Sustaining change: Reflections including the role of regional networks and NQICAN and using Patient and Public Involvement / Patient Leaders Kat Young MA Senior Quality Improvement Lead, Royal Berkshire NHS Foundation Trust Chair, National Quality Improvement and Clinical Audit Network Member, National Advisory Group for Clinical Audit and Enquiries Member, Faculty Medical Leadership and Management Twitter: Clin_Q Email kat.young@royalberkshire.nhs.uk

The change cycle Define a problem Implement change measure Implement change Analyze causes Identifying feasible solutions Develop and implement action plan Re-audit / Sustained? Sensible? Effective?

Model for Improvement

Run Charts

What to measure? Only collect the data you need to answer the questions – link to aim/objectives Outcomes measure Are we fulfilling our aim? Measures of the customer (patient, family) Process measure Things we think will lead to improvement in outcome Measures of the workings of the system Balancing measure – What is the risk? Is something else being affected by our changes (good or bad)?” Measures of the other parts of the system

Run charts Keep measuring What change works? Measure little and often Process, Outcome Balancing measure Keep measuring Is it still working? Make results visible Ward to Board Patient/user friendly

Sustainability from the start… © Royal Berkshire NHS FT 2013 Employers felt 55% of change management initiatives met initial objectives, but only 25% felt gains were sustained over time http://www.towerswatson.com/en/Press/2013/08/Only-One-Quarter-of-Employers-Are-Sustaining-Gains-From-Change-Management felt gains were sustained over time.

IPPs Ideas Measure Plan RoI Organise Vital Behaviours Evaluate RBFT QIPP Programme IPPs The Quality Improvement Approach: IMPROVE Ideas Measure Plan RoI Organise Vital Behaviours Evaluate … do we want to improve? … good are we and how do we know? … do we make the changes? … do we prioritise? …do we reduce waste? … do we demonstrate it’s worth it … do we make it happen … will our behaviours support the change … will we know we have made a difference, and how do we keep improving? How… Brainstorm Process Map Model for Improvement Spaghetti Diagram RAG Study Benchmark Audit Historical analysis Baselines Lean Pareto Staff +Patient Engagement 5 D’s PDSA PMO Docs Human / Financial cost and saving SPC Business Cases Project Plan Owners Timescales Rapid Improvement Events Six Sigma Open to change See the benefit or bigger picture Engagement Review performance Communicate change Ensure sustainability Celebrate Success Methodology

Testing for sustainability “Quality is impossible without an honest conversationDeming Preferences, attitudes and behaviours Appetite for improvement Motivation / desire To individual as well as organisation Ability / skills Ownership Objectives Leadership Visibility of results ***KEEP CHECKING! Picture: © Paul Souders/Corbis

Testing sustainability Questions to ask Are they aware? Do they care? Is it fair? will they do it? Can they do it? Anything they need in order to do it? Is it primary or secondary to role?

Sustaining continuous improvement: Communication Timely, frequent communication Articulate key messages and benefits and results Celebrate great work / achievements – focus on the positives Highly visible Make it fun, be creative Multiple stakeholders / channels Engage those doing the doing Organisation Staff Patients

Winning hearts and minds Does it connect? Continue to connect? Hard facts/ numbers + emotion / story Patient and Public Involvement Patient Leaders

Ways of Working SMARTER not harder Behaviour and values Listen and understand negativity Find the positives, find ways to share the positives, build energy and momentum Build capability and capacity Support networks / Champions

Role of Networks Create energy, enthusiasm and skills Provides support – we know it can be tough Advice and guidance Shared learning What works / what doesn’t work

NQICAN and Regional Clinical Audit Networks nqican@gmail.com @nqican

15 Regional Clinical Audit Networks nqican@gmail.com @nqican NQICAN Website to be launched at HQIP Conference

Summary… Know what works – Measure measure measure: little and often Change involves people Vision / Purpose / Fulfilling work Positive experience Involve patients Work together, support each other, network Test: Organisational commitment Leadership Financial Visibility of key messages and communication Work together Use your Network

Thank you for listening Questions? Discussion…