Embed Size (px)
Citation preview
Professor Jean Penny, University of [email protected]
Embedding Improvement Science in Training Programmes:
Why Bother?
All working life in and with NHSDiagnostic Radiographer and teacherNational improvement roles 1994 – 2008Improvement educator and advisor 2008 – present Awarded OBE for services to NHS 2003Visiting professor University of Derby 2008
Improvement: 19 years and still learning
Healthcare will not realise its full potential unless change
(improvement) making becomes an intrinsic part of everyone’s job, every
day, in all parts of the system.
Batalden, P. B et al. Quality and Safety in Health Care 2007;16:2-3
◦ What is Improvement Science?
◦ Why bother embedding it into training programmes?
Who likes change?
Any improvement is a change◦not every change is an improvement◦but we cannot improve something unless
we change it
Eliyahu GoldrattGoldratt E (1990) Theory of Constraints, North River
Press, Massachusetts
Any improvement is a change any change is a perceived threat to security◦there will always be someone who will
look at the suggested change as a threat
Eliyahu Goldratt
Any improvement is a change any change is a perceived threat to security
any threat to security gives rise to emotional resistance◦ you can rarely overcome emotional resistance
with logic alone
Eliyahu Goldratt
“Anyone who thinks you can
overcome emotional
resistance with logic was probably
never married”
Any improvement is a change any change is a perceived threat to
security any threat to security gives rise to
emotional resistance emotional resistance can only be
overcome by a stronger emotion
Eliyahu Goldratt
What to change?◦ Pin point the core problems
What to change to?◦ Construct (simple) practical solutions
How to cause the change?◦ Induce the appropriate people to invent such solutions ◦ they must own the problem
Eliyahu GoldrattGoldratt E (1990) Theory of Constraints, North River
Press, Massachusetts
4 equally important parts of improvement
Diagnostic tools and techniques
Project and programme
management
User and public involvement
Change management
Discipline of improvement in health and social care (Penny 2003)
People Process
What
How
If I had one hour to save the world, I would spend 59 minutes defining the problem and one minute finding a solution
A Einstein
Challenge the
paradigms
What are you trying to accomplish?
How will you know that a change is an improvement?
What changes can you make that will result in the improvements that
you seek ?
Act Plan
Study Do
The Model for The Model for Improvement Improvement Understanding the problem.
Defining what you’re trying to do
Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The improvement guide: a practical approach to enhancing organizational
performance 2nd ed, Jossey Bass Publishers, San Francisco
Average length of pre-ward stayStroke Ward
from 01/2007 to 07/2007
0
0.5
1
1.5
2
2.5
3
3.5
1 2 3 4 5 6 7Months
Mike Davidge NHS Institute for Innovation and
Improvement
Average length of pre-ward stayStroke Ward
from 01/2007 to 07/2007
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31
Weeks
Patient length of pre-ward stay Stroke Ward
from 01/2007 to 07/2007
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
Patients
What are you trying to accomplish?
How will you know that a change is an improvement?
What changes can you make that will result in the improvements that
you seek ?
Act Plan
Study Do
The Model for The Model for Improvement Improvement
What have others done? What does the evidence say? What hunches do we have? What can we learn as we go along?
Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The improvement guide: a practical approach to enhancing organizational
performance 2nd ed, Jossey Bass Publishers, San Francisco
Solution / change in
team / organisation A
Change principle Change principle
Solution / change in team / organisation
B
PDSA cycle for learning and PDSA cycle for learning and improvementimprovement
Act
• what changes are to be made?
• next cycle?
Plan•objective• questions and predictions (why)• plan to carry out the cycle (who, what, where, when)
Study
•complete the analysis of the data
•compare data to predictions
•summarise what was learned
Do
• carry out the plan• document problems and unexpected observations• begin analysis of the data
We planned to.......( state the basic plan)In order to ….. (tie it back to the aim)
What we did was….. (brief description of actions)
Looking at what happened, what we learned from this was….. (lessons learned)
What we plan to do next is …. (state next plan)
The Model for Improvement breaks things down into small steps and works on the ‘little dots’ – at the frontline
These small steps should be part of the answer to the question of how to move the ‘big dots’
Align all improvement projects to strategy
Intervention 1
Intervention 2
Intervention 3
Intervention 1
Intervention 2
Intervention 3
Intervention 1
Intervention 2
Intervention 3
The interventions / change ideas that contribute directly to secondary drivers
Secondary Drivers:Contribute directly to
primary drivers
Intervention 1
Intervention 2
Intervention 3
Intervention 1
Intervention 2
Intervention 3
?
Primary Drivers:Contribute
directly to the strategic aim
The strategic aim (and
big problem)
◦ What is Improvement Science?
◦ Why bother embedding it into training programmes?
To develop health and social care students who are curious about how they could improve their service, and who are receptive to different ideas and able to bring about the necessary changes by applying a variety of tools and techniques in their own context
Improvement in pre-registration Improvement in pre-registration education: education: aim – to raise awareness to aim – to raise awareness to improvement for better safer careimprovement for better safer care
2006
‘my duty, part of my professional role, I should get involved’
‘be prepared to extend role and take on new responsibilities’
‘small problems have a big impact on patients’
‘anyone can take part – we’re all responsible’
‘I have the skills’
Tribal consulting, External evaluation 08/09
‘…..I have interviewed over 100 applicants of newly qualified staff …..One of the questions asked was " Service development is everyone's responsibility, …have you been involved in any changes happening while you have been on a placement?
It was obvious …that one particular University's candidates had all identified an area for improvement in practice .. and had tested and evaluated them during their stay there. Some of their ideas were still in use and others were not. Some of the ideas were interesting and made us think about looking at those areas for improvement ourselves.
…..it was very clear that the candidates from other local universities had not been involved in any changes
……we employed those that could clearly discuss how to introduce and evaluate a change in practice or improvement to patient care’.
Nurse Manager, Neonatal Unit, North of England, March 2011
It is making a difference......
Engagement of key stakeholders◦ Barriers in engaging
with practice◦ Engaging Faculty and
colleagues Resources
◦ Time◦ Funding◦ Human Resources
and Extra work◦ Rooms
Timescale / Timing◦ University structures i.e.
plan everything in advance
◦ Difficult time as currently revalidating
◦ Difficulty getting everybody in the same room at the same time
Attitudes◦ Student Attitude and
receptiveness◦ Staff Attitude and
receptiveness
Tribal Consulting, External evaluation of 08/09
The main challenge to sustainability is ensuring that key faculty and senior academics truly understand and value improvement as a concept. When this happens improvement is prioritised and sustained in an ever pressurised curriculum.
Replies from 33 universities (69%) of the 48 universities on the NHSI contact list
Work with your team /colleagues: value differences Really understand the problem Develop aims and measures: What are you trying to
achieve? Measure for improvement: How will you know a
change is an improvement? Gather change ideas: What changes can you make
that will result in the improvement you want? Test change ideas (PDSA cycles) before implementing Learn from things that do not work Link frontline changes to strategic objectives
Healthcare will not realise its full potential unless change
(improvement) making becomes an intrinsic part of everyone’s job, every
day, in all parts of the system.
Batalden, P. B et al. Quality and Safety in Health Care 2007;16:2-3
Professor Jean Penny, University of Derby
Embedding Improvement
Science in Training
Programmes: Why Bother?
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make that
will result in improvement?
Model for Improvement
‘Competence: what individuals know or are able to do in terms of knowledge and skill
Capability: extent to which individuals can adapt to change .... and continue to improve their performance’
‘These days there is so much knowledge available that we risk drowning in it.......Learning about how things are interconnected is often more useful than learning about the pieces’
Fraser Greenhalgh (2001) Coping with complexity: educating for capability
