Quality Improvement Tools Kate Godfrey National Lead for Quality Improvement And Development

The one constant you can rely on…….

Leading Change Communicate the vision and share all possible information as widely as possible Involve those affected by the change in planning and implementing Encourage people to air their feelings / ask for advice Explain the impact of change on individuals not the organisation Be honest about the benefits and challenges change will bring Celebrate milestones large and small

Facilitating Change Understand the goals of the meeting and the organisation Keep the group focussed on the agenda and moving forward Involve everyone in the meeting, including drawing out the quiet participants and controlling the domineering ones Make sure that decisions are made democratically

Two tools for making group decisions

Driver Diagrams Driver diagrams help to break down an overall improvement goal into underpinning goals - ‘drivers’ This allows you to easily define the changes that you need to undertake Driver diagrams are structured charts with three or more levels

Driver Diagrams 1. The improvement goal is the desired outcome determined from the audit findings 2. The primary drivers are the high-level factors that you need to influence in order to achieve this aim 3. The secondary drivers are the specific activities that influence these factors

Improve the outcome for people following stroke First hours bundle Rapid recognition tool e.g. ROSIER Confirmation of diagnosis Start aspirin First day bundle CT scan Admission to co-located beds Swallow screen First 3 days bundle 36h continuous monitoring Manual handling assessment Nutritional assessment Physiotherapy assessment First 7 days bundle OT assessment commenced MDT goal setting meeting Information sharing with patients/carers Reduce the number of episodes of avoidable harm Interventions identified by the Global Trigger Tool analysis The improvement goal is set by agreement after reviewing the audit findings

Improve the outcome for people following stroke First hours bundle Rapid recognition tool e.g. ROSIER Confirmation of diagnosis Start aspirin First day bundle CT scan Admission to co-located beds Swallow screen First 3 days bundle 36h continuous monitoring Manual handling assessment Nutritional assessment Physiotherapy assessment First 7 days bundle OT assessment commenced MDT goal setting meeting Information sharing with patients/carers Reduce the number of episodes of avoidable harm Interventions identified by the Global Trigger Tool analysis Primary drivers are agreed by discussion then grouped by the audit lead or facilitator

Improve the outcome for people following stroke First hours bundle Rapid recognition tool e.g. ROSIER Confirmation of diagnosis Start aspirin First day bundle CT scan Admission to co-located beds Swallow screen First 3 days bundle 36h continuous monitoring Manual handling assessment Nutritional assessment Physiotherapy assessment First 7 days bundle OT assessment commenced MDT goal setting meeting Information sharing with patients/carers Reduce the number of episodes of avoidable harm Interventions identified by the Global Trigger Tool analysis Then everyone has the chance to contribute ideas for secondary drivers

Group Work Primary Drivers To eat more of what is good for me To eat less of what is bad for me Secondary Drivers More fruit and vegetables More lean meat / vegetarian alternatives Fat free / low fat alternatives Less full fat dairy Less red meat Less biscuits and sweets Desired Outcome: To eat a healthier Diet

Edward De Bono’s Six Thinking Hats © thethinkingbusiness.com

White Hat: This means focussing on the data available. Looking at the information you have, and seeing what you can learn from it. It includes looking for gaps in your knowledge and either trying to fill them or taking account of them. This is where you also analyze past trends, and try to extrapolate from historical data

Green Hat: stands for creativity. This is where you can develop creative solutions to a problem. It is an unrestrictive way of thinking, in which no idea is a bad idea.

Black Hat: means looking at all the bad points of the decision(s) and the counter balances. Look at it cautiously and defensively. Try to see why it might not work. This is important because it highlights the weak points in a plan. It allows you to eliminate them, alter them, or prepare contingency plans to counter them

Red Hat: involves looking at problems using empathy, intuition and emotion. You need to try to think how other people will react emotionally and anticipate the responses of people who do not fully know your reasoning.

Yellow Hat: helps you to think positively. It is the optimistic viewpoint that helps you to see all the benefits of the decision and the value in it. Yellow Hat thinking helps you to keep going when everything looks gloomy and difficult and also helps you to catalogue the benefits to share with your teams

Blue Hat: stands for process control. This is worn by the facilitator or chair throughout the meeting. For example, when running into difficulties because ideas aren’t forthcoming, they may direct activity into Green Hat thinking. When contingency plans are needed, they should switch to Black Hat thinking.

Group Work Moving Home – White Hat – What information do you need? – Black Hat – What is the down side of moving? – Red Hat – How do you feel about moving? What emotions may be stirred up in the family during the process? – Yellow Hat – What are the good things about moving home? – Green Hat – What is the best and most creative solution to the problems identified?

Strategies for change STRATEGY A Form the committee of experts Spend at least 6 months and many hours developing the perfect solution Educate all the staff over 2-3 days Implement house-wide tomorrow Look for it in 12 months! STRATEGY B Use front-line knowledge 1 doc, 1 nurse, 1patient, one PDSA Reassess and learn from initial test Repeat, progressively increasing confidence in solution then…. Test under varying conditions before….SPREAD

Using the PDSA cycle A rapid change cycle used to test and develop an idea: Define the question Gather information and resources (observe) Form hypothesis Perform experiment and collect data Analyze and interpret data Generate new hypothesis and retest ACT PLAN STUDYDO

Any Questions?

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