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Jason LeitchNational Clinical Director, Scottish Government
Derek FeeleyPresident and CEO, IHI
Translation company seeks speakers of “Glaswegian English”…
…to meet interpreting needs of clients who find it a challenge.
The day:
The morra:
The night:
The noo:
Today
Tomorrow
Tonight
At the moment, just now
I asked her the day to meet me the night
but she said she couldnae til the morra
so I’ll need to call her the noo.
Nae-borra: Literally means “No bother”. Translated,
this means no problem at all.
100%50%25%18%
Source: Gallup, State of the global workplace report, 2017
Job engagement, by region
Source: Gallup, State of the global workplace report, 2017
41% Lower Absenteeism
58% Fewer Patient Safety Incidents
Source: Gallup, State of the global workplace report, 2017
What makes a change like that
happen??
Scooby: A clue, normally used in the phrase “I don’t
have a scooby” meaning I don’t have a clue.
What we know…
Glaikit: Stupid, foolish, not very bright, vacant.
Scottish Quality & Safety Fellowship Programme
222Quality & Safety
Fellows
141Medics
70NMAHPs
10Pharmacists
1Dentist
143 34 14 13 15 1 1 1Scotland N Ireland Ireland Denmark Norway England Wales Canada
Source: NAS
Source: NASA
Live here
2.5 hours drive
Live here
Unstaffed rooms
Strontian
Staffed clinics
Small Isles
Grantown
Bonar Bridge
Raasay
Open
Open
Open
Open
OpenOpen
Open
Open
Open
Open
Open
Open
Open
Pure dead brilliant: Used to enthusiastically describe
something that is really great.
Purposeand courage
Supportive culture
Method for change (QI)
Widening horizons Agency
The Morrison Theory
AGENCY
The ability of an individual or group to choose to act with purpose
PowerThe ability to
act with purpose
CourageThe emotional resources
to choose to act
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Psychology of Change
Psychology of Change FrameworkUnleash Intrinsic
Motivation
Co-Design
People-Driven
Change
Co-Produce in Authentic Relationship
Distribute Power
Adapt in Action
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
System
Interpersonal
Self
3 Levels of Agency
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Self
3 Levels of Agency
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
A wee belter: An exceptional or outstanding example of
someone.
Purpose and courage
Supportive culture
Method for change (QI)
Widening horizons
Agency
The Christensen Theory
Interpersonal
3 Levels of Agency
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Toatey: Small, little, wee.
FAMILY
EDUCATION
Support parenting
Engage parents in care
PEER to PEER
Enable parents to share experiences and support each
other
COMMUNICATION
Share ideas and plans
ENVIRONMENT
& RESOURCES
Physical factors to support family care
STAFF EDUCATION
Empower staff to support parents
Purpose and courage
Supportive culture
Method for change (QI)
Widening horizons
Agency
The Patel Theory
System
3 Levels of Agency
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Purpose and courage
Supportive culture
Method for change (QI)
Widening horizons
Agency
The Morrison Theory
Purpose and courage
Supportive culture
Method for change (QI)
Widening horizons
Agency
The Morrison Theory
Purpose and courage
Supportive culture
Widening horizons
The Morrison Theory
Method for change (QI)
Agency
Purpose and courage
Supportive culture
Method for change (QI)
The Morrison Theory
AgencyWidening horizons
Gie it laldy: to do something with 100% effort.
Baseline Median 1.00Median 2 = 0.94
Reduction from
Baseline = 6%
Current Median 0.87
Reduction from Baseline = 13%
0.0
0.2
0.4
0.6
0.8
1.0
1.2M
ar-
11
Jun-
11
Sep
-11
Dec
-11
Ma
r-1
2
Jun-
12
Sep
-12
Dec
-12
Ma
r-1
3
Jun-
13
Sep
-13
Dec
-13
Ma
r-1
4
Jun-
14
Sep
-14
Dec
-14
Ma
r-1
5
Jun-
15
Sep
-15
Dec
-15
Ma
r-1
6
Jun-
16
Sep
-16
Dec
-16
Ma
r-1
7
Jun-
17
Sep
-17
Dec
-17
Ma
r-1
8
Jun-
18
Sep
18
p
Ho
spit
al S
tan
dar
dis
ed M
ort
alit
y R
atio
HSMR for deaths within 30 days of admission to a Scottish hospital
13% reduction
Data source: SPSP returns
Baseline Median 1.98
Median 2 = 1.76
Reduction from Baseline = 11%
Current Median 1.42
Reduction from Baseline = 28%
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Feb
-13
Apr
-13
Jun
-13
Au
g-1
3
Oct
-13
Dec
-13
Feb
-14
Apr
-14
Jun
-14
Au
g-1
4
Oct
-14
Dec
-14
Feb
-15
Apr
-15
Jun
-15
Au
g-1
5
Oct
-15
Dec
-15
Feb
-16
Apr
-16
Jun
-16
Au
g-1
6
Oct
-16
Dec
-16
Feb
-17
Apr
-17
Jun
-17
Au
g-1
7
Oct
-17
Dec
-17
Feb
-18
Apr
-18
Jun
-18
Au
g-1
8
rate
pe
r 1
00
0 d
isch
arg
es
Total rate of Cardiac Arrest for 17 Scottish hospitals
This is a 28% reduction = approx 25 fewer cardiac arrests per month
Data source: SPSP returns
Baseline Median 0.57
Median 2 = 0.42
Reduction from Baseline = 9%
Current Temporary Median 0.42
Potential reduction from Baseline = 24-26%
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
Ma
y-15
Jun
-15
Jul-1
5
Au
g-1
5
Sep
-15
Oct
-15
Nov
-15
Dec
-15
Jan
-16
Feb
-16
Ma
r-16
Ap
r-1
6
Ma
y-16
Jun
-16
Jul-1
6
Au
g-1
6
Sep
-16
Oct
-16
Nov
-16
De
c-1
6
Jan
-17
Feb
-17
Ma
r-17
Ap
r-1
7
Ma
y-17
Jun
-17
Jul-1
7
Au
g-1
7
Sep
-17
Oct
-17
Nov
-17
De
c-1
7
Jan
-18
Feb
-18
Ma
r-18
Ap
r-1
8
May
-18
Jun
-18
Jul-1
8
Au
g-1
8
Sep
-18
rate
per
100
0 O
BD
sTotal rate of Pressure Ulcers (2-4) for 22 Scottish
hospitals
This is a 24-26% reduction = approx 44 fewer pressure ulcers per month
Data source: SPSP returns
Baseline Median 5.47
Median 2 = 4.97
Reduction from Baseline = 9%
Current Median 3.83
Reduction from Baseline = 30%
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
20
07
Q1
Q2
Q3
Q4
20
08
Q1
Q2
Q3
Q4
20
09
Q1
Q2
Q3
Q4
20
10
Q1
Q2
Q3
Q4
20
11
Q1
Q2
Q3
Q4
20
12
Q1
Q2
Q3
Q4
20
13
Q1
Q2
Q3
Q4
20
14
Q1
Q2
Q3
Q4
20
15
Q1
Q2
Q3
Q4
20
16
Q1
Q2
Q3
Q4
20
17
Q1
Q2
Q3
Q4
20
18
Q1
Q2
Q3
Q4
Rat
e p
er
1,0
00
live
bir
ths
Rate of Stillbirth in Scotland
23% reduction since the launch of MCQIC in 2013
Data source: SPSP returns
System
Interpersonal
Self
3 Levels of Agency
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Gaun yersel: a Glasgow encouragement to action.
1. Read the IHI Psychology of Change Framework
2. Work out your own version of the Morrison theoryChristensen theoryPatelMcSporranMacDuffMacLarenMacNeeSmithRogersThomasWilliamsLyngeHenricks
@derekfeeleyIHI@jasonleitch
@clareupnorth@ses3105
