1. The Model for Improvement, Improvement Tools and Teamwork 21 st September 2010 Presenter: Des Brown National Leadership and Innovation Agency for Healthcare

2. The Model for Improvement and Improvement Tools

3. The Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in the improvements we seek? ActPlan StudyDo The three fundamental questions for improvement Aims Measures The fourth question: how to make changes Ideas

4. The Model for Improvement Ideas “Just trying harder is the worst quality improvement plan of all.” W. Edwards Deming

5. The Model for Improvement Ideas ‘A Hundred Improvements’

6. Improvement Tools Process Mapping Lateral Thinking 5 Whys (assumption busting)

7. Improvement Tools The Jimi Hendrix principle for process mapping: Start high and stay high as long as possible! Process Mapping

8. Improvement Tools All the steps performed - By one person - in one place - at one time Start high and work down (if you need to) Pre-op assessment Admission Theatre Recovery Anaesthetic Listing Discharge DiagnosticsOPD Discharge Surgery GP Follow up

9. Improvement Tools 2 days 70 days 13 days 45 day 130 days Value added Elapsed time time 10 mins 25 mins 20 mins 45 mins Total time 100 mins WHY? GP OPD POA Surgery WHY?

10. Improvement Tools Lateral Thinking How do you cross a bottomless moat 10m wide with two planks each 9.5m long?

11. Improvement Tools Lateral Thinking Join all the dots with four straight lines, without lifting your pen from the paper

12. The Model for Improvement 5 Whys (assumption busting)

13. The Model for Improvement Root Causes Generating many possible solutions Divergent thinking Convergent thinking Selecting the best solution Implementing the solution Ideas

14. The Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in the improvements we seek? ActPlan StudyDo The three fundamental questions for improvement Aims Measures The fourth question: how to make changes? Ideas

15. The Model for Improvement AP S D A P S D AP SD D S P A DATA Very small scale test Follow-up tests Wide-scale tests of change PDSA Cycles Implementation of Change Hunches, theories, ideas

16. The Model for Improvement

17. Experiment with the process Change the process in a planned way and measure the results (PDSA) “To determine what happens with a process when you interfere with it, you have to interfere with it, not passively observe it.” George E. P. Box

18. Team Work

19. Professor Michael West describes “real teams” as; Those groups of individuals who come together to perform a common task who: Have common, shared objectives Need to work interdependently to achieve these objectives Have different and defined roles Have a team identity - that is they recognise themselves to be a team and are recognised by others to be a team Are of a size to achieve the task and no larger.

20. Team Work Alternative definition of a team: A psychological group whose members share a common goal which they pursue collaboratively. Members can only succeed or fail as a whole, and share all the benefits and costs of collective success or failure. David Buchanan and Andrzej Huczynski

21. Team Work Team mission, planning and goal setting Team rolesTeam operating processes Team interpersonal relationships Inter-team relations Clarity of goals and clear direction lead to greater accomplishment and increased motivation Clear roles and responsibilities increase individual accountability Problem solving and decision making are smoother and faster. Processes enable accomplishment without undue conflict Open data flow and high levels of team working leading to accomplishment in a supportive environment Working across boundaries ensures that organisational goals are more likely to be achieved Adapted from Esther Cameron and Mike Green

22. Team Work “It’s not enough to do your best; you must [all] know what to do, and then do your best.” adapted from W. Edwards Deming

23. Questions?