – how does our work stack up? Workstream presentations – 30 mins each including Q&A Table top reflection on own learning and application of improvement methodology

3. The Bootcamp Experience : from this…..

4. The Bootcamp Experience : to this……

5. Components of a Learning System 1. System level measures 2. Explicit theory or rationale for system changes 3. Segmentation of the population 4. Learn by testing changes sequentially 5. Use informative cases: “Act for the individual learn for the population” 6. Learning during scale-up and spread with a production plan to go to scale 7. Periodic review 8. People to manage and oversee the learning system From Tom Nolan PhD, IHI

6. Our Work to Tackle Poverty in South Lanarkshire Kay McIntosh, South Lanarkshire Council

7. Our Community Planning Partnershiph The South Lanarkshire Community Planning Partnership works to improve the quality of life for people in South Lanarkshire by improving service delivery.

8. Current Projects 1.Parenting skills and fostering good attachment in children – increasing uptake of income maximisation service for pregnant mums /new families 2.Working to reduce the impacts of substance misuse on children - work to increase uptake of LARC by women accessing substance misuse services. 3.Supporting children to achieve their potential at age 2, 5 and 8 – work to increase attendance at 27-30 month assessments

9. Income Maximisation…..Why?.... Around 18% of children in South Lanarkshire live in poverty Can be as high as 60% in some communities Lack of money /debt can have impacts on children and parents health Welfare Reform having negative impacts on the poorest families Starting a family can trigger additional money worries/issues

10. Our Aim To increase the proportion of referrals to the Money Matters Telephone Advice service from Midwifery Services (ensuring early intervention at pregnancy stage) and increasing uptake of benefits

11. Applying the Science…. Midwife identified Baseline established Consider tests of change Test Measure Analyse Test, measure ………

12. Key Wins… 6 of Midwife’s clients have accessed the service 5 have benefited financially NHS referrals have increased from 4 a month to 25 in August

13. Next Steps Scale up ….. E Kilbride Locality - 1 midwife - new referral process Hamilton – midwife to share knowledge and practice across the team and apply new referral process Money Matters to provide monthly feedback on NHS referrals

14. Key Lessons Learnt A good opportunity to raise awareness of EYC Starting small is manageable Get all key stakeholders involved from day 1 Involve the people we want to support Run charts – best in delivery offices Regularly review progress Don’t be put off by unexpected/poor results

15. Key Wins in the Area of Measurement Test new referral process. All women given case studies leaflets/encouragement data protection issues raised re case studies. Midwife not to use. Midwife only working 1 day this week referral process changed Women (with an interest or need) contact details phoned into helpline Midwife on A/L

16. Lessons Learned in the Area of Measurement Don’t wait until the end of the year to look at numbers/data. Everyone needs to be measuring … not just managers A good story needs told with words and 1,2,3,….

17. Testing and Lessons Learned Start small Simple = Effective Common sense Time to reflect

18. Plans for next 3-6 months Continue to test the scaled up model. Ongoing review discussions with key partners. If outcomes are positive - further scaling up. Manage the implications of this…

19. Healthy Start Vouchers - Orkney

20. Orkney CPP In Orkney, the people working with children and young people strive to make sure that each day, each child and young person gets `the right help, at the right time, in the right way`

21. Current Projects Reduce by half the number of failed appointments across NHS Orkney dental services for all children age 0-8 by March 2014 95% of eligible families will receive healthy start vouchers by Jan 2014

22. Key Wins in Presented Area of Work Empowerment of families Commitment of shopkeeper to help Collaborative working

27. Key Lessons Learnt Initially thinking too big Attention to detail Dramatic scale that can be achieved Concentrate on finding the right people to get on board with you

28. Key Wins in the Area of Measurement Collaborative working commenced Prior to EYC - local activity to advertise and promote healthy start vouchers Focus of activity to engage geographically hard to reach families using PDSA

29. Antenatal survey has told us……

30. Lessons Learned in the Area of Measurement Ownership of data Patience and trust in methodology The power of a run chart

31. Key Wins in the Area of Testing Understanding methodology Sharing successes Families sharing with each other Building confidence

34. Lessons Learned in the Area of Testing Specific aim – being clear about what we want to achieve Follow up – learning what works/doesn’t work Scaling up – reaching out to all families who can benefit

35. Plans for next 3-6 months Introducing PDSA activity with another health visitor for Hoy and then for other islands with other health visitors. Look at availability of healthy start vouchers on the islands.

36. TABLE DISCUSSION Who are individuals and/or teams currently working on/in this area? Are they currently using Quality Improvement methods/PDSA cycles to guide their learning? Reflecting on the emerging knowledge within this area, and today’s plenary session on scaling up your work, what are some considerations you need to plan for to get to scale for your project?