Spreading story use

Why are stories so important? To give patients and service users a voice. To highlight the need for change To focus senior leaders about purpose. To build energy and common purpose among staff. To celebrate success.

National policy developments “ Developing a shared narrative so that all staff understand what is needed and why” “ It is important that service users are empowered to describe their experiences to those who provided their care A national approach to measuring patient experience An approach to putting things right, centred on personal experiences, rather than processes. “ A new partnership with the public: Involving communities in assessing and designing services improves services; Involving patients in decisions about their own care improves outcomes.

Components of the task Technical knowledge. Supporting infrastructure and systems Bringing story use into routine practice.

Tipping point Snowball effect Sysiphus effect Tipping point

Beyond the 1000 Lives Campaign 2.5% 13.5% 34% 34% 16% Beyond the 1000 Lives Campaign

Understanding the Force Field Driving forces Restraining forces Lack of understanding Technical knowledge Poor infrastructure Enthusiasts Competing priorities for time Examples of success Lack of alignment with other priorities Strong alliances

Who are your allies Putting Things Right teams Corporate clinical governance/patient safety leads. Quality & safety committee chairs Service improvement leads Executive Directors Division/Directorate leaders Comms teams.

Putting yourself in others shoes? Key people or groups W I F M + Impact - Risk What could they do to support or prevent spread? What can we do to reduce the risks and support impacts? An exercise in putting yourself in other peoples’ shoes Key people or groups: List all the people and groups that may be affected by the change WIIFM Views or comments those in each group may hold or make. Deeply held values; Working relationships; Conditions of work; Job security; Nature of work; Status, power, responsibility What could they do to support or prevent improvement Actions they could take to support or resist the initiative. Will they show: Apathy? Commitment? Non-compliance? What can we do to reduce the risks and support impacts? What can we do to address specific concerns and: Move people from non-compliance to Neutrality; Move people from neutrality to support; Build on Support and counter non-compliant behaviour Personal notes: It’s not just you!

Developing the top team script… This work is about…. It is important to us because… The advantages of this work are…. We expect the impact to be…. We can support this work by…

Gathering examples of success- Using the model for Improvement (1) What are we trying to accomplish? (2) How will we know that a change is an improvement? (3) What change are we testing to see if results in improvement? So where do you start - before you think about planning your PDSA, get together with your team and ask yourselves the following three basic improvement questions: What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? (Langley, Nolan, Nolan Norman & Provost, 1996) Optional (Thinking about these questions really will help you to focus on what you are trying to achieve, how you’ll know if you’ve got there, and the path you’re going to take in order to get there. If you’re looking for inspiration, remember the aims of your improvement work. PDSA’s that are best at making things better are objective focused, recorded, measured, shared and help to: Pull the whole team together to learn about and improve the situation Consider the three basic questions for improvement Consider patients, clients and carers opinions with the needs of the population and service Develop and try out ideas for change that might result in measured and sustainable improvement Break the idea for improvement down into small, bite-sized pieces Create simple measures to help to monitor and attribute improvement Define and agree the who, what, where, and when of improvement action Define and agree dates for the team to talk together again, review the situation, and plan the subsequent stage/cycle. (Don’t forget though, that talking together doesn’t have to mean a face to face meeting, you can use telephones if the recorded PDSA is shared)) Source: Nolan

A PDSA cycle: We want to improve understanding and engagement of Q&S committee members in priority clinical improvements. We will know we have improved if committee members provide positive feedback that meeting time was well spent, understanding has improved and required actions are clear. We will use a patient story, aligned to a core agenda item in the next meeting, and will seek feedback from committee members.

A PDSA cycle. We want to identify stories of avoidable harm that are aligned with improvement priorities. New stories will be identified, developed and used in different forums to engage staff in improvement work. We will work with the Putting Things Right team to review complaints and incidents from one month against identified priorities and identify potential ‘new’ story-tellers.

ACTIONS Map out your Forcefield. Review and assess your allies. Prepare your top team script. Plan your next PDSA