Communication Summit 26th October 2016 Welcome

What’s in store… This session will provide an opportunity to develop a draft driver diagram. This includes: Agreeing Aims for Improvement Measurement Introduction Plan, Do, Study, Act Cycle (PDSA) Driver diagrams – focus of our session Welcome

All improvement requires change, but not all changes are an improvement A vision – capable of stirring the heart of the community and able to serve as a constant reference and anchor point as the change moves forward. A story – to enable people to recognise where they have been and where they are going. A set of actions – to take us to the next steps towards releasing the vision. A clear framework for improvement. A strategy to engage and empower the workforce - to provide the stimulation, development and opportunity our staff need to fully release their deep commitment to public service. An understanding of how change will work locally (everywhere) – recognising communities are different and creativity should be nurtured and released at a local level. A guiding coalition – a team of key people to drive the change when the going gets tough, and to sustain support. Aim- Is there an agreed aim that is understood by everyone in the system? Correct changes - Are we using our full knowledge to identify the right changes and priorities those that are likely to have the biggest impact on our aim? Clear change method- Does everyone know and understand the method(s) we will use to improve? Measurement- Can we measure and report progress on our improvement aim? Capacity and capability - Are people and other resources deployed in the best way to enable improvement? Spread plan- Have we set out our plans for innovating, testing, implementing and sharing new learning to spread the improvement everywhere it is needed? http://www.gov.scot/Resource/0042/00426552.pdf

Just a quick refresh- teach grandma to suck eggs

Model for Improvement Act on the plan - Testing That’s where the Model for Improvement comes in. It hands the power back to front line and supports people to find processes that deliver i.e. doing the right things right Focus on the thinking if we don’t create a plan that people can understand they will Thinking

A good aim… Attributes of an aim: WHAT, HOW MUCH and BY WHEN Specific Timed Aligned Numeric Attributes of an aim: WHAT, HOW MUCH and BY WHEN We are going to focus on SPECIFIC and Aligned- Clear sense of what we are trying to accomplish it can be high level (large population/large system) or low level (focussed on small group/one department) Clearly states objectives Aligned – with the aims of the collaborative/programme and the strategic goals of the organisation. What Deming meant by “aims create systems”

Why are you collecting data? Start to think about what data there is – Outcome- Voice of the customer or user. How is the system performing? What is the result Process - Voice of the workings of the system. Are the parts/steps in the system performing as planned Balancing- Looking at a system from different directions/dimensions. What happened to the system as we improved the outcome and process measures (e.g. unanticipated consequences, other factors influencing outcome)? Improvement?

 Do  Study  Act  Plan  Do  Study  Act “What will happen if we try something different?” “What’s next? ” Welcome “Did it work?” “Let’s try it!”

Why test changes? To learn how to adapt the change to conditions in your setting Increase the belief that the change will result in improvements in your setting Minimise resistance when spreading the change throughout the organisation If you roll out a fully formed plan and it doesn’t work it gets shelved. Testing allows for tweaking and improvement so that good ideas aren’t abandoned before they’ve been given a real chance. The more tests you do, the more evidence of you ability to adopt. Adapt: taking preexisting knowledge but making it locally relevant Minimise resistance – people buy in when you are able to offer them solutions and work arounds before implementation Side effects – you will have balancing measures in place so that you are not at risk of missing the impact of your work on the bigger picture. Evaluate the costs and “side-effects” of changes

Why a driver diagram? Supports the team to explore all factors that will help achieve the aim Helps identify measures Provides an improvement route map Communication tool There are various mechanisms for mapping out an improvement plan – this is helpful because it is visual and interactive – it is also fluid – the outcome aim should not change but processes and change ideas may be adapted/altered as the learning journey progresses. Developing a locally agreed driver diagram for your improvement priority will help you engage the people you need on board and provides a shared vision for the work Explore all factors – people see where they and their ideas fit into the bigger picture Clearly maps work that is relevant to your aim. Handy comms tool – it is a handy shorthand for making sure people understand your aim. shows your whole strategy on one page

Driver Diagram for Quality Improvement in… Theories about what drives this work for QI Aim Primary drivers Secondary drivers Tests of change Secondary factors which will influence delivery of the primary drivers The changes or proposed interventions that can be tested out to achieve the secondary drivers A network of factors that drive the outcome/aim Aim statement: general description of desired Improvement (what, how much by when) Here’s a schematic view of a system – a ‘driver diagram’. On the left we depict the outcome. As we move right we drill down into the network of causes that drive the outcome, from ‘primary’ to ‘secondary’ drivers. On the right we depict the ideas for system changes that might ultimately impact the outcome. This diagram represents our theory about how to modify the system to change the outcome. Primary Drivers Key system factors which will contribute to moving the outcome aim Secondary Drivers A number of elements of the associated primary driver. They can be used to create projects or a change package that will affect the primary drivers and ultimately the outcome aim and then….. your change ideas The ideas you will take forward as tests with PDSA tests directly supporting delivery of the drivers

Driver diagram for a new healthier me! Aim Primary drivers Secondary drivers Tests of change Reduce daily intake Low fat foods CALORIES IN Substitute low Calorie meals Plan meals in advance A NEW HEALTHIER ME!! Reduce weight by 1 stone in 3 months Limit alcohol intake Keep to shopping list Drink water not coke CALORIES OUT Exercise regime Gym 5 x per week Increased activity at work Cycle to work Use stairs not lift

Driver diagram for a new healthier me! Aim Primary drivers Secondary drivers Tests of change Running calorie count Ave. Cal/day Limit daily intake Track calories CALORIES IN Substitute low calorie Plan meals Meals off plan/week % of opportunities used Daily calorie intake A NEW HEALTHIER ME!! Reduce weight by 1 stone in 3 months Limit alcohol intake Keep to shopping list Avg. Drinks per week Drink water not coke CALORIES OUT Exercise regime Non water drinks/week Gym 5 x per week Weight BMI Body Fat Waist size Fitness pal Calories burned/day Activity at work Cycle to work Use stairs not lift A Family of Measures aid monitoring progress in improving system. Improving reliability right to left results in outcome

Activity Remember a primary driver- is a Key factor that deliver the aim Each person (alone) takes a bunch of post it notes and thinks about the things that need to happened to enable us to reach our aim. 10 minutes Table discussion- what points are similar on each table- 15 minutes Take post it put on wall/ delegate from each table start to group together- Those at the table start to think about what the themes where- Can we name them?- Access -

Reflections Have we agreed our aims? Do we have a few primary drivers? Over lunch I will group the drivers- (name them with working titles) After our afternoon session we will replicate this process to look at the secondary drivers Q &A thanks

Activity Remember a Secondary Driver- is a number of activities that will influence delivery of the primary drivers Replication of the AM session Spit the group according to the theme/ topic of the primary drivers- People can move to the most appropriate table. Each in the group will look at the primary driver and think what things do we need to do to achieve this driver Each person (alone) takes a bunch of post it notes and thinks about the things that need to happened to enable us to reach our aim. 10 minutes Table discussion- what points are similar on each table- start to group these together the way we did this morning – start to name them. On a flip chart start to write the drivers for this PD 30 minutes Spokes person from each table to talk through the secondary drivers- Each table feedback then puts the driver on the wall. AC or SH to talk through what picture is forming.

What do we need to do to achieve the aim we have set? Do we have the skill/ resource/ ability in the room? If not who is missing? Where do you start? Think about the team? Go back to the data that we skimmed over before let it guide you Q&A