Scottish Improvement Skills

Scottish Improvement Skills
Workshop 2 Scottish Improvement Skills Full Programme Workshop 2 Facilitator Slides Detailed notes for facilitators are provided on the following slides. These also refer to activities that use materials other than slides. They include: Aim Key messages Timing Materials Activity instructions for Lead facilitator, Co-facilitators, and Participants (Lead Facilitator refers to the person leading that part of the session, not necessarily the same person each time). General principle for Lead Facilitator is to ask questions to elicit from participants, rather than ‘tell’, as much as possible. Answer ‘key’ ‘Optional’ – indicates that this slide or activity could be omitted if time is short. A red circle at the bottom right hand corner of a slide indicates that after going through the slide itself, there is an activity to do before moving on to the next slide.

Housekeeping

Workshop 1 By the end of the workshop, you will have planned a first test of change to carry out in the workplace, taking into account the work context and priorities for improvement, and the needs of stakeholders. To reorient participants to where we are in the programme.

Project work By the time your return for Workshop 2, you will have:
reviewed the Three Questions with your team collected data to help you identify your priority for change collected baseline data carried out several tests of change collected qualitative and quantitative data And we also asked you to: Prepare and submit your project charter work through some online learning modules and we recommended some other resources to consolidate and extend your learning. And you have also attended mid-course learning events, where you used a creating thinking approach (Six Thinking Hats) to discuss issues around including a service user on your improvement project team, and reviewed the 4 run chart rules. Today we’re going to assume that you know the run chart rules.

Find someone who ... Aim Icebreaker, to get people talking to each other and to get some idea of how the project work and other learning they have done compares with others. To get their heads into ‘improvement’ mode. Material Find someone who Timing Approx mins for mingle Total 20 mins including set up and debrief Lead facilitator So, let’s find out what you’ve been doing over the last few months. Find one person who has done each of these things (project activities, workplace learning). Write their name and find out more – note down what they learned by doing it. Debrief – elicit from a few people – what have a lot of people done? What have few people done? Why? Share some learning in plenary if appropriate. One issue that sometimes arises is the availability of ongoing support, either in-board or from national organisations. Facilitators Don’t take part, but listen discreetly to some of the conversations to get a feel for what participants have been working on/learning.

Workshop 2 By the end of the workshop, you will have created run charts with your own project data, and practised talking about your data with your team or other stakeholders. Which brings us to now.

Workshop 2 Content Interpretation of run charts
Creating run charts on MSExcel An improvement journey: from testing to implementation Talking about data in run charts To achieve that objective, this is what we’re going to work on. Run charts – going beyond the 4 rules to consider different features of run charts that can help us with data analysis. MS Excel – starting with data we provide, then use your own or data that is meaningful for you. Don’t worry if you don’t have enough data of your own. You can use data from other projects that you are familiar with, or use made up data. Improvement journey – going beyond testing change to consider appropriate next steps Talking about data – we’ll be looking at a framework that many find useful when talking about data in run charts, then you’ll use the framework to talk about the run chart you created earlier.

Improvement principles
By the end of this session you will be able to: apply Deming’s System of Profound Knowledge to help you understand the complexity in your improvement project. Aim Consolidate earlier learning about the System of Profound Knowledge Build confidence in understanding and applying the framework To reorient participants to improvement principles before new learning in Workshop 2 Key messages System of Profound Knowledge is helpful to understand the complexity in any health or health and care setting; a useful framework to think about your own project Timing 45 mins Lead Facilitator Before moving on to the next slide, elicit the 4 components of Profound Knowledge

System of Profound Knowledge
Practice Lead Facilitator This framework provides us with a way of thinking about our improvement work Last time we talked about how the System of Profound Knowledge can help you understand the complexity/messiness of life. Now you’re going to take that a step further and apply it to a healthcare scenario and then your own project. Deming 2000

Aim: promote staff wellbeing
Aim  Driver  Driver Change ideas Staff complete safety climate survey Promote the physical, mental and emotional wellbeing of staff. By March 2017: (1) reduce staff absences from 5.2% to 4.2% (2) reduce staff related incidents from 140 to 100 per month. Environment Action planning from survey Lean visual management of cupboards, notice boards etc A workplace that is safe for staff Activity Use and location of hand gel dispensers Staff able to focus as required Schedule regular team huddles Aim To contextualise the activity material Lead facilitator Staff wellbeing driver diagram We previously looked at a driver diagram and change ideas relating to this aim. This is half the driver diagram re aim (2) only. We’re going to look at components of the System of Profound Knowledge in relation to this change idea: to prioritise use of hand gel dispensers and locate them accordingly [this is abbreviated on the slide] Leadership training for team leads People Staff engaged in health and wellbeing practices Offer Bereavement support programme for managers

Practice Task 1 Aim To practise breaking down the complexity of a system by thinking about improvement work in terms of the System of Profound Knowledge First, using a topic that is not their own improvement project, to develop thinking through discussion. To get people thinking in improvement terms again, using an example that they don’t have any particular ownership of. This will help to prepare for the Project activity. Timing 7 – 10 mins Materials Profound Knowledge graphic Hand hygiene slips Profound Knowledge Hand Hygiene Key: completed Profound Knowledge table to guide discussion if needed – but NB this is one of many ‘possible’ solutions. Facilitators One facilitator at each table (aim for about 4-5 participants in each group). Participants work as a group to assign each slip to one of the four categories, with facilitated discussion. Some of the items clearly relate more to one component of Profound Knowledge than the others; some items could fit in different components. If there are not enough facilitators for one per table, facilitators monitor the room and Lead Facilitator lead a short plenary debrief. Task 2 Project To apply the same kind of thinking to their own improvement project, and use it to think more systematically about how to tackle project challenges. Material Profound Knowledge template Lead Facilitator Thinking about your own project, write a few bullet points for each of the four components. Put items in the place they seem to fit best. No debrief from here – move on to pairs activity on next slide Leave the table while participants do individual work. Monitor the room to support as required. 5 – 7 mins Deming 2000

Which of the 4 components are you finding most challenging in your project right now? Is this reflected in what you’ve included, or in there being gaps? What would you advise the project team to work on? Aim To think about own project in a structured way and to gain confidence through advising on another project. Lead facilitator Continuing from previous task: Work in pairs (1 group of 3 if necessary), one as A, one B A: show B your Profound Knowledge sheet. Which of the four components are you finding most challenging in your project right now? Is this reflected in what you’ve included, or in there being gaps? B: based on your experience, what would you advise the project team needs to work on? Give approx time of 5 minutes to discuss. Ask pairs to swap over after 5-7 mins. Timing 10 – 15 mins, to include both ways round. Facilitators Light touch facilitation - monitor the room and respond to any participant queries, and intervene if appropriate. Plenary debrief. Any particular components that seem to be more challenging than others? Why might this be? When you were B: how did it feel advising your partner? (aiming to generate some confidence here) These are the kind of discussions that you will find helpful with your project team.

Analysing data we are mainly in Understanding Variation (also the other components in so far as we are using that understanding of variation to appreciate the system, develop theory, and communicate about data to effectively involve relevant stakeholders). We’re going to be working with run charts. Elicit: what is the main purpose of displaying our data in run charts? To identify any signals of non-random variation in our system, to help us understand what factors are associated with improved processes and outcomes. They help us to find and then evaluate causes of non-random variation. Deming 2000

Analysing data: interpretation of run charts
By the end of this session you will be able to: Explain the importance of using annotation to help interpret run charts Discuss how the type of median used affects interpretation of signals from run charts and impacts on decision making Explain use of phasing, stratification, and what to do with extreme values on run charts. Learning outcomes

Analysing data: Interpretation of run charts
Annotation Median Phasing Extreme values Stratification DISCOVERY Timing 2 mins for introductory slides Lead facilitator What we are going to look at in this session: What a run chart can help us understand about the system that we are working in, and how we can best use a run chart to do this. Annotation – what kind of notes we need to add to a chart Median – we can create the median in different ways – we’ll look at how we decide which kind of median to use Phasing – this is also about making the best use of medians Extreme values – what action we may need to take if we have a lot of extreme values eg 0% or 100%, and why Stratification – this is about how we break down our data – something we need to consider when developing our measures and operational definitions Info for Facilitator: Quote from Sandy Murray (IHI): Stratification is the separation and classification of data according to selected variables or factors. The object is to find patterns that help in understanding the causal mechanisms at work

Aim  Driver  Driver Change ideas Offer Bereavement support programme for managers Promote the physical, mental and emotional wellbeing of staff. Within 12 months (1) reduce staff absences from 5.2% to 4.2% (2) reduce staff related incidents from 140 to 100 per month. A workplace that is safe for staff Flyer on staff health and wellbeing programmes Staff education Hold staff health fairs Smoking cessation campaign Staff engaged in health and wellbeing practices Set up walking groups Healthy lifestyle programmes for staff We are going to look at some examples of each of these features of run charts. Most of the following charts (but not all) relate to this scenario Staff wellness driver diagram – the run chart examples display data relating to the aim ‘reduce staff absences’ Improve staff diet at work Offer lunchtime yoga Enable cycling to/from work

Annotation Hours lost through sickness absence
Median 5.2 Fit Note introduced Aim Participants use the annotations in a run chart to better interpret the data Participants annotate their own run charts with key information that will support data analysis. Participants keep their run charts uncluttered. Key messages: Annotation must include: median value, changes introduced as part of an improvement project, any changes in the external or internal environment that may have an influence on your data Annotation should include: an indication of what ‘good’ means eg by signalling ‘goal’, or less specifically indicating whether up or down is good (using an arrow in that direction) Timing (for Annotation, Medians, and Phasing) 10 – 15 minutes (some participants find this a particularly challenging part of the programme, so allow plenty of time) Lead Facilitator For this ‘improving staff wellbeing’ project, is this measure (% hours lost through sickness absence) outcome, process, or balancing? (outcome) Always annotate with any information of relevance to your improvement project. This must include start (and end) of any changes. And may include other features that will help you and others to interpret the chart. Eg here, something in the external environment that may have had an impact on your data. Some people annotate the Goal too. If you don’t indicate the goal, it is useful to indicate whether good is up or down. Visually – good practice is to keep the data as uncluttered as possible, so put the annotation at the bottom linked to the date, rather than attached to the data point itself, unless the chart doesn’t have space near the X axis for this. Goal

Median (1) Women walking 10,000 steps
Baseline median Extended median Pedometers issued Challenge announced Aim Participants can select the appropriate median for their data at different stages in their project Participants can explain the reasons for selection of a given type of median. Key messages Baseline median + extended median should be the standard, with an ‘improper’ median only used when there are not enough data points for any other type (eg when gathering baseline data). Lead facilitator This is the type of median that we’re using most of the time. Baseline median – refers to the section used to calculate the median. Extended median – refers to the extension of this line – the data points around it were not used to create the median. This is indicated using a dotted line. Here, there could be no baseline without the pedometers, so the pedometers were issued before announcing the 10,000 steps challenge. However, simply issuing the pedometers may have had an impact on the number of steps people walked during the baseline period. Why is it important to use baseline + extended medians? Because it affects the decisions you make based on the data and application of the rules. Compare this with the same data using an ‘improper median’ (see next slide)

Signal detected here Lead facilitator Improper median: all data points are used to calculate the median. Applying the four run chart rules each time we add a data point, we would detect a signal of non-random variation on the final Monday. Elicit: which rule is this signal associated with? (shift – 6 consecutive data points all above the median) NB the data point for the Thursday before the signal is detected is on the median, so doesn’t break the run/shift, but is not counted. Pedometers issued Challenge announced

Baseline median Extended median Signal detected here Pedometers issued Challenge announced Lead facilitator So, by correctly using the extended median, you detect signals of non-random variation sooner, and can act on this. For example, here you might want to communicate the improvement (which itself may encourage the behaviour that you want), scale up your next test of change, or introduce a new change. The ‘challenge’ to each member of staff to walk 10,000 steps has had some impact; what could we do to increase the % further? (Elicit some ideas) Depending on your project changes and measures, this may make a significant difference eg if you can scale up your tests of change sooner, then more of your service users (whether internal or external) will get the benefit sooner.

Creating a baseline median
Use historical data if available Collect new baseline data before introducing a change, if this makes sense in your context If no baseline data is available, create a baseline median using the first 10 data points. Key messages: Having no baseline data, or only a little, need not put off introducing changes. How you use baseline data, how much you need etc depends on the context and the nature of the improvement goal. Lead facilitator If baseline data is available, it allows you to identify whether the variation in your system is all random before you introduce your first change, or whether there is some non-random variation. If you identify any signals of non-random variation, you know this is not related to your change and can investigate and take action. Normally you need 10 or more data points to create a median. In most contexts, it’s UNlikely that you will get a significant change in your data immediately after introducing a change into your system (particularly for an outcome measure). So, if there is an urgent need to make a change and you don’t have 10 data points of baseline data, you can use the first 2 or 3 data points to create the baseline median.

Phasing Women walking 10,000 steps
Pedometers issued Challenge announced Looking at the same measure: Having detected a signal of change (a shift), once you are confident that it’s sustained you may decide to use that as a new ‘baseline’, from which you introduce a new change. So, first we used the extended median to detect whether there was a signal of special cause variation. Then, you apply the same rules in relation to the new ‘phased’ median. You need to wait until you have enough data points to do this. So, applying the rules to the new median (here the orange median line): Rule 1 – shift – no Rule 2 – trend – no Rule 3 – too few or too many runs – 11 useful data points, 9 runs – no Rule 4 – astronomical point – no Random variation – these fluctuations are due to chance. So, to improve further, you would need to introduce a new change. From the point where the new change is introduced and new data is collected, create an extended median from this orange ‘baseline’, until there is a signal of non-random variation, then consider phasing the median again. The same rules apply around each median (NB a baseline + extended median is a single median so far as the rules are concerned). Depending how participants are getting on with this, it may be useful to add: If you have a high degree of belief, you may decide to introduce a new change, or move to implementation, before you can apply the rules to the phased median.

Interpretation of run charts
Each run chart can be improved to make the data easier to interpret. Possible improvements may relate to: Type of median line used Measure used For each chart, decide what improvements would be most useful, and why. Annotation Design PRACTICE Timing 10 minutes Materials Interpretation of run charts Run chart checklist Lead facilitator Work individually first, then compare notes in pairs or small groups. Facilitators If there are enough facilitators, have one at each table of participants to support discussions. Otherwise, monitor around the room, respond to any participant queries, and intervene as required. No plenary debrief here – do this after the next section on extreme values and stratification. NB the Discovery stage is split in two because if all done at once before the Practice, it tends to be a long time for participants to focus on slides and the Lead facilitator.

Break During the break, get your laptop running, and open the files we sent you. Facilitators Check everyone has what they need, and provide xls sheets from USB or by if necessary.

Extreme values Frequent events Rare events
More than half the data falls on the median line More than half the data is at ‘extreme’ values eg 0 or 100 on percentage scale DISCOVERY Aim Participants can correctly interpret data in charts with frequent or rare events or when more than half the data falls on the median line. Participants consider the option of changing the measure in order to get more useful data. Key messages (for this series of slides) Extreme values: the median cannot be applied because it will be the extreme value itself; so, the 4 rules cannot be used. These may be a signal that a change has been sustained, so it may be time to consider stopping collecting data Or, it may be necessary to change the measure used. Data on median line – the rules cannot be applied – again, it may be necessary to change the measure used. Timing (extreme values and stratification) 10 – 15 minutes

Extreme values (1) Compliance with hand hygiene
Lead facilitator Elicit – would you create a new median, and if so, when? How would it help? No point creating a new median, because it would be 100% If someone queries this, demonstrate how this would work: to calculate the median using the data points in this shift (just using the first 9 data points as an example), they would be 99, 99, 99, 100, 100, 100, 100, 100, 100 - the middle number of these is 100

Extreme values (2a): Number of needlestick incidents per month
Lead facilitator This slide relates to the other half of our staff wellbeing project – a workplace that is safe for staff. See the median at the bottom (in blue – NB facilitators – the median shows up on slideshow, not on normal view) In this case, it is a rare event, so there are a lot of zeros. Still, even though it’s a rare event, it needs to be improved – we want to reduce the frequency even further, so we use a different measure – see next chart. A needlestick incident is a penetrating wound from a needle or sharp object that may result in exposure to blood or other bodily fluids.

Extreme values (2b): Number of patients seen between needlestick incidents
Number of cases between events. Using this measure you can apply the usual rules. Here we have a different x (horizontal) axis from usual – here instead of dates we have a series of events, in sequence. This is still a time series. And as usual the vertical axis is the measure. Elicit: here, do we want the data to go up or down? (up – in the previous ‘incidents per month’ chart we wanted the data to go down) The measure here means: the number of patients seen in the clinic between incidents. Ie, from the time when one member of staff experiences a needlestick incident from the time another member of staff experiences a needlestick incident, how many patient/staff interactions are there?

Stratification (1): Inpatient requests for MRI
Aim Participants look for opportunities to stratify their data while developing their measurement plan, based on their appreciation for a system and theory of knowledge. When interpreting a run chart, participants look for patterns that may indicate a need for stratification. Lead facilitator Different scenario – this slide is not related to the same project. Here there are too many runs – according to Rule 3, this is a signal of non-randomness. But visually you can see the variation is consistent across this whole time period. This tells us more than just whether or not there is non-random variation. It may not relate to change or improvement. It may be a feature of what data is being collected and how. For example: Elicit possible problem and solution in this scenario. Bring up the next slides when appropriate.

The different colours help identify two distinct sets of data. These should be collected and analysed separately. This is the kind of decision that should be made when planning data collection, to avoid the problem of having data that is not useful. If you’ve done that, you won’t ever come across a chart that looks like this. But from time to time you do. Thinking about how you will label your x axis (usually time, or eg patient sequence), should help prevent this problem occurring.

This shows even more clearly the two distinct sets of data

Stratification (2) Staff walking 10,000 steps (men and women)
Median 35.25 This is another example of the need for stratification based on the 10,000 steps measure we looked at earlier. Here the data for men and women that we looked at earlier has been combined. What do the run chart rules tell you? This chart signals a shift, and you would plan action on that basis. However, if we think about how we might stratify this data, we can see that this chart is disguising more useful signals. (See next 2 slides.) Challenge announced Pedometers issued

Stratification (2) Staff walking 10,000 steps (women)
Median 29 Pedometers issued Challenge announced For women there’s a clear shift.

Stratification (2) Staff walking 10,000 steps (men)
Median 41 The extent of the change among women obscured the men’s data, which shows random variation ie no significant improvement. The median is higher, but it was higher to start with – the challenge did not change anything for men. The evidence base clearly demonstrates an existing difference in steps per day for men and women, so they have a different starting point. From these charts we can see that to increase steps per day we may need different strategies to target men or women. Key messages Use the evidence base to establish measures and any stratification needed if possible in advance of collecting data. And, look out for the possible need for stratification in data once you’ve put it in a chart. Pedometers issued Challenge announced

Interpretation of run charts
Each run chart can be improved to make the data easier to interpret. Possible improvements may relate to: Type of median line used Measure used For each chart, decide what improvements would be most useful, and why. Annotation Design PRACTICE Timing 10 – 15 minutes Materials Interpretation of run chart (already used above) Run chart checklist (already used above) Facilitators Return to the same run charts. Discuss re extreme values and stratification. If enough facilitators, one at each table to support discussions. The Lead facilitator only a short plenary debrief using the following slides. If the number of facilitators does not allow this, monitor around the room, respond to any participant queries, and intervene as required. Then Plenary debrief will be longer. For each of the three charts, elicit from participants their improvements based on all the features addressed in this module. The slides give some possible improvements; accept other responses as appropriate.

Interpretation of run charts (1) Complaints dealt with in 20 days
Complaints admin on holiday Quiet workstations introduced KEY What is the goal? It would be helpful to indicate it to help decide what to do if/when the shift is sustained on the basis of this single change. Depending on goal, consider changing range on Y axis. Annotate median Complaints ‘dealt with’ – need a clear operational definition, but no space to include here in either title or measure name. See next slide for proposed solution.

Interpretation of run charts (1) Complaints dealt with in 20 days
Goal Median 62 Quiet workstations introduced Complaints admin on holiday KEY What is the goal? It would be helpful to indicate it to help decide what to do if/when the shift is sustained on the basis of this single change. Depending on goal, consider changing range on Y axis. Annotate median Complaints ‘dealt with’ – need a clear operational definition, but no space to include here in either title or measure name.

Interpretation of run charts (2) Outpatients cost per attendance
KEY Needs annotations – have any changes been introduced? Has anything else that may impact on this measure happened over this period? Fuller dates needed – year as well as month What type of median is it? Is this appropriate? To decide, we need more information, eg when changes were introduced. If this is all baseline, it’s fine to use an ‘improper’ median – this helps us to understand whether our current system is stable before we start introducing changes. But if we have made changes, a baseline and extended median will be more useful. Continue X axis for a couple of points to demonstrate that you are planning to continue collecting data. Otherwise it looks as if data is no longer going to be collected for this measure. Which way do we want cost to go? Indicate this either with a ‘goal’ annotation, or an arrow going up or down. Remember that up is sometimes good and sometimes bad. And you don’t always get the result you’re aiming for. Here we have a shift that seems to have been sustained over 8 months – is this good or bad? Design – eliminate distractions eg remove colour as much as possible – a little colour can be used to highlight; remove gridlines See next slide for proposed solution.

Interpretation of run charts (2) Outpatients cost per attendance
New referral process introduced KEY Needs annotations – have any changes been introduced? Has anything else that may impact on this measure happened over this period? Fuller dates needed – year as well as month What type of median is it? Is this appropriate? To decide, we need more information, eg when changes were introduced. If this is all baseline, it’s fine to use an ‘improper’ median – this helps us to understand whether our current system is stable before we start introducing changes. But if we have made changes, a baseline and extended median may be more useful. Continue X axis for a couple of points to demonstrate that you are planning to continue collecting data. Otherwise it looks as if this is fixed. Which way do we want cost to go? Indicate this either with a ‘goal’ annotation, or an arrow going up or down. Remember that up is sometimes good and sometimes bad. And you don’t always get the result you’re aiming for. Here we have a sustained shift – is this good or bad? Design – eliminate distractions eg remove colour as much as possible – a little colour can be used to highlight; remove gridlines

Interpretation of run charts (3) Ventilator Associated Pneumonia (VAP) rate
Chlorhexidine oral gel introduced Closure of neuro ICU ‘daily goals’ introduced KEY (no improved version to follow – too many options and need too much information). Needs other types of median. Depends on what counts as baseline, which could be up to Closure of ICU, or could be up to ‘daily goals’ - need local knowledge to decide. That would also affect when you would start phasing. Phasing would help to identify whether you have a rare event, and would benefit from using a different measure. A clear signal of a rare event is the median being zero – if you don’t change how you calculate your median to include phasing, this won’t stand out as clearly. Design – for clarity, preferably change colour of run line to black; remove decimal points from Y axis; add median annotation; possibly add more annotation of changes and other potentially relevant factors. Needs title

Analysing data: Interpretation of run charts: summary
Annotation Median Phasing Extreme values Stratification Aim To briefly recap the session content: To support a sense of learning and accomplishment To aid memory of the session later An opportunity for participants to ask any outstanding questions from any part of the session Timing 2 – 5 minutes, depending on time available Lead facilitator Elicit key messages relating to each of the bullets eg What annotations should you include in every run chart? When would you expect to use an improper median? How does a baseline+extended median normally help us with decision making? When would you decide to use a phased median? What are the two main options to consider if you data includes a lot of extreme values? When should you start to consider stratifying your data?

Creating run charts we are still mainly in Understanding Variation. We are using run charts to help us understand whether there is any non-random variation in our system. Once we’ve created a run chart we also bring in the other components in so far as we are using that understanding of variation to appreciate the system, develop theory, and communicate about data to effectively involve relevant stakeholders. Deming 2000

Visual display of data: using Excel to create run charts
By the end of this session you will be able to: Create annotated run charts with baseline and extended medians using Excel Create an annotated run chart showing phasing with Excel Learning outcomes

A New Healthier Me Aim 1 Driver 2 Driver Change ideas
Lose 7 pounds in 3 months Leisure activity Calories in meals Calories in drinks Calories in alcohol Work activity Calories in snacks No alcohol Monday to Thursday Max 1 x juice or soft drink per day Reduce portion size Cook evening meals from scratch Replace biscuits/cakes with fruit Keep to shopping list Get up from desk to talk, instead of phone or Use stairs not lift Walk to a daily step target Swim at least twice a week Calories in Calories out This personal improvement project provides the context for the charts that you’re going to create now. We looked at this driver diagram and change ideas before. Now we’ll be using data collected in relation to several of these change ideas (see items with red border): the outcome, and two change ideas.

Visual display of data Basic run chart
Run chart with baseline and extended median Run chart with phasing Run charts with your data Annotations. Aim Participants are able to create run charts with an appropriate type of median, selecting between the following medians: Improper Baseline median + extended median Phased median Key messages Selection of appropriate median Annotation Uncluttered chart Timing 75 – 90 minutes Materials One laptop per participant, with power cable (connected to power source) and mouse. Excel spreadsheets in a version that meets the needs of participants, pre-loaded on all laptops and the Lead facilitator’s PC/laptop: Exercise 1 Exercise 2 Exercise 3 Powerpoint available on all laptops Create a run chart on Excel If participants do not all use the same version of Excel, it may be necessary to provide different versions of the exercises, and have a breakout room and facilitator to work with a second version of Excel. Lead facilitator Talk briefly through the activities using this slide and next: We’ll start with what we’re calling a ‘basic’ run chart for the outcome measure ie a run chart using an improper median – Exercise 1 For this run chart, I’ll show you each step, and you follow with the same step on your laptop. Once we’ve finished that, you can practise with the same type of median using a couple of different data sets, for the two process measures. 2. Then you will use the guidance document with Exercise 2, to create run charts with baseline and extended medians. 3. Then you will use the guidance document with Exercise 3, to create run charts with phased medians. Use your own data to create one run chart, with the appropriate type of median. Copy your own run chart into Powerpoint and annotate it. [You will use this later to talk about your project. – If following this module with Communicating Improvement Stories] Participants work in pairs so one stronger can help one less experienced (based on info they have provided about their previous experience with Excel). DISCOVERY Weight. Lead facilitator build up basic run chart step by step, participants copying each step. NB The examples here just number the weeks 1,2,3 etc. Creating a series of dates is something you can get support with elsewhere. The guidance document includes a note on how to create dates. Apples. Participants use guidance doc to create basic run chart. Walk to work – more practice depending on time available and amount of practice needed. PRACTICE Then participants continue using the guidance doc: Exercise 2 – baseline/extended median Exercise 3 – phased median PROJECT Then they create one using their own data, or based on relevant data from their department that they’ve brought with them – or if none, create some data for a measure that is meaningful in their own project. Create chart and annotate. It is best to transfer to Powerpoint before annotating, as annotations will not be carried over (depending how they were created). Facilitators Several in each of the two rooms depending on number of participants. Monitor and support as required. Make sure that everyone has a first draft of a run chart of their own data before the end of this session.

Leading change: from testing to implementation
By the end of this session you will be able to: Describe typical stages in an improvement journey - testing, implementation and spread Make decisions based on learning from PDSA cycles and data analysis Demonstrate understanding of when to move from testing to implementation Draft an implementation plan. Learning outcomes – Lead facilitator read out or participants read. Leading and managing improvement projects is a huge area – we worked on some issues in Workshop 1 eg influencing, communications, stakeholder management. Today we are going to focus on some issues directly relating to data and measurement for improvement: The improvement journey – we’ll look in more depth at PDSA cycles and the role they play at different stages of an improvement project

In this module we need to consider all four components of Profound Knowledge: Variation, because we need to interpret our data to help us decide whether we are ready to move on to the next stage of our improvement journey. Psychology, because we’re talking about how we lead people through an improvement journey, from one project stage to another Theory of Knowledge and Appreciation for a System because our progress depends on having a good understanding of our context and the features of our system. All of them because we are continually working through PDSA cycles. Deming 2000

An improvement journey
A P S D Identify opportunity for change Plan Test Sustain the change Implement Hold the gains Spread DISCOVERY Aim Participants can list the stages in an improvement journey and identify at any point in their project which stage they are at. Key messages Stages of an improvement journey, as in this slide and next. Features of the three key stages Timing 15 – 20 minutes (through to end of testing, implementation, spread activity) - 5 minutes (Improvement journey, Examples) 10 minutes (testing, implementation, spread activity) Materials Arrange the furniture so that there is space for all participants to stand in the middle, and to go to three different areas for the testing, implementation, spread activity. Corner labels TIC Blu tac Features of testing, implementation, spread Lead facilitator These are some of the steps that you may go through on an improvement project. Depending on the initial objectives of an improvement project, and their relevance beyond the team that initiated the project, you may go through some or all of these. Last time we focussed on the first 3 steps. Now we are briefly going to look at some of the others. PDSA cycles are a feature of ALL stages in the journey.

An improvement journey
A P S D Identify opportunity for change Plan Test Sustain the change Implement Hold the gains Spread Now we’re going to look at some of the broad differences between these 3 stages in the journey, before looking at testing and implementation in some more detail.

Examples of change: medicines reconciliation
Testing Implementation Spread 3 nurses on one ward use a new reconciliation and order form All 30 nurses on the unit use the new medication and order form Nurses from the ‘pilot’ unit assist all nursing units in the organisation to adopt or adapt the change Lead facilitator Examples – briefly talk through slide. Refer to these examples during the following ‘features’ task. Decide if each of the following features of an improvement journey is Testing, Implementation, or Spread (could be more than one)

Testing? Implementation? Spread?
Failure is a useful, natural part of the improvement process. PRACTICE Lead facilitator Do this example in plenary while still seated. Is this a feature of Testing, Implementation, or Spread – or more than one of these? Elicit responses and ask participants to give reasons. Then all participants stand in the middle of the room. Facilitators put corner labels up ready for the next item – as far apart as possible in parts of the room that are accessible, where a large cluster of participants can gather Lead facilitator read out the feature. Participants go to the stage label where you think it most applies. You can be between labels if you think the feature is common to more than one. Discuss with others in the same place – do you have the same reasons for being there? Plenary debrief. Facilitators If a participant is on their own at any point, a facilitator join them and ask them to explain their reasons. Then bring all participants to the middle again, and repeat with the next item. It is unlikely that you will need to use all 7 items. 3 or 4 are usually enough. Decide which ones to use based on the discussion generated by previous items. At the end of the activity give out the Features document. Make sure that issues highlighted during this activity are consistent with this summary document. Ask participants to have a quick look at it and ask questions if anything is not clear.

The change becomes part of the routine operation of the unit.

Work out how to explain the benefits of a change beyond the unit.

Use PDSA cycles.

Learn what works in your system.

Change is not permanent.

Develop infrastructure (eg policies, job descriptions, SoPs) to maintain the improvement.

Test cycles: Act on your learning
Abandon the change Modify the change Increase the scope of the change Test the change under different conditions Stop collecting data Implement the change DISCOVERY Aim Participants can recognise when their project (or one change idea in the project) is ready to move from testing to implementation Key messages Three criteria for implementation Timing 10 minutes, including Building Knowledge, your project Lead facilitator Now looking in more detail at Testing, and Implementation. Once your have Studied your data in each PDSA test cycle, your Act stage should include a decision to take action in one of these ways. Your decision will depend on 3 things: see next slide

Three criteria for implementation
High degree of belief that a change will result in improvement Small cost of failure The organisation is ready to make the change. Lead facilitator If these criteria are all true, you are ready to move on to the implementation stage. This slide is a summary – the next slide goes into more detail.

From testing to implementation
Cost of failure Current commitment within the organisation None Some Strong Degree of belief that change idea will lead to improvement Low Large Very small scale test Small Small scale test High Large scale test Implement Lead facilitator Expand on the previous slide Moving to Implementation should only be considered if these 3 criteria apply: The team has a high degree of belief that the change will result in improvement The cost of failure is small ie risk is low, losses from a failed test are not significant The organisation is ready to make the change. Implementing a change includes (summarise some of the issues arising from T/I/S activity) Makes the change part of routine for the whole unit Continues to use PDSA cycles Requires more time than testing More people are involved, so challenges are often related to people’s reactions to change Adapted from: The Improvement Guide p146

Sequential building of knowledge
A P S D Implementation cycles Learning and Improvement Wide scale tests Test new conditions Follow up tests For one change idea, we would expect to go through a series of PDSA cycles before we are ready for implementation. This is called a ‘ramp’ of PDSA cycles. Each change idea will have its own ramp. Some may never reach implementation, if you learn that this change doesn’t lead to the improvement you are looking for. Small scale test Very small scale test Develop a change

ICU: Reduce Length of Stay
Aim Primary Driver Secondary Driver Change idea Reduce average length of stay in Central General ICU by 20% by March 2015 Assessment and management of sedation and agitation Improved management of delirium Validated sedation tool Appropriate sedation Incidence of acute cognitive dysfunction Structured daily sedation breaks Staff information leaflets Staff training sessions Improve multidisciplimary team communication Assess sedation and agitation using the RASS tool (Richmond Agitation Sedation Scale) Use ear plugs to improve sleep Use Dexmedetomidine as alternative to benzodiazipines Develop and follow guidelines for daily sedation breaks Assess for delirium using CAM-ICU (Confusion Assessment Method for ICU patients) Investigate and correct underlying causes Include delirium as part of safety brief Medical staff and family jointly keep an ICU diary Improved identification of delirium Validated delirium tool Staff education Care bundle initiated within 2 hours of diagnosis Engage with patient/family/carer Mobilise patients earlier and more frequently To contextualise an example of ramps: ICU Length of Stay Refer back to the module Planning with PDSA case study and project: we looked in detail at some PDSA cycles relating to staff training. Now we are going to look at how we might work on that and the other two change ideas highlighted here - more information about this on the following slide – PDSA ramps.

PDSA Ramps A P S D A P S D A P S D Education package RASS scoring tool
Develop content Restructure content – 2 staff nurses Test with 1 staff nurse Revise wording – 1 nurse Test with all staff Education package A P S D Develop tool Amend tool (colour) & test at 1 bed space Test at 1 bed space Test at 2 bed spaces Amend tool (wording) & test at 1 bed space RASS scoring tool A P S D Develop poster Move poster so not obscured when doors opened Display outside ward Layout of poster more readable Size poster to fit space Poster for families Key messages To increase the pace of change test 2 or more change ideas at the same time – the different ramps may be at different stages ie one may reach implementation before others Collecting data for too many measures can reduce the time people have to devote to testing changes – so collect just enough data. Collect qualitative as well as quantitative data, particularly during very small scale tests - Very small scale means that changes in quantitative measures may be very small

Building knowledge: your project
How could you increase your degree of belief? What different conditions could you test your change under? Which change ideas could you work on at the same time? How could you minimise the cost of failure? How could you better make your department/organisation ready for the change? PROJECT (OPTIONAL) Aim Participants think through these questions in relation to their own project Timing 10 minutes Materials Ask participants to bring their own project documents including driver diagram and PDSA reports Facilitators Check in with each participant to make sure their thinking will help move their project forward. If no time: this provides questions to consider about your own project, once back at work.

Components of Implementation
Standardisation eg policies, procedures Documentation eg job descriptions Training Measurement Resourcing eg equipment purchases Aim Participants can list the tasks to be carried out as part of implementation Key messages PDSA cycles continue A lot of work still to be done Increasing importance of attention to Psychology as more people get involved Timing minutes Materials Implementation planning template Example of this implementation planning sheet, completed. Implementing change People issues Lead facilitator These are the components of implementation that need to be addressed in all improvement projects, for any change idea.

Aim  Driver  Driver Change ideas Staff complete safety climate survey Promote the physical, mental and emotional wellbeing of staff. By March 2017: (1) reduce staff absences from 5.2% to 4.2% (2) reduce staff related incidents from 140 to 100 per month. Environment Action planning from survey Lean visual management of cupboards, notice boards etc A workplace that is safe for staff Activity Use and location of hand gel dispensers Staff able to focus as required Schedule regular team huddles We are going to look at an example based on this case study, for the ‘hand gel’ change idea Leadership training for team leads People Staff engaged in health and wellbeing practices Offer Bereavement support programme for managers

Components of Implementation
Standardisation eg policies, procedures Documentation eg job descriptions Training Measurement Resourcing eg equipment purchases Lead facilitator Participants work in groups of 3 - 4 Read the different items on the example that need action. Discuss: - Sequence – what are the interdependencies, what would need to be done before some others could be done? (depending on time available, you might ask for numbering of PDSA cycles across the whole list) - What issues would you need to consider, particularly with respect to the People issues, and how would you deal with these? Allow time for everyone to read the example, then elicit immediate ideas on sequencing, as an example of the kind of thing that groups should be discussing. Facilitators Monitor the room, respond to any participant queries, check in from time to time and intervene as necessary. Plenary debrief. Focus debrief on: Practical issues re sequence – what did participants identify? What are the key people issues, and how would participants deal with them? It may be too early in some participants’ projects to be applying this now, but highlight that they should start considering whether they are ready for this with a single change idea. Optional Activity if time and if participants are expected to be moving on to implementation soon: Use the Planning template to act as a checklist PDSA reports for each ramp that you identify. For example use the sequence of 5 PDSAs for the ICU case study (used in module Planning with PDSA case study and project), and the ramps above In pairs or small groups, use these to develop an implementation plan. Use the planning template, and refer to the example and Implementing a change docs. Do one example in plenary to get them started.

Leading change: from testing to implementation: summary
An improvement journey Criteria for implementation PDSA ramps Components of implementation Aim To briefly recap the session content: - to support a sense of learning and accomplishment - to aid memory of the session later An opportunity for participants to ask any outstanding questions from any part of the session. Timing 1 – 5 minutes, depending on time available Lead Facilitator Elicit what content was covered for each of the bullets eg: What are the key stages in an improvement journey? What are the three criteria for implementation? How many of them need to apply to move on to implementation? How many PDSA ramps might you work on at the same time? (more than 1) What are the five components of implementation that you need to work on? How many PDSA cycles are you likely to need during implementation? (lots)

Communicating improvement stories: A framework for talking about data
By the end of this session you will be able to: list key components of an effective improvement story describe 4 steps in talking about data. Learning outcomes

When we talk about data in our improvement project, we are drawing on our understanding of all four components of the System of Profound Knowledge: Understanding Variation – the content of what we want to say about our data, and random or non-random variation within our data Psychology – our understanding of how data may influence people, and how uncomfortable some people may be around data Theory of knowledge and Appreciation for a system – putting our data in context in a way that will be meaningful for the people we are talking to Deming 2000

Communicating improvement stories
Stakeholder analysis Planning communications Talking about data Writing reports Sharing success Put this module in context – refer to other modules that participants have completed and/or modules that they will attend in future. Eg: In previous modules we looked at stakeholder analysis and planning communications. Today we are going to work on talking about data, which may be formally eg in a presentation to senior stakeholders or more informally with project team members. In future modules we will be looking at some other types of communications that may be useful for your project.

Communicating improvement stories: key stages
Why this project Changes Results Lessons learned Next steps DISCOVERY Aim When talking about their project data, participants put it in context, with more or less detail at each stage depending on the current reason for communicating Key message Whether in writing or spoken, we need to cover the same key areas, with the emphasis shifting depending on the purpose and audience. Timing 10 minutes Lead facilitator What we’re going to focus on now is the stage in the story where you will talk about your data – ie Results.

Talking about data: 4 steps
The 4 Ws Horse and Cart Dimensions GEE Lead facilitator Brief overview of the 4 steps: Who, what, where, when Provide context before the data Explain the graph structure Generalisation, example, exception – give your interpretation of the chart

Step 1: The 4 Ws Where, Who, What, When
Median 41 Pedometers issued Challenge announced Lead facilitator This is part of your preparation – you will have covered most of this when you were creating the run charts that you are going to talk about. Where – eg Board, organisation or department What – what is the measure Who – Is it a particular person’s clinic or a particular group of service users? When – What period does the data cover? Which of these you highlight will depend on the context. This also affects where the detail of the 4 Ws is provided eg it might be in headings and labels, or annotations.

Step 2: Horse and Cart You want to put the horse before the cart – don’t let yourself be rushed into displaying and talking about the data before you’ve explained to people why you’re showing it to them.

Step 2: Horse and Cart So for example:
1. Give a brief overview of the context in which this data is being collected and analysed, something about your project: Horse and cart So for this chart, for example, the information about why you are showing it to them may be: Over the last 18 months we have introduced a number of new initiatives to improve staff wellbeing and reduce sickness absence. I’m going to show you the results of a number of different initiatives. One recent initiative has been to encourage all staff in the hospital to walk more, and to measure this we have issued all staff with a pedometer, and set the challenge of walking 10,000 steps per day. I’m going to start by showing you a chart with data on the number of steps walked by male staff. 2. Then click to reveal the chart (here it’s on the next slide)

Step 2: Horse and Cart Median 41 Pedometers issued Challenge announced
Show this slide briefly as the end of Step 2, then move on.

Step 3: Dimensions Horizontal axis Vertical axis Data points
Median line This step helps our ‘audience’ understand the different components of a run chart, before we discuss the data itself. We need to include these four elements.

Step 3: Dimensions Median 41 Pedometers issued Challenge announced
For example: Dimensions We’re asking staff to record the number of steps that they are walking each day, so the horizontal axis is a time series, with dates. The vertical axis is the percentage of men who meet or exceed the target number of steps walked on each of those days, which is 10,000. The black line with the dots is the percentage of men walking at least 10,000 steps on each day. The blue line is the median. This median was created taking all the measurements from the first ten days. We are considering this period to be the baseline – it was only possible to create a baseline once the pedometers had been issued. The pedometers were issued during the week before we started collecting data on 11 February. Ten days later we announced that the ‘Walker of the week’ would be identified and announced.

Step 4: GEE Generalisation
Example Exception Summarise what the chart is saying Point out data that illustrates the generalisation Draw attention to any exceptions Read this out or ask participants to read it themselves.

Step 4: GEE Median 41 Pedometers issued Challenge announced
Example GEE Here the Lead Facilitator could either go through this themselves, or elicit each step from participants. If eliciting, it’s important to go through the three steps in sequence – and pick up on any responses that don’t fit in the particular step. Generalisation As you can see from the chart, most of the data points are close to the median line, with variation from one day to the next being due to chance. Example The median is 41%, and you can see here and here that the percentage fluctuates just above and below this level. Exception There is one exception to this. On this particular date, the percentage was much lower, only 24%. We have investigated this particular date, and identified the likely cause of this variation. There was heavy snow in the morning, and a number of staff came to work by car who usually either walk or come by bus. Also, more staff than usual, particularly those who live in more rural locations, worked from home. Point out that you can go through all this without any reference to ‘random’ and ‘non-random’ variation, as in this example. Use the language that will be most meaningful for your audience. From here, you would do one of the following: Remember that this is the third step of 5 in communicating an improvement story. If this is the only chart you are presenting, go on to the final two steps. Elicit: explain lessons learned and next steps. If you have more data on other charts, it may make more sense to talk about those charts first, then move on to lessons learned from all of them, then next steps.

Talking about data: 4 steps
The 4 Ws Horse and Cart Dimensions GEE So, those are the steps. Now we’ll look at a couple more examples.

Talking about data: staff who smoke
Support group launched Re-launch Free fruit Buddies PRACTICE Aim Participants can categorise components of a talk about data according to the four steps just outlined. Participants can include the four steps in sequence in planning a talk based on a given run chart. Timing Task 1: 10 – 15 minutes Task 2: 10 – 15 minutes Materials Staff who smoke slips Staff who smoke Key – the highlighted text distinguishes between G, E, E Lunchtime yoga Task 1 Hand out Staff who smoke slips – one set per pair of participants. With reference to this chart, sequence the slips so that they are in the 4 step sequence that we have been looking at. Facilitators Monitor the room and help out if participants haven’t understood the task. There may be some confusion around the fact that there are no slips relating to the 4 Ws. This highlights the fact that they are (and should be) included in the run chart itself. When most pairs have finished, give out the Staff who smoke Key – one per participant. Compare yours with this solution. If yours is different, think about why the solution is organised as it is – how does it fit the 4 step sequence? Facilitators monitor the room and facilitate if participants seem to have ordered their slips in a completely different way. Plenary debrief – any outstanding queries participants might have about this example. Participants may ask about why a baseline and extended median was not used in the first place. This could for example be because: if you have reported previously with fewer data points, this could be an update using the same median as before (eg after 6 and 12 months). It would have been hard to provide a rationale for selecting a baseline period earlier than that, unless there is data from before Jan 2012. Task 2 Create a script for how would talk about this run chart, using the 4 step sequence. Work individually for a few minutes, then compare notes in pairs. Plenary debrief: any issues that came up when drafting that – what was tricky, and elicit some different solutions that participants came up with.

Communicating improvement stories: A framework for talking about data: summary
Key stages Why this project Changes Results Lessons learned Next steps 4 Ws Horse and cart Dimensions GEE Aim To briefly recap the session content: To support a sense of learning and accomplishment To aid memory of the session later An opportunity for participants to ask any outstanding questions from any part of the session Timing 2 – 5 minutes, depending on time available Lead facilitator Elicit key messages relating to each of the bullets eg We’ve been focussing on talking about data in the context of your wider improvement story ie focussing on Results. What are the four steps in the framework? Click to reveal the four steps. 1. What are the four Ws – what kind of things do they include? When do you first think about the four Ws? (when creating run chart) 2. What does Horse and Cart remind us we must do before we show our run chart? (context – why this project, changes) 3. What are the 4 dimensions we need to explain? 4. What does GEE stand for? What do we talk about next? (either move on to another run chart, or to Lessons Learned and Next Steps)

Break Depending how timing is going, this may just be a comfort break, and bring tea/coffee back to table while work participants draft their own talk.

Communicating improvement stories: Talking about your data
By the end of this session you will have created and an improvement story based on your project data, and talked about it using the four-step framework. Learning outcomes

Talk about your data Small groups, each with a facilitator
Up to 4 minutes – start by telling your audience who they are ‘Audience’ will note some comments and questions 2 minutes for discussion A brief outline of what they will be doing with the talk that they are going to prepare. If there are not enough facilitators to do this as a group activity, remove this slide. The only purpose of this slide is to allay any concerns about giving a presentation to a big audience. Without enough facilitators, the activity becomes pair work – slide 93 below.

Communications plan Stakeholders Purpose of communication
Key messages to be communicated Timing of communication PROJECT Aim Participants identify the audience for their talk Key messages Communication must be planned and purposeful Timing 5 minutes Material Communications plan template W2 Lead facilitator Before you can start preparing your presentation, you need to remind yourself why you are doing it. Complete one line of this plan, with reference to stakeholders who you are going to talk about this chart with.

Prepare to talk about your data
Paste your run chart into a Powerpoint slide, and annotate. Create 1 – 2 other slides if necessary. Plan what you are going to say using the report structure: Why this project What changes you tested Results Lesson learned Next steps Aim Participants apply the four step framework to talking about their own project data Key messages Until you can successfully follow this framework without planning it in advance, it’s important to spend some time planning what you are going to say. Otherwise there’s more risk that you will confuse people and/or make them less interested in your project. Timing 30 minutes Materials Laptop, power cable, mouse Each participant’s run chart, drafted previously Lead facilitator Using one (or maximum two) of the run charts that you created earlier. Make this as real as possible – this may be a practice run for a presentation or informal chat about your project back at work. Paste the run chart into a Powerpoint slide and complete the annotation (this completes the 4 Ws step) Focus should be on Results, following the structure we’ve been looking at, as appropriate to your context. Next steps – including any action you want from the audience. Facilitators Monitor, respond to any participant queries, and make sure everyone will have a presentation ready in time. For early finishers/people finding this too easy, either: Ask them to help others (practise leading their team) Or – give them an additional challenge eg to create a chart for another project measure Or – ask them to note down what questions they think they might be asked by their real workplace audience – this may lead to them revising the presentation Or any other additional task that seems relevant.

Talk about your data Small groups
Up to 4 minutes – start by telling your audience who they are ‘Audience’ will note some comments and questions 2 minutes for discussion Talk through this briefly.

Feedback What questions might you have as target audience? What do you like about the way the data is presented? Suggest one way this talk could be improved. When you are in the audience, you will be asked to note down your comments in response to these three points, discuss them briefly and then give your written comments to the speaker.

Talk about your data Small groups
Up to 4 minutes – start by telling your audience who they are ‘Audience’ will note some comments and questions 2 minutes for discussion Aim Participants gain confidence in talking about data Key messages You can do this. It takes practice. Timing 40 minutes, assuming group size of 4 – 5 participants This includes set up time, with some participants moving around in the same room, or going to break out rooms. If working in pairs, about 15 minutes will be enough. Materials Laptops, power cables Feedback slips Facilitators Divide participants into groups of One facilitator with each group. If there are not enough facilitators, have participants work in pairs. The principle is the same, but the feedback will be from only one person. Each presenter start by telling group who the presentation is to ie who the audience is. Roughly 4-5 mins to present – facilitator manage time. Facilitator lead feedback/discussion – about 2 mins or longer if time allows. Presenter – how do they feel it went? What would they do differently next time? Others – use the prompts on slips to generate feedback/discussion. Facilitator – if not yet covered, feed in key messages for that presenter, particularly where wider relevance After discussion, audience give their comment slips to presenter. Final summing up after all presentations by facilitator as appropriate. Return to plenary for final debrief – comments from participants on how it felt and what they learned from doing this themselves and observing others. All facilitators feed in key messages as appropriate.

Commmunicating improvement stories: Talking about your data: summary
Prepare Aim To briefly recap the session content: To support a sense of learning and accomplishment To aid memory of the session later An opportunity for participants to ask any outstanding questions from any part of the session Timing 2 – 5 minutes, depending on time available Lead facilitator Elicit: Based on what you’ve just experienced, what advice would you give to others who are starting to talk about their project data using run charts? Click: brings up ‘prepare’. Until you’ve done this a lot, it needs preparation.

Next steps Online evaluation Project charter
Action planning, including actions that demonstrate: Working with your team on developing and testing changes Use of run charts to display and analyse your project progress Communications within and outwith the project team Optional slide What we need you to do to get the certificate. We’ll remind you of this in an later this week, including the date we would like these to be returned by (roughly 2 weeks). NB Project charter was asked for after Workshop 1. This is a reminder about the few remaining. We will contact you in a few months’ time as part of our evaluation of the programme to find out which of your Action Plan actions you completed, and any barriers or enablers you encountered. Info for facilitators: These are all important activities for participants in relation to their projects. They also provide data for evaluation of the programme: Action plans: Level 1 engagement – are they completed and how thorough and timely are they? Level 2 – do they include the right things? Level 3 – find out if these actions have been carried out, a few weeks or months later. Online evaluation: Level 1 – engagement questions Level 2 – same knowledge and skill questions as in baseline questionnaire

And finally … Workshop 3 Briefly summarise content: Communications
Routine Celebrating success Including communications in a range of formats – not just in writing. Will draft content for 2 different comms during the workshop

References and further resources
VProvost Lloyd P & Murray S (2011) The Health Care Data Guide: Learning from Data for Improvement Jossey-Bass Online learning module: Measurement for improvement: Presenting data There are more resources (online learning modules, videos) to help participants with run charts on the Workplace Learning document, issued at the end of Workshop 1 of the full Scottish Improvement Skills programme.

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