Fostering Champions of Change “making improvement routine in Grampian” We are a team We take risks We learn from failure We celebrate each others success We Aim Big! Jenny Ingram, Head of Service Improvement, NHS Grampian jenny.ingram@nhs.net

Our Approach Had been delivering Quality Improvement (QI) development for various groups ranging from ½ day to a collaborative model. Head of Service Improvement and Improvement Advisor support both the Scottish Improvement Skills (SIS) and Scottish Improvement Leaders (ScIL) programmes. To provide consistency we adapted some of our existing tools to fit with SIS and ScIL. Resulted in development of a more formalised approach to building QI capacity within Grampian.

Building Sustainable QI Capacity ½ day session on improvement and human factors now built into the supervisory management programme led by L&D I day QI session run for Consultants now extending into induction for Senior Medical Staff. Supporting Clinical Development Fellows. Head of OD is a key part of the QI Hub re our Talent Management Framework and improvement skill building. Built QI skills for 23 multidisciplinary teams (110 + staff) over four learning sessions as part of our Older People in Acute Care Collaborative. Working with RGU re delivery of QI including a post-graduate module. Delivering our own QI Practitioner Level Programmes as defined by the NES QI Curriculum Framework Grampian Quality Hub Building organisational improvement capacity which will harness and focus leadership and professional skills on effecting the step changes and actions set out in our strategic plans.

AHP QI Practitioner Programme Overview LS 1 15th & 16th June Action Period Personal Learning Mentoring Support LS 2 17th & 18th Aug LS 3 26th & 27th Oct Self-Assessment LS 5 23rd & 24th Feb LS 4 7th Dec Pre-Work Application & Selection April-May Action Period Personal Learning Mentoring Support Poster Development session (Jan 16) Next Steps Agreed Learning Session 1 Learning Session 2 Learning Session 3 Learning Session 4 Learning Session 5 NHSScotland’s Improvement Journey. Understanding the 3-Step Improvement Framework Recognising the steps for improvement. Stakeholder analysis. Project Improvement Charters. The Model For Improvement. Personal Journey of an AHP Improvement Advisor (NHS Shetland). Developing Driver Diagrams including use of cascading driver diagrams. PDSA/Tests of Change. The phases of improvement. Testing for the next stage. Understanding the Lens of Profound Knowledge. Measurement for Knowledge Network Masterclass. Sharing project reflections from testing, learning , barriers and actions. Understanding random and non-random variation. Quality Measurement analysis. Managing barriers and breakthroughs. Human Factors. Tactical decision making. Communicating your improvement story. Skill self-assessment. Leading and managing change supported by NHSG Organisational Development Manager. - Introduction to MBTI types. - Exploration of own type with feedback on own report. - Effective Team Working - Exploring strategies to work with others. - Behaviour Change in individuals & organisations. - Z Problem Solving Model. From testing to implementation & spread. Holding the gains. Practical application of the CLEAR mentoring model. Self-assessment skills revisited. Next steps agreed. Participants showcase their work in a poster event for an invited audience of Lead AHPs & Senior Leaders. Commissioned and supported by Associate Director of AHPs & Moray Lead AHP (ScIL Cohort 1). Programme developed and delivered by Head of Service Improvement with additional mentoring support for the cohort from IA (SPSP Fellow), SPSP Programme Manager (ScIL), AHP ScIL. Cohort of 13 AHPs from across the professions and Sectors within NHS Grampian

Outcomes & Learning The style, format and timing of the learning sessions and mentoring support facilitated and accelerated participants skill development. Utilising internal staff to support mentoring worked (i.e. IA, SPSP Programme Manager, Moray AHP Lead) to focus the cohort and provide advice. The materials were well received, built nicely with each session and mixed with our own provided a consistent approach in delivering national approaches locally. A half day learning session with the AHP Leads built further understanding of improvement science, supported these projects and has identified need for other improvement work and education. ALL participants completed an improvement project, demonstrated results and were able to showcase a QI poster on their work.

Practitioner Outcomes “Investing in doing not telling has proved to work” “ This has empowered me & my team to make changes happen” “Results have shown others the value of this approach” “Valued the space & time to think” “A wave of change is happening” “On a professional level it has enabled me to develop skills & knowledge that allows me to have QI conversations with colleagues out with the scope of my project.”

Project Outcomes Occupational Therapy clinical time released by introducing a structured Board Round tool. Decreased wait time for out- patient radiography. Improved SLT attendance by introducing an initial parent appointment by telephone. Increase in SVQ Assessors supporting Healthcare Support Workers. Increased mobilisation of older people within 12 hrs of admission. A clinical supervision case review programme for Orthotists. Improved access to nutritional care for Learning Disabilities clients within a residential setting. “Great, an initiative that will help our development and clinical practice”

Project Outcomes Increased person-centred Dietetic consultations with improved quality markers completed. Improved utilisation of voice therapy clinic with quality focused patient sessions. Increased completion rate of Pulmonary Rehab classes via a person-centred approach. Introduction of a falls self- assessment tool in Acute has increased accurate referrals to community staff. Improved quality of dental imaging with a MDT approach. Increased early referral to Paediatric Physiotherapy with a self-referral process for parents. DNA rates reduced. Introduction of exercise groups; reduced wait time and empowered patients. “ Being back in a group is better after having the stroke because if you concentrate too much on the 1:1 stuff you get tied up within yourself and you get angry annoyed, confused, stuff like that. But if you have other distractions you seem to get a lot better and you do not think of the task you are doing. I think for myself”

What Next? The cohort identified that they wished to continue to further their development and this is underway. Cohort two is being finalised with Cohort 1 supporting. We are utilising Quality Improvement Facilitators to support teaching. To build further capacity for AHPs and link to key deliverables an MSK six month collaborative is planned for August. We are running our local version of SIS from May 16. There are a further three AHP’s on the first cohort. Acute Services and the three Integrated Joint Boards are determining their approach to and requirement for the development of a QI infrastructure. The Grampian Quality Hub has been approved by the Senior Leadership Team.

Supporting Continuous Improvement In Grampian Strategic Change Group We are committed to creating the environment and effective frameworks and systems that are applicable in all settings to continuously improve the care and services we deliver sustainably over time. Strategic Change Group Grampian Quality Hub AIM: The Grampian Quality Hub (GQH) will support, facilitate and contribute to improving the health and care system for the population of the North East of Scotland by: Working directly with individuals, teams and service areas to improve the quality of care and services delivered on objectives and priorities agreed by the Strategic Change Group. Establishing and managing a Quality Improvement (QI) Network across the North East of Scotland to share learning and promote collaborative working, empowering staff and teams to make improvements. Promoting QI methodology and developing and delivering a range of QI learning and development opportunities for all levels of staff. Establishing links with neighbouring Health Boards and Health and Social Care Partnerships in the North of Scotland and wider to share and learn. Acute Services and Heath & Social Care Partnerships Improvement Infrastructure Providing Leadership to drive, create the conditions for and align support to deliver improvement priorities at a local level. Innovation Hub Creating an approach to innovation for the health and social care system in the North East of Scotland that stimulates and releases the potential of staff to contribute to change at all levels. Research & Development Ensuring research in Grampian is conducted to high scientific, ethical and financial standards by providing guidance and support to researchers throughout the whole process. Grampian Quality Hub We believe that quality is the responsibility of every employee and promoting a culture of continuous improvement will allow organisations to do the right things at the right time, every time. Make the improvement Create the conditions Change the world Improvement Priorities Four strategic themes: prevention, self-management, planned care, unscheduled care. National Improvement Programmes e.g. Patient Safety, Early Years, Six Essential Actions, Delivering Outpatient Integration Together (DOIT). Local agreed priorities for service redesign. Improvement Collaboratives (e.g. Older People in Acute Care, Discharge Collaborative Work). Building Improvement Capacity Range of QI development opportunities offered locally (from ½ day to 9 day QI Practitioner Lead). Co-ordination & support for national QI Programmes. Lead role for the annual Quality & Safety event. Network of QI Practitioners meeting quarterly.

Fostering Our Champions Of Change “There is a superhero in all of us we just need the courage to put on the cape”