1. LS3: From here to eternity From here to eternity 30 September 2014 Presenter: Mike Davidge

2. LS3: From here to eternity A leader’s walkround

3. LS3: From here to eternity Stop 1: Theatre

4. LS3: From here to eternity Stop 2: Ward

5. LS3: From here to eternity Stop 3: ITU

6. LS3: From here to eternity Stop 4: Physios

7. LS3: From here to eternity Stop 5: Pharmacy

8. LS3: From here to eternity Which future?

9. LS3: From here to eternity This could be you! Could it? How?

10. LS3: From here to eternity How did they get there? “The wise man built his house upon the rock.” The rock of reliability

11. LS3: From here to eternity How did they stay there? Sustainability is when new ways of working and improved outcomes become the norm. Spread is the extent to which learning and change principles have been adopted in other parts of the organisation that could benefit from them.

12. LS3: From here to eternity Tips for Sustaining your gains WIIFM  Clear benefit for stakeholders Education, education, education  Training and education, new and old It’s not what you do, it’s the way that you do it  Build the change into the structure of the organisation and make it the new standard “We manage what we measure”  Build in ongoing measurement of key outcomes and processes Make it part of the day job  Job descriptions and objectives Party time!  Celebrate, renew and set the bar higher

13. LS3: From here to eternity How likely are you to slip back? Take an area you have recently improved. Discuss with your neighbour how many of the 6 factors are in place:  Staff involved see the benefit to them  Training programme in place for new and temporary staff  Change now incorporated into standard way of working  You review regularly 1 measure each of outcome and process  The change is now in any relevant Job descriptions and objectives  You have recently celebrated the success Which one do you want to tackle next?

14. LS3: From here to eternity Sustainability model & guide www.institute.nhs.uk/sustainability

15. LS3: From here to eternity How does spread happen? Spread is the result of the process of adoption, not the other way round. In other words, spread happens best when people pull the change into their work rather than have it pushed (or foisted) on them

16. LS3: From here to eternity Adopt principles not solutions Solution in Area A Solution in Area B Change principle And expect local re- invention

17. LS3: From here to eternity Spread v Adoption Spread  push ideas outward to others  my agenda = the centre of the larger organisation  use of organisational structure and hierarchy  tools, techniques and processes Adoption  pull ideas into myself  my agenda = the sharp end of delivering care  use of social systems  relationships and facilitation Taken from Fraser SW and Plsek PE, Translating evidence into practice: Can it be done through the process of spread?

18. LS3: From here to eternity Spread strategies Cards stacked in your favour  Choose your partners carefully Create pull  Curiosity, communications, commitment Consider infrastructure support Concentrate on principles and values  To leave room for local innovation and adoption Carpe diem  Look out for local initiatives and build on their successes

19. LS3: From here to eternity Spread quiz How many have you tried? 1. Chosen teams to spread to based on assessing the risk 2. Planned to weaken resistance where you’re working next 3. Tailored your communications to attract new volunteers 4. Raised local awareness by using local process mapping events 5. Encouraged teams to observe the benefits without having to commit to change immediately 6. Resourced extra staff to facilitate spread 7. Built on existing projects

20. LS3: From here to eternity “The successful projects have obviously not been those projects that have gone to a consultant and said, “You’ve got to do this.” It has been, “This is the benefit to you, this is the benefit for your patients” and it’s those projects that have got groups of clinicians on board and then have used those clinicians to sell the project to other clinicians, that have been the really successful ones.”

21. LS3: From here to eternity W Edwards Deming 1. Constancy of purpose Create constancy of purpose for continual improvement of products and service to society, allocating resources to provide for long range needs rather than only short term profitability … “When the going gets tough, the tough hold their nerve” targets patients treatments

22. LS3: From here to eternity Which is your future?