1. Collaborative Improvement Learning Model for Improvement PDSA & Team working
Mob:
Insert name of presentation on Master Slide

2. Now we know what we don’t want!
Successful Collaborative Meetings!?
Successful Collaborative Spread!?
Beyond the 1000 Lives Campaign

3. Session objectives The expected collaborative process
To have heard about (and hopefully understood):
The expected collaborative process
The Model for Improvement
the framework for change
The ‘PDSA’
the tests of change
Teamwork
the mechanism of change
Beyond the 1000 Lives Campaign

5. Original Meds Mgt measures
For this Bundle, use the following process measures:
% of patients with a diagnosis of dementia with a documented record of indication for antipsychotic
% of patients with a diagnosis of dementia prescribed an antipsychotic
DDD/1000 PUs for an agreed basket of antipsychotics

7. Dementia target 3 Measures:
For this intervention, process measures to be used include:
Number of people with dementia who are receiving anti- psychotic medication
Proportion of people with dementia who are on anti-psychotic medication where review within 3 months
Proportion of people with dementia who have been on anti-psychotic medication for >9 months
% compliance with care bundle (all 4 above interventions documented)

8. “Houston, we have a problem …”
We are here because:
PRINCE Project Management
Targets
Performance Management
alone doesn’t work.
1000 Lives Plus

9. Knowledge for Improvement
Improvement: Learn to combine subject matter knowledge and profound knowledge in creative ways to develop effective changes for improvement.
Subject Matter Knowledge
Profound Knowledge
Improvement

10. “Knowing is not enough; we must apply
“Knowing is not enough; we must apply Willing is not enough; we must do.” Goethe 3 6

11. Collaboration Peers learning (& competing with?) from one another
Support the methods
Share the practice
1000 Lives Plus

12. Collaborative Improvement Model
Repeated improvement cycles: planning → testing → evaluation → sharing → implementing
Repeated improvement cycles: planning → testing → evaluation → sharing → implementing
Repeated improvement cycles: planning → testing → evaluation → sharing → implementing
Learning session 1
Learning session 2
Learning session 3
Planning
Support systems
1000 lives support team
Interactive learning sessions
Inter-clinic communication (e.g. monthly meetings)
Continuous feedback (sharing data)

13. Learning Sessions aimed at achieving…
LS1
WILL/IDEAS
Get ideas
Get methods
Get started
LS2
WILL/IDEAS/
EXECUTION/MONITOR
Get more ideas
Get better at methods
Get a ‘Stride’
LS3
WILL/IDEAS/
EXECUTION/SPREAD
Celebrate success
Get ready to sustain
and spread
1000 Lives Plus

14. How to change the system?
1. The Aim….
2. The Goals and Measures…
3. The ideas and evidence….
4. The tests of change….
To be successful, any improvement effort must start by addressing the three basic questions shown here:
1. The first question is about setting an aim that is measurable, specific, and yet an aim that requires taking the status quo off the table in order to achieve it.
2. The second question requires that the team decide on how it will measure its progress in reaching the aim. For example: you don’t know whether your golf game is improving unless you keep track of the number of strokes per round.
3. The BTS gives teams a place to start - with changes that have been shown to be effective. This question is based on the assumption that all improvement requires change, but not all changes lead to improvement.
The Model for Improvement (Nolan &Colleagues IHI)
1000 Lives Plus 14

15. Tools for improvement:
Data tools: Team tools: Action tools:
Run Charts  Team assessment PDSA’s 
Schewart Charts  Process mapping  SBAR
Frequency Plots  Learning sessions  ‘How to guides’ 
Pareto Charts  Team ‘meetings’
Posters
MONITOR
WILL/IDEAS
EXECUTION
Beyond the 1000 Lives Campaign

16. Tools to Learn from Variation in Data
Run Chart
Shewhart Chart
Frequency Plot
Scatterplot
Pareto Chart
IH p. 8-34

17. Assessment Scale 1. Forming team 2. Activity but no changes
3. Modest improvement
4. Significant progress
5. Outstanding sustainable results 1 8 9 9

18. “The First Law of Improvement”
Every system is perfectly designed to achieve exactly the results it gets.

19. Process Mapping for improvement …system focus
Problems in hand-off
between steps
Problems in execution within steps
Source: Juran Institute

20. All improvement requires change - but not all change results in improvement!
Have you undertaken any recent changes that haven’t resulted in improvement?
Individual exercise 4-5 mins with an example from each table describing why you think it went wrong
So change can go wrong or even make it worse – think Poll tax!
That’s where PDSA’s come in…

21. Beyond the 1000 Lives Campaign

22. THAT PDSA!
PLAN
IMPLEMENT
CRASH!!

23. How to change the system?
1. The Aim….
2. The Goals and Measures…
3. The ideas and evidence….
4. The tests of change….
To be successful, any improvement effort must start by addressing the three basic questions shown here:
1. The first question is about setting an aim that is measurable, specific, and yet an aim that requires taking the status quo off the table in order to achieve it.
2. The second question requires that the team decide on how it will measure its progress in reaching the aim. For example: you don’t know whether your golf game is improving unless you keep track of the number of strokes per round.
3. The BTS gives teams a place to start - with changes that have been shown to be effective. This question is based on the assumption that all improvement requires change, but not all changes lead to improvement.
The Model for Improvement (Nolan &Colleagues IHI)
1000 Lives Plus 23

24. Repeated use of the PDSA Cycle
Changes that result in improvement A P S D
DATA D S P A
Implementation of change A P S D
Hunches, theories, best practices
Wide-scale tests of change A P S D
Once a process functions reliably 90% of the time or better, it is reasonable to pursue improvement in the next PDSA cycle
Follow-up tests
Sequential building of knowledge under a wide range of conditions
Very small scale test (but with HUGE potential!!!)
1000 Lives Plus

25. Multiple PDSA Cycle Ramps
Detail Design A P S D
Risk/harm assess’s
Alternate
Therapies
Review
Patients
Capacity/
Demand

26. Developing improvement with PDSA (real world)? P D S A
Improvement P D S A
Improvement warning - Remember cycles link but don’t always take you to where you want to go….because change is never as simple or as easy as we hope it will be!
Bright
idea! P D S A

27. Because change involves people…
Receptionists
Patients
AHPs
Carers
Pharmacists
Outside Agencies
Social Services
Managers
Doctors
Volunteers
Nurses

28. So let’s try it now… PDSA… WHAT Planning your improvement actions:
SO WHAT
Using the PDSA/PDCA trainer sheet…identify for yourself an objective and start to write down things you could try to achieve the objective whilst deciding what you will measure to let you know when you have achieved it!
E.g. weight, fitness, golf handicap?
Review
NOW WHAT

29. Adopter Categorization: Speed of Adoption
Innovators
Early Adopters
Early Majority
Late Majority
Tradition-alists 2%
13%
35%
35%
15%

30. Recorded medication reviews in Care Homes (in last 12 months)
By some teams trying this PDSA/PDCA…

32. Scripts leaving the practice with ‘As directed’ instructions (as directed)
By some teams trying this PDSA/PDCA…

34. ADAPT – for your situation IMPROVE – for the reason you started with
ADOPT – something else
ADAPT – for your situation
IMPROVE – for the reason you started with
Sherlock Holmes

35. And finally, there are a number of responses to the frustration of trying to change behaviour…
Did you know it takes 42 muscles in your face to frown……
and only 17 to smile
However - it only takes 4 muscles to extend your arm and smack someone in the mouth

36. If we can improve
care for one person,
then we can do it for ten.
If we can do it for ten,
then we can do it for a 100.
If we can do it for a 100,
we can do it for a 1000
And if we can do it for a 1000,
we can do it for everyone in Wales.