Improvement 101 Learning Series Module 2: A Process for Improvement Your Host: Leanne Couves Improvement Advisor Hello and welcome to the BCPSQC webinar series on improvement topics.  Thanks for listening.  My name is Leanne Couves and I will be your host today.  I am a Faculty member for Quality Academy and work on a number of improvement projects in the healthcare system.   This series is specifically designed for patient partners and volunteers who work within BC’s healthcare system to help improve care.   Authentic engagement with patient partners is not something that happens by accident. It requires planning and well-intentioned, principled actions.  A necessary shift is taking place in our health care system – inviting patients into improvement work is not something that is nice to do or a privilege to patients, but rather something that needs to be done whenever decisions that impact patients are being made. Patient Partners are recognized as part of the care team and increasingly, an important part of our improvement teams.   We hope that these learning modules will provide a deeper understanding of some of the language, methods, processes, tools and techniques that healthcare teams are using to make system improvements. There are a total of 4 modules in the series.  Each module tackles a specific improvement topic.  The first five minutes of the recording will provide an overview of the topic.  For some, this content may be enough to get you started and answer your initial questions.   For those who want to go deeper, the next 15 minutes will provide more details, information and resources. 

This is Module 2: A Process for Improvement This is Module 2: A Process for Improvement. This module describes a process that many health authorities and organizations use to make improvements.

Reflect on your experience From Module 1, remember that improvement is the process of making things better. Think about a time when YOU wanted to make something better. Maybe your family wanted to improve your eating habits or become more active? Perhaps you wanted to get the kids to school on time without those early morning struggles? Or think about the projects you’ve been involved with as a patient partner. Think about a specific situation, pause the recording and write down your responses to the following questions: How did you go about making changes? What did you actually do?

Reflect on your experience From Module 1, remember that improvement is the process of making things better. Think about a time when YOU wanted to make something better. Maybe your family wanted to improve your eating habits or become more active? Perhaps you wanted to get the kids to school on time without those early morning struggles? Or think about the projects you’ve been involved with as a patient partner. Think about a specific situation, pause the recording and write down your responses to the following questions: How did you go about making changes? What did you actually do?

Reflect on your experience From Module 1, remember that improvement is the process of making things better. Think about a time when YOU wanted to make something better. Maybe your family wanted to improve your eating habits or become more active? Perhaps you wanted to get the kids to school on time without those early morning struggles? Or think about the healthcare projects you’ve been involved with as a patient partner. Think about a specific situation, pause the recording and write down your responses to the following questions: How did you go about making changes? What did you actually do?

Reflect on your experience How did you go about making changes? What did you actually do? From Module 1, remember that improvement is the process of making things better. Think about a time when YOU wanted to make something better. Maybe your family wanted to improve your eating habits or become more active? Perhaps you wanted to get the kids to school on time without those early morning struggles? Or think about the projects you’ve been involved with as a patient partner. Think about a specific situation, pause the recording and write down your responses to the following questions: How did you go about making changes? What did you actually do?

Processes for Improvement: Some Common Features Welcome back. Over the next few minutes, I’m going to review some common features of making improvements. As I go through them, review and compare YOUR responses for similarities and differences. There are many different frameworks or methods or models for improvement, but most have some common features. First, the “Why”. It is useful to understand and articulate why we want to make changes and what problem or opportunity we are trying to address. Specific goals or expectations are often stated with a deadline to achieve them. The second feature is actually changing something – a process, a system, a behaviour. Some changes will work, some won’t. Most improvement methods have a means for trying our ideas first, usually on a small scale. Almost all methods use data and feedback to learn more about the problem or opportunity, to see what changes work and to learn about our progress. These data can come in many forms – numbers, words, reactions and observations. We collect data and analyze it along the way to understand the problem and understand progress towards our goals. The final feature of most improvement efforts is involving others. With only a few exceptions, we cannot do improvement work alone. Most methods assume we need to engage others, including those who do the work and those who benefit from the work. We can use everyone’s knowledge, energy and experience to develop, test and implement changes. Projects are usually not done by only one person or one department, they use a team approach.

Processes for Improvement: Some Common Features Problem or Opportunity The “Why” Goals Welcome back. Over the next few minutes, I’m going to review some common features of making improvements. As I go through them, review and compare YOUR responses for similarities and differences. There are many different frameworks or methods or models for improvement, but most have some common features. First, the “Why”. It is useful to understand and articulate WHY we want to make changes and what problem or opportunity we are trying to address. Specific goals or expectations are often stated with a deadline to achieve them. The second feature is actually changing something – a process, a system, a behaviour. Some changes will work, some won’t. Most improvement methods have a means for trying our ideas first, usually on a small scale. Almost all methods use data and feedback to learn more about the problem or opportunity, to see what changes work and to learn about our progress. These data can come in many forms – numbers, words, reactions and observations. We collect data and analyze it along the way to understand the problem and understand progress towards our goals. The final feature of most improvement efforts is involving others. With only a few exceptions, we cannot do improvement work alone. Most methods assume we need to engage others, including those who do the work and those who benefit from the work. We can use everyone’s knowledge, energy and experience to develop, test and implement changes. Projects are usually not done by only one person or one department, they use a team approach. Expectations

Processes for Improvement: Some Common Features The “Why” Make changes Systems Processes Behaviours Welcome back. Over the next few minutes, I’m going to review some common features of making improvements. As I go through them, review and compare YOUR responses for similarities and differences. There are many different frameworks or methods or models for improvement, but most have some common features. First, the “Why”. It is useful to understand and articulate why we want to make changes and what problem or opportunity we are trying to address. Specific goals or expectations are often stated with a deadline to achieve them. The second feature is actually changing something – a system, a process, a behaviour. Some changes will work, some won’t. Most improvement methods have a means for trying our ideas first, usually on a small scale. Almost all methods use data and feedback to learn more about the problem or opportunity, to see what changes work and to learn about our progress. These data can come in many forms – numbers, words, reactions and observations. We collect data and analyze it along the way to understand the problem and understand progress towards our goals. The final feature of most improvement efforts is involving others. With only a few exceptions, we cannot do improvement work alone. Most methods assume we need to engage others, including those who do the work and those who benefit from the work. We can use everyone’s knowledge, energy and experience to develop, test and implement changes. Projects are usually not done by only one person or one department, they use a team approach.

Processes for Improvement: Some Common Features Data: The “Why” Make changes Get feedback Numbers Words Welcome back. Over the next few minutes, I’m going to review some common features of making improvements. As I go through them, review and compare YOUR responses for similarities and differences. There are many different frameworks or methods or models for improvement, but most have some common features. First, the “Why”. It is useful to understand and articulate why we want to make changes and what problem or opportunity we are trying to address. Specific goals or expectations are often stated with a deadline to achieve them. The second feature is actually changing something – a process, a system, a behaviour. Some changes will work, some won’t. Most improvement methods have a means for trying our ideas first, usually on a small scale. Almost all methods use data and feedback to learn, to see what changes work and to see if we are making progress. These data can come in many forms – numbers, words, reactions and observations. We collect and analyze data to build understanding and see if we are meeting our goals. The final feature of most improvement efforts is involving others. With only a few exceptions, we cannot do improvement work alone. Most methods assume we need to engage others, including those who do the work and those who benefit from the work. We can use everyone’s knowledge, energy and experience to develop, test and implement changes. Projects are usually not done by only one person or one department, they use a team approach. Observation

Processes for Improvement: Some Common Features The “Why” Make changes Get feedback Involve others Teams Everyone’s knowledge, energy and experience Welcome back. Over the next few minutes, I’m going to review some common features of making improvements. As I go through them, review and compare YOUR responses for similarities and differences. There are many different frameworks or methods or models for improvement, but most have some common features. First, the “Why”. It is useful to understand and articulate why we want to make changes and what problem or opportunity we are trying to address. Specific goals or expectations are often stated with a deadline to achieve them. The second feature is actually changing something – a process, a system, a behaviour. Some changes will work, some won’t. Most improvement methods have a means for trying our ideas first, usually on a small scale. Almost all methods use data and feedback to learn more about the problem or opportunity, to see what changes work and to learn about our progress. These data can come in many forms – numbers, words, reactions and observations. We collect data and analyze it along the way to understand the problem and understand progress towards our goals. The final feature of most improvement efforts is involving others. With only a few exceptions, we cannot do improvement work alone. Most methods assume we need to engage others, including those who do the work and those who benefit from the work. We can use everyone’s knowledge, energy and experience to develop, test and implement changes. Projects are usually not done by only one person or one department, they use a team approach.

A Model for Improvement In a healthcare setting, you might have seen this graphic. It’s called a Model for Improvement. It is simple and intuitive model for improvement that can be applied in a wide range of circumstances, from improving your family’s eating habits to transforming the healthcare system. The first part of the model includes three questions. These questions help to define an improvement initiative and provide direction, focus and context for the improvement. • The first question is “What are we trying to accomplish?” This questions allows us to articulate our why – our goals and expected outcomes and timelines for achieving them. • The next questing is “How will we know a change is an improvement?” This question helps us identify what data and feedback we will use to assess our progress and see if the changes we are trying are leading us towards our goals. • The final question is “What changes can we make that will result in an improvement?”, the question that allows us to identify change ideas. The questions are often asked at the beginning of an improvement initiative. They can be answered in any order and are sometimes documented in something called a “Project Charter” or “Improvement Charter”. For simple initiatives, I’ve seen charters scribbled on the back of a napkin. For more complex projects, like the ones you might be involved with, a Charter may be several pages long and reviewed and agreed to by many people. The second part of the model is a cycle for learning and improvement based on the scientific method. The PDSA, meaning Plan-Do-Study-Act, help turn plans into action and connects action to learning. The cycle is used to develop, test and implement proposed changes in real time and in real work settings. It is a “trial & learn” approach to making changes. We identify a potential change, plan how to try it out, actually try it (preferably on a small scale at the beginning), get feedback on how it worked, then act on what was learned for the next PDSA.

Reflect on your experience How would you answer the three questions for improvement? What ideas did you or the team try? Did you try them out before you incorporated them into a new routine? Did they work they way you expected? Think back to your experience you reflected on previously. How would you answer the three questions for improvement? What ideas did you or the team try? Did you try them out before you incorporated them into a new routine? Did they work they way you expected?

Thank you! PatientVoicesBC.ca @PatientVoicesBC Thank you for listening to the first 5 minutes of Module 2. It hopefully provided “just enough” information to answer your initial questions about a process for improvement. You are welcome to stop the recording now and enjoy the rest of your day. However, if you want to dig deeper, I welcome you to continue with the recording and learn more about a process for improvement.