1. Version 1.5 – 07/11/08 5S Housekeeping January 12 th 2010 Cohort 1 - Day 1 January 12 th 2010 Cohort 1 - Day 1 NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL

2. Version 1.5 – 07/11/08 5S Housekeeping Welcome from Milton Keynes NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 2 © Heart of England NHS Foundation Trust. All rights reserved

3. Version 1.5 – 07/11/08 5S Housekeeping Checks:  Fire Tests  Mobiles/Bleeps  Breaks  The Loo’s NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL © Heart of England NHS Foundation Trust. All rights reserved 3

4. Version 1.5 – 07/11/08 5S Housekeeping Group Introductions:  Who are you, what is your role and why are you here? (it’s ok if your Manager sent you) NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 4 © Heart of England NHS Foundation Trust. All rights reserved

5. Version 1.5 – 07/11/08 5S Housekeeping Setting the Scene:  HEFT journey thus far  The Improvement Model  High level explanation of the 4 days of training NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 5 © Heart of England NHS Foundation Trust. All rights reserved

6. Version 1.5 – 07/11/08 5S Housekeeping DAY 1 - FOUNDATION FOR CHANGE CHECK CONSENSUS MANAGING CHANGE o Contracts / Roles o PAL Score (Practical Tool) o Skills / Training Needs o Contracts / Roles o PAL Score (Practical Tool) o Skills / Training Needs o Setting The Scene o Human Dimension of Change o The Change Curve o Basics of Transactional Analysis o Rapport Building o Setting The Scene o Human Dimension of Change o The Change Curve o Basics of Transactional Analysis o Rapport Building NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 6 © Heart of England NHS Foundation Trust. All rights reserved

7. Version 1.5 – 07/11/08 5S Housekeeping DAY 2 - INVESTIGATION DEFINE OUTCOME AND BENEFITS CLARIFY NEED AND DEEPLY UNDERSTAND o Outcome Wanted – PSV o Outcome Measures from a Quality/Cost/Time Perspective o Benefits Mapping o In/Out Scope o Outcome Wanted – PSV o Outcome Measures from a Quality/Cost/Time Perspective o Benefits Mapping o In/Out Scope o Compelling Need o Patient, Staff, Value (PSV) o 4 N’s & Waste Walk o Supporting Evidence Needed o Current State o Compelling Need o Patient, Staff, Value (PSV) o 4 N’s & Waste Walk o Supporting Evidence Needed o Current State NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 7 © Heart of England NHS Foundation Trust. All rights reserved

8. Version 1.5 – 07/11/08 5S Housekeeping DAY 3 – INVESTIGATION AND DEPLOYMENT PREPARE AND DELIVER PLAN o Variation Simulation, Root Cause Analysis and Flow Simulation o VSI & RIE Simulation o A3 and Project Management Simulation o Variation Simulation, Root Cause Analysis and Flow Simulation o VSI & RIE Simulation o A3 and Project Management Simulation NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 8 © Heart of England NHS Foundation Trust. All rights reserved

9. Version 1.5 – 07/11/08 5S Housekeeping DAY 4 – CHECK AND ADJUST REVIEW IMPACT AND HANDOVER o Project Management Exercise o Issues & Blockages o Case Study Development o Communications Strategy o Next Steps o Project Management Exercise o Issues & Blockages o Case Study Development o Communications Strategy o Next Steps NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 9 © Heart of England NHS Foundation Trust. All rights reserved

10. On The Other Hand: NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 10 © Heart of England NHS Foundation Trust. All rights reserved

11. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Lets Take a Break – 15 Minutes NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 11 © Heart of England NHS Foundation Trust. All rights reserved

12. Circle of Conce rn Restructur e 4 hour breaches Traffic Managing Change NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 12 © Heart of England NHS Foundation Trust. All rights reserved

13. Change  Who has re-decorated some part of their home in the last 12 months?  Who has changed their car in the last 18 months?  Who has go a new mobile in the last 6 months?  Who has changed their partner in the last 10 years?  Who has moved house in the last 5 years? NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 13 © Heart of England NHS Foundation Trust. All rights reserved

14. Change – expect it It is the nature of complex adaptive systems to change – we are all complex adaptive systems NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 14 © Heart of England NHS Foundation Trust. All rights reserved

15. The Elisabeth Kubler-Ross Model 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Five Stages of Grief NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 15 © Heart of England NHS Foundation Trust. All rights reserved 1 2 3 4 5

16. The Change Process What you may feel during a change process 1. Numbness 2. Denial 3. Depression 4. Accept / Letting Go 5. Testings / Startings 6. Search for Meaning 7. Internalisation NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 16 © Heart of England NHS Foundation Trust. All rights reserved 1 2 3 4 5 6 7

17. The Experience of Change Reflect upon a change that you have gone through (work or personal) and then map out your experience of that change by answering the questions overleaf. NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 17 © Heart of England NHS Foundation Trust. All rights reserved

18. The Experience of Change 1. Shock – how did you feel initially? 2. Denial – to what extent did you avoid/dismiss what was happening? 3. Incompetence – were there areas you felt unsure of? 4. Letting go – at what point did you let go of the old and start to accept the change? 5. Testing – how did you test out the changes? What happened to help you move forward? 6. Acceptance – how did you demonstrate your acceptance? 7. Integration – looking back what do you think about your experience of the change? What lessons did you learn? NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 18 © Heart of England NHS Foundation Trust. All rights reserved

19. “Its all about broken systems & processes- not bad people” NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 19 © Heart of England NHS Foundation Trust. All rights reserved

20. Resistance to Change People resist change because they…  may have a poor appreciation of the need to change  may have a poor understanding of the solution or do not consider the solution to be appropriate  disagree how the change should be implemented  are experiencing change fatigue  believe the organisation has failed to successfully implement change in the past NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 20 © Heart of England NHS Foundation Trust. All rights reserved

21. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Understanding Normal Human Behaviour NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 21 © Heart of England NHS Foundation Trust. All rights reserved

22. Behavioural Change Radio WIIFM - What's In It For Me People measure the perceived implications of a proposed change against various work-related criteria:  Place of work, hours of work & conditions  Salary  Job security  Nature of work (tasks & responsibilities)  Power, status, position & identity  Working relationships NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 22 © Heart of England NHS Foundation Trust. All rights reserved

23. Ego State Model “in our Parent” Controlling/Nurturing Feelings, thoughts & behaviours are copied. Stress tends to take us here P “in our Adult” Rational Executive Feelings, thoughts & behaviours based on the here & now. Tends to be here when we are task focused & seeking information A “in our Child” Adapted/Rebellious Feelings, thoughts & behaviours replayed from childhood. Stress tends to take us here C A NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 23 © Heart of England NHS Foundation Trust. All rights reserved

24. Ego State Model - Communicating A P A C P A C Stimulus Response NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 24 © Heart of England NHS Foundation Trust. All rights reserved

25. Ego State Model – Communicating effectively A P A C P A C Stimulus Response NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 25 © Heart of England NHS Foundation Trust. All rights reserved

26. The Drama Triangle A P A C A Rescuer Persecutor Victim NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 26 © Heart of England NHS Foundation Trust. All rights reserved

27. The Drama Triangle Victim Characteristics:-  Act as if they do not have the resources to solve their problem (or someone else has to change for them to be happy)  Act as if their neediness is so acute it prevents them from solving problems Discounts:-  I can’t solve this NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 27 © Heart of England NHS Foundation Trust. All rights reserved

28. The Drama Triangle Rescuer Characteristics:-  Take over the thinking & problem solving  Do more than their share  Do things they do not want to do Discounts:-  The Victim cannot solve his/her problem NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 28 © Heart of England NHS Foundation Trust. All rights reserved

29. The Drama Triangle Persecutor Characteristics:-  Others suffer on account of their behaviour  Part of the Persecutor ‘s goal is to punish Discounts:-  The Victim doesn’t matter NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 29 © Heart of England NHS Foundation Trust. All rights reserved

30. The Drama Triangle A P A C A Rescuer Persecutor Victim NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 30 © Heart of England NHS Foundation Trust. All rights reserved

31. The Winners Triangle A P A C A Carer Assertive Vulnerable NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 31 © Heart of England NHS Foundation Trust. All rights reserved

32. The Winners Triangle Victim Vulnerable Characteristics:- Use Adult ego state for thinking problem solving  Use their feelings as data for problem solving Skills:-  Problem solving  Self-awareness NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 32 © Heart of England NHS Foundation Trust. All rights reserved

33. The Winners Triangle Rescuer Caring Characteristics:-  Do not do the thinking  Do not take over unless asked  Do not do more than their share  Do not do things they do not want to do Skills:-  Listening skills  Self-awareness NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 33 © Heart of England NHS Foundation Trust. All rights reserved

34. The Winners Triangle Persecutor Assertive Characteristics:-  Asks for what they want  Say no to what they don’t want  Give feedback & initiate negotiation  Do not punish Skills:-  Assertion skills NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 34 © Heart of England NHS Foundation Trust. All rights reserved

35. The OK Corral  I’m Not OK → You’re OK  I’m OK → You’re Not OK  I’m OK → You’re OK NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 35 © Heart of England NHS Foundation Trust. All rights reserved

36. The Circle of Concern/Circle of Influence Circle of Concern Circle of Influence NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 36 © Heart of England NHS Foundation Trust. All rights reserved

37. What Concerns Me? Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic Restructure A last minute presentation Paedophiles 4 hour breaches Traffic NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 37 © Heart of England NHS Foundation Trust. All rights reserved

38. What is in my Sphere of Influence? Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic Restructur e 4 hour breaches NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL Restructure A last minute presentation Paedophiles 4 hour breaches Traffic 38 © Heart of England NHS Foundation Trust. All rights reserved

39. Focus on your Sphere of Influence Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL Proactive people focus their efforts in their Circle of Influence. They work on the things they can do something about 39 © Heart of England NHS Foundation Trust. All rights reserved

40. Your Turn… Circle of Conce rn Circle of Influnc e Restructur e A last minute presentation 4 hour reaches Traffic NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL What ‘s concerning you at the moment ? 40 © Heart of England NHS Foundation Trust. All rights reserved

41. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? The 20 Answers Game NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 41 © Heart of England NHS Foundation Trust. All rights reserved

42. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Time for Lunch – 30 minutes NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 42 © Heart of England NHS Foundation Trust. All rights reserved

43. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Negotiation NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 43 © Heart of England NHS Foundation Trust. All rights reserved

44. Negotiation Things to consider before you start:  Know your objective – prepare  Know your bottom line – prepare  Have a positive approach  Aim to achieve a win-win outcomes Remember:  You will probably have to live/work with that person again!  The other person has needs and wants a desired outcome  Your behaviour now will set up expectations for the future NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 44 © Heart of England NHS Foundation Trust. All rights reserved

45. Negotiation Exercise Negotiating a pay rise!  Decide who is going to be the Employer and who will be the Employee  Read the appropriate instructions on the handouts  Begin negotiating! NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 45 © Heart of England NHS Foundation Trust. All rights reserved

46. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Building Rapport NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 46 © Heart of England NHS Foundation Trust. All rights reserved

47. Rapport Building  The ability to enter someone else’s world  The ability to go fully from your perception to theirs When established, rapport builds an environment of trust, confidence and participation NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 47 © Heart of England NHS Foundation Trust. All rights reserved

48. Why Build Rapport? We cannot not communicate! Some people have a natural ability to influence and generate instant rapport. For most of us there are some people whom we take an instant liking to With others this just is not there NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 48 © Heart of England NHS Foundation Trust. All rights reserved

49. Building Rapport  The Content (the words alone) 7%  Vocal Influences (tone, rhythm, pitch) 38%  Non-verbal (posture, gesture, facial expressions, eye movements) 55% Only 7% of the messages processed come from auditory, therefore 93% of our ability to influence in any communication is coming from outside of the specific words we use. NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 49 © Heart of England NHS Foundation Trust. All rights reserved

50. How can you Create Rapport? By having something in common Requires going from your world (1 st position) to somebody else’s world (2 nd position) How we experience the world – its all about perception NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 50 © Heart of England NHS Foundation Trust. All rights reserved

51. Mastering the Skill of Rapport  Ability to be sensitive and observant  Be flexible  Adjust your responses accordingly  Watch others posture, gestures and speech patterns NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 51 © Heart of England NHS Foundation Trust. All rights reserved

52. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Lets Have a Go NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 52 © Heart of England NHS Foundation Trust. All rights reserved

53. Creating Rapport 1. Find a partner and agree who is person 1 and who is person 2 2. Person 1 think of a subject you could talk about freely for 1 minute while deliberately creating rapport remembering the above tips on how to create rapport 3. Person 2 sit and listen 4. OK – start talking for 1 minute! 5. Person 2 - How did that feel? Did you feel a rapport building? 6. Now swap over and do the same 7. Now do it without Rapport! NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 53 © Heart of England NHS Foundation Trust. All rights reserved

54. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Lets take a break – 15 minutes NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 54 © Heart of England NHS Foundation Trust. All rights reserved

55. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Process, Accountability and Leadership Score (PALS) NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 55 © Heart of England NHS Foundation Trust. All rights reserved

56. Version 1.5 – 07/11/08 56

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58. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Training Needs NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 58 © Heart of England NHS Foundation Trust. All rights reserved

59. NameExcell Leadership 5SValue Stream Mapping Change Agent Measureme nt

60. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Team Roles and Descriptions NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 60 © Heart of England NHS Foundation Trust. All rights reserved

61. RoleExpectations of Roles Sponsor (ED) Initiates the process, invites team members, decides which people are key. To provide executive leadership to the planning & execution of the improvement and individual actions. Operation Lead To lead the operational change required to achieve the goals and outcomes of the team. To ensure effective communication across all key stakeholders about the need for change and the goals and progress. Nurse / Medical Lead To provider leadership and direction to the nursing and medical staff who are part of the change process ensuring that they are clear on the reason for change, the goals of the project and their roles in the success of the projects. Ensure nurses and medics have adequate skills and capabilities to effect change locally. Lean Support To facilitate the group through the process. To provide training for identified team members. To provide the tools and techniques appropriate to the objective. OD Support To provide expertise in developing the leadership skills, team dynamics and cultural change required to support the change projects Finance Support To support the definition of cost and productivity measures and track the impact of service change Governance Support To support the analysis of the safety culture, risks inherent within the current systems & processes and provide safety training. Ensure improvement programme contributes to better safety. Data Analyst For each project and for the programme overall, support the definition of key performance measures, the improvement targets and co-ordinate the reporting of KPIs using dashboards and web based systems

62. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? NameAttendi ng? RoleNameAtten ding? Executive Lead Clinical Lead Operation Lead Nurse Lead LEAN Support OD Support Finance Support IT Support Governanc e Support Data Analyst Mark with a “*” for people who MUST attend NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 62 © Heart of England NHS Foundation Trust. All rights reserved

63. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? Bolton & Bolton Self Assessment NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 63 © Heart of England NHS Foundation Trust. All rights reserved

64. Circle of Conce rn Circle of Influen ce Restructur e A last minute presentation Paedophiles 4 hour breaches Traffic What ‘s concerning you at the moment? End of Day Wrap Up and Action Setting NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 64 © Heart of England NHS Foundation Trust. All rights reserved

65. Action Setting  Bring back case studies/stories of your personal observation from today‘s sessions  Practical use of the PALS sheet from own project NHS MILTON KEYNES QUALITY IMPROVEMENT MODEL 65 © Heart of England NHS Foundation Trust. All rights reserved