Innovation and Quality Improvement across a Network Mark Dyke Clinical Lead Neonatal ODN Consultant Norfolk and Norwich

New Year resolution

January 31st Changing yourself is hard

Your perfect life partner….?

Life partner not quite perfect…..? Changing someone else is even harder

Organisational change Who comes to work to do a bad job? Who would not want to improve the care they give if that’s possible? So, why is change so difficult in healthcare? What are the barriers to change?

Barriers to Managing & Improving Quality Simon Feary: Chartered Quality Institute Time available Key individuals; not overall staffing Leadership [lack of…] Training [lack of…..in Quality Improvement] Morale Limited focus on quality in staff appraisal

Overcoming Organisational Barriers to Change Carolyn Pexton Cultural complacency “You might, but we don’t have a problem…” Resistance “We don’t do it like that here…” Scepticism “Nice idea: won’t work here…” Poor communication “Just do it [why? ‘cos I say so…]”

Overcoming Organisational Barriers to Change Carolyn Pexton Lack of accountability “not my job to fix it; must be someone else’s….” Absent leadership “the staff will sort it, I needn’t bother” Micro-management “I can’t trust those idiots; I’d better do it all myself”

Overcoming Organisational Barriers to Change Carolyn Pexton Overloaded workforce “we’re run off our feet already, we can’t do this as well” Inadequate systems “Data, what data? We were meant to record something..??” Lack of sustained focus “we fixed that last week; surely we don’t need to go there again...?”

Barriers to change in Healthcare NHS Institute for Innovation & Improvement Only 2/3 healthcare improvements lead to sustained change Problems – “Top down” selling of change Failure to engage and/or consult Leads to resistance – “Training” vs “Facilitated learning” – Poorly defined goals vs SMART Objectives

Effective change management Thoughtful planning Sensitive implementation Consultation with those required to change Involvement of those required to change Think: – What do we want to achieve? Why? – Who is affected? Have we consulted with them? – How will we know…? – What can we effect ourselves? – What help do we need? – Then : PDSA

PDSA Plan What [small] changes will we make [& how]? What data is needed to test outcome? Do Put plan into action Study Analyse data [frequent feedback] Act Adopt, modify or reject plan

Common Principles of Managing Improvement The Health Foundation Understanding the [healthcare] process Mapping of a pathway Work out which steps add value Data “if you don’t know how you’re doing, you can’t know if you’re doing better”

Common Principles of Managing Improvement The Health Foundation Improving reliability Understand [then improve] the reliability of delivery of key steps [Care Bundle approach] Enthuse & involve staff Leadership & staff engagement crucial to success Most clinical staff inherently keen to improve Involve staff early in setting goals Senior staff engagement = role modelling Involve clinical networks Provide evidence

First Hour Care Project