Striking the Balance: Approaches to Accountability and...

Striking the Balance: Approaches to Accountability and Quality

Improvement to Achieve Results

Helen Bevan Chief Transformation Officer

Horizons, NHS England

Christina KrauseExecutive Director

BC Patient Safety & Quality Council

@helenbevan @ck4q #qfA9 #quality2016

Speed Networking

“When do you feel most engaged and energized at work?”

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Three ways to enhance quality

Qualityplanning

Qualityimprovement

Qualitycontrol

Source: Juran quality trilogy

All three are necessary for

quality outcomes

All three need to be aligned

QP

QCQI

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Three ways to enhance quality

Source of model: Juran quality trilogy

Identify the needs of population, create aims

& metrics for outcomes & set out a series of

steps for meeting our aims

Ensuring high quality

care through

monitoring, inspecting,

accrediting, regulating

& include corrective

responses

Achieve better

outcomes through a

systematic change

approach with strong

leadership, adaptive

culture and people who

are skilled in QI methods.

QP

QCQI

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TRIZ: Theory of Inventive

Problem solving

Stopping counter-productive

activities and behaviours

“Every act of creation is first an act of destruction”

Pablo Picasso

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Our TRIZ topic…

How can we deliberately create a health care system that favours quality assurance over

quality improvement as a strategy for improving care?

TRIZ

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Step 1

As a table group make a list of “to-dos” on the first paper sheet in response to this task:

How can we deliberately create a health care system that favours quality assurance over quality improvement as a strategy for

improving care?

• Go wild!

• 5 minutes

TRIZ@helenbevan @ck4q #qfA9 #quality2016

Step 2

As a table group, go down your first list and ask:– Is there anything that we are currently doing that

in any way, shape or form resembles any of the items on list one?

– Is there an element of truth in here?

• Cross out anything that you do not currently do, circle those that do – Be unforgiving about these items and talk about

their impact

• 5 minutes

TRIZ@helenbevan @ck4q #qfA9 #quality2016

Step 3

As a table group, for each one you circled ask:

“what are the first steps that will help us stop getting undesirable results?”

• Make a list of actions on a new sheet

• Be prepared to share some of your content from lists 2 and 3 with the wider group

• 5 minutes

TRIZ@helenbevan @ck4q #qfA9 #quality2016

Intrinsic motivators

build energy and creativity

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Intrinsic motivators •connecting to shared purpose

•engaging, mobilising and calling to action

•motivational leadership

build energy and creativity

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Intrinsic motivators •connecting to shared purpose

•engaging, mobilising and calling to action

•motivational leadership

build energy and creativity create focus &

momentum for delivery

Drivers of extrinsic motivation

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Drivers of extrinsic motivation

create focus & momentum for delivery

Intrinsic motivators •connecting to shared purpose

•engaging, mobilising and calling to action

•motivational leadership

build energy and creativity

•System drivers & incentives•Payment by results•Performance management•Measurement for accountability

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Internal motivators

•connecting to shared purpose

•engaging, mobilising and calling to action

•motivational leadership

build energy and creativity

Drivers of extrinsicmotivation

•System drivers & incentives•Performance management•Measurement for accountability

create & focusmomentum for delivery

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The power of extrinsic drivers

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Three types of levers for large scale change

‘Prod mechanisms’targets

performancemanagement

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

clinicalquality standards

Type one:

Type two: Type three:

Source: Health Foundation Constructive comfort: accelerating change in the NHS 2015

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Three types of levers for large scale change

‘Prod mechanisms’targets

performancemanagement

price & payment incentives regulation

competition

‘Proactive support’

relies on building ‘intrinsic motivation’ in

staff to make the right changes to

improve

‘People focused’ education and training

national contractsprofessional regulation

clinicalquality standards

Type one:

Type two: Type three:

Source: Health Foundation Constructive comfort: accelerating change in the NHS 2015

Less than 10%of the potential

for improvement

at system level can be

delivered through type one change

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“I have some Key

Performance

Indicators

for you”

or

“I have a

dream”

Source: @RobertVarnam

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https://www.youtube.com/watch?v=DKK-yFn7e_0

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https://www.youtube.com/watch?v=DKK-yFn7e_0

@helenbevan @ck4q #qfA9 #quality2016

@helenbevan @ck4q #qfA9 #quality2016

@helenbevan @ck4q #qfA9 #quality2016

What Is the Balance in Your System?

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Adapted from the Danish national quality strategy

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@helenbevan @ck4q #qfA9 #quality2016

What Is the Balance in Your System?

Table Discussion

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Examples of Polarities to Manage

Old power AND

Transactional AND

Micro AND

Collaborative learner AND

Customizing AND

Wholeness AND

Complex AND

New power

Transformational

Macro

Expert advisor

Standardizing

Linear

Simple

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#qfA9

Positive results of focus on this left pole

Negative results of over-focus on the left pole to the neglect of the right pole

Negative results of over-focus on the right pole to the neglect of the left pole

Deeper Fear from lack of balance

Greater Purpose Statement - why balance this polarity?

*

and

Adapted from the Polarity Management map, Polarity Associates

Polarity MapAction stepsHow will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures?

Action StepsHow will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures?

Early Warnings Measurable indicators (things you can count)

that will let you know that you are getting into

the downside of this left pole.

Early WarningsMeasurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole.

Positive results of focus on this right pole

At Your Tables …

An opportunity to dive deeper on quality assurance and quality improvement through polarity mapping.

Using the worksheet on your table – explore the concepts of:

Accountability AND Improvement

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Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA

old power new power

Currency

Held by a few

Pushed down

Commanded

Closed

Transaction

Current

Made by many

Pulled in

Shared

Open

Relationship

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So what does this mean for us in the room today?

• Striking the balance … both/and, not either/or

• Understanding and applying within our own contexts

• Turn to your neighbour …

What does it mean for you back home?

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Thank you!

Helen Bevan @helenbevan

Helen.Bevan@NHSIQ.nhs.uk

Christina Krause@ck4q

ckrause@bcpsqc.ca

@helenbevan @ck4q #qfA9 #quality2016