Knowing You’re Making a Difference © 2014 AQuA Amanda Huddleston

© 2014 AQuA

NHS Model For Improvement © 2014 AQuA

Using Measurement for Improvement An Introduction © 2014 AQuA

Focus Today: How Will We Know? 1 Decide aim 2 Choose measures 3 Define measures 6 Review measures 5 Analyse & present 7 Repeat steps Collect data

1 Decide aim 2 Choose measures 3 Define measures 6 Review measures 5 Analyse & present 7 Repeat steps Collect data Step 1: Decide your aim

© 2014 AQuA

Before you decide your aim, do you really understand the problem?? © 2014 AQuA Solution vs Problem

© 2014 AQuA

‘Results indicate that when preschoolers ask "why" questions, they're not merely trying to prolong conversation, they're trying to get to the bottom of things.’ © 2014 AQuA Frazier et al. Preschoolers' Search for Explanatory Information Within Adult-Child Conversation. Child Development, 2009; 80 (6): 1592 DOI Useful Tools: 5 Whys

Useful Tools: Diagrams © 2014 AQuA

Useful Tools: Maps © 2014 AQuA Process Map Value Stream Map

© 2014 AQuA Useful Tools: Fishbone (Root Cause)

© 2014 AQuA 5 Min Think: How do you know what needs improving? We benchmark poorly We’re failing our target Patients who complain Our Outcomes are poor Quantitative data Patients we interview Qualitative data Staff feedback

© 2014 AQuA Safety In Your Area Think about a patient safety issue in your area How do you know what needs improving? Solution or Problem? Buckets and / or plasters? What are your sources of data / intelligence?

1 Decide aim 2 Choose measures 3 Define measures 6 Review measures 5 Analyse & present 7 Repeat steps Collect data Step 1: Decide your aim

Aim Statement Brief rationale What’s the problem? Why is it important? What are we going to do about it? What exactly are you trying to achieve? For whom are you going to improve it for? By how much will you improve it? By when are you aiming to achieve it? 21 Adapted from

Cause & Effect: Driver Diagrams Helps you to think about the aim that you want to achieve and more importantly what necessary changes you need to make Simple way of organising visually the actions that will help you achieve your aim

© 2010 AQuA 23 Aim A reduction in incidents of violence& aggression by 20% in the Unit during 2012/13 Care Planning Environment Workforce A. Raise awareness B. Introduce a SU advanced statement re management of V&A. A. Post all records (agreed actions) of the community meetings in a central area. B. Post a weekly activity programme at a central point on the ward. A. Develop a formal process regarding the planning of social & therapeutic activities. B. Introduce a community meeting. C. Redesign role of staff member – activity co-ordinator. Primary drivers are the systems changes which will contribute to achieving the Aim outcome measure. Secondary drivers are interventions associated with primary drivers. They can be used to create projects or change packages that will affect the primary driver. A. Review and compare data – make data easily available to staff.. B. Identify specific times/places/ personnel involved in V&A. C. Provide poster for staff comments re new PDSAs. D. Provide staff with written updates re V&A to inform staff on return from days off. E. Recruit permanent staff to vacant posts. Therapeutic Intervention s Primary Drivers Secondary Drivers

1 Decide aim 2 Choose measures 3 Define measures 6 Review measures 5 Analyse & present 7 Repeat steps Collect data 24 Step 2: Choose measures

Family of measures Outcome Process Balancing If the family were a fruit, it would be an orange, a circle of sections, held together but separable - each segment distinct

Decrease household fuel costs by 50% by December 2015 Reduce price per litre Reduce miles driven Increase mpg Increase mpg Improve car efficiency Improve driving patterns Limit speed Use appropriate gear Use appropriate gear Drive smoothly Drive smoothly Aim Primary drivers Secondary drivers Tertiary drivers Actions/ Interventions Buy a diesel car next time Buy a diesel car next time Stick to 70 mph on motorway Get into highest gear more quickly Accelerate more slowly Book onto AA course Fill up at supermarket Combine journeys Use alternatives Plan ahead Work from home Cycle or walk short distances Fuel Costs Number of Miles Cost per litre No of non vehicle journeys

Other Types of Measures we Use KPIs CQUINS / QOFS Clinical Outcomes Improvement Project

1 Decide aim 2 Choose measures 3 Define measures 6 Review measures 5 Analyse & present 7 Repeat steps Collect data An operational definition is a description, in quantifiable terms, of what to measure and the steps to follow to measure it consistently 28 Step 3: Define measures

Understanding your Population All Population Simple Random Sampling Proportional Stratified Random Sampling Judgement Sampling IF IN DOUBT ASK FOR HELP!

Step 4: Collect Data 1 Decide aim 2 Choose measures 3 Define measures 6 Review measures 5 Analyse & present 7 Repeat steps Collect data

© 2014 AQuA Data Overload ?

© 2014 AQuA

Monthly data shows improvement 33 The chart shows the average monthly length of time before patients got to the Stroke ward

Weekly data tells a slightly different story 34

Patient level data adds another level of understanding 35

Measurement Checklist

“The type of presentation you use has a crucial effect on how you react to data ” 1 Decide aim 2 Choose measures 3 Define measures 6 Review measures 5 Analyse & present 7 Repeat steps Collect data Step 5: Analyse and present

Importance of Collecting & Presenting Timely Data

2011 Complaints Distribution – per Quarter

Comparison of Complaints

Analysing qualitative data Thematic analysis: Look for the common themes Construct a story around typical findings The power of a good quote

Qualitative Data

Focus Today: How Will We Know? 1 Decide aim 2 Choose measures 3 Define measures 6 Review measures 5 Analyse & present 7 Repeat steps Collect data

Handy Hints Use tools to really understand the problem Utilise local experts: Who are they? Make friends with the ‘data people’ Work collectively on your aim & driver Don’t get hung up on striving for completeness and perfection – you will NEVER get there! Don’t be afraid to ask for help

Measurement for Improvement 1 Day Course Dates via AQuA Portal © 2014 AQuA