1. “Introduction to the Model for Improvement”
Candace Sinclair
Improvement Advisor
Alice Bayles
Intro –
Hello my name is and intro everyone else
Health & Safety –
Fire Drill
Toilets
Tweet –
Using #CYPIC
Link to the session via ‘insert title of app’
“Introduction to the Model for Improvement”

2. Breakout Objectives
Provide an introductory overview to the Model for Improvement
Introduce the framework of the 3 critical questions that can help drive your quality improvement work:
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in improvement?
Introduce the Plan, Do, Study, Act, tool and how it supports making an improvement

3. How We’ll Spend Our Time
Present the Model for Improvement
Have a go at PDSA through the Paper Airplane Challenge
Review and Reflect how the model could support you to make the improvements

4. We want to change Scotland’s place in the world and to do this we must find new and better ways to achieve the outcomes we want.
This 3-Step Improvement Framework has been developed to help unlock and channel the collective knowledge and energy of our people towards a common goal of real and lasting improvement across our public services.
The Framework is designed to prompt self-assessment and debate. It is about getting started and ‘doing’: creating conditions for and implementing the improvements
A vision – capable of stirring the heart of the community and able to serve as a constant
reference and anchor point as the change moves forward.
A story – to enable people to recognise where they have been and where they are going.
A set of actions – to take us to the next steps towards releasing the vision.
A clear framework for improvement.
A strategy to engage and empower the workforce - to provide the stimulation,
development and opportunity our staff need to fully release their deep commitment to public
service.
An understanding of how change will work locally (everywhere) – recognising
communities are different and creativity should be nurtured and released at a local level.

5. The Improvement Framework
Provides a clear thinking approach to change and improvement
Can be applied to business processes and systems as well as policy making and delivery
Recognises all improvement happens where the work is and the conditions needed to support this
It’s about getting started, and doing…………
Aim- Is there an agreed aim that is understood by everyone in the system?
Correct changes - Are we using our full knowledge to identify the right changes and priorities those that are likely to have the biggest impact on our aim?
Clear change method- Does everyone know and understand the method(s) we will use to improve?
Measurement- Can we measure and report progress on our improvement aim?
Capacity and capability - Are people and other resources deployed in the best way to enable improvement?
Spread plan- Have we set out our plans for innovating, testing, implementing and sharing new learning to spread the improvement everywhere it is needed?

6. The Typical Approach… Conference Room Real World APPROVE DESIGN DESIGN
Traditionally we have not been good at making change for improvement reliable – because we have not tested whether it will be delivered appropriately in various conditions and environments before we expect all to implement and make part of every day business.
e.g. previous experience of launching new protocols/guidelines – as of Mon am….. expect all to comply fully without really knowing that it’s practical for every system – then we wonder why people don’t comply and the system is unreliable.
IMPLEMENT

7. The Improvement Framework Approach
Conference Room
DESIGN
APPROVE
IF NECESSARY
Real World
The improvement framework approach takes things out to the real world ASAP and tests on a small scale, building up as we go along.
TEST & MODIFY
TEST & MODIFY
TEST & MODIFY
START TO IMPLEMENT

9. Why would you use the model for improvement?
It’s not about working harder and faster – need to change

10. Fundamental Principles of Improvement
Knowing why you need to improve
Having a feedback mechanism so you know if a change is an improvement
Developing effective changes
Testing changes before attempting to implement
Knowing when and how to make a change permanent

11. Model for Improvement Act on the plan - Testing
The Model For Improvement
No model is perfect – some are useful
The Thinking Part – relate back to the content of their “what better would look like” conversation.
The specifics – the what (service output), the who (children and families) and the where (your establishment / your Aim
Have you identified when you want (need) it to happen Aim
What it would look like – more/less/all , a number , a percentage Measures
Did you even start to discuss ideas of what you could do differently, stop doing, introduce something Changes
The Doing Part – PDSA

12. Q.1 What do you hope to accomplish?
Provides a clear sense of what we are trying to accomplish
Measurable – how much by when?
Specific – who, where?
Unachievable by hard work alone
An improvement aim…
Provides a clear sense of what we are trying to accomplish
Measurable – how much by when?
Specific – who, where?
Unachievable by hard work alone… YOU WANT TO INSPIRE TRANSFORMATIONAL CHANGE. change to the system not within the system
Once you’ve got A CLEAR AIM THAT EVERYONE IS BOUGHT IN TO, STICK WITH IT!!!! WHAT ARE WE TRYING TO ACCOMPLISH??

13. Vision and aims matter
Getting everyone behind the improvement Understand what success looks like
The Model For Improvement  - What are we trying to acomplish?
Aim – Be specific (health warning – check for strategic fit) – Need for a common purpose
“what better would look like” conversation
The specifics – the what (service output), the who (children and families) and the where (your establishment / your Aim
Have you identified when you want (need) it to happen Aim

14. Q3: What changes can we make that will result in improvement?
‘Not all change is improvement, but all improvement requires change’ (Berwick)
Copy: learn from the experience of others
Think creatively
Prioritise: impact on aim, feasibility
Use the evidence
Change ideas to test…
There are a few generic pointers we can share…
QI is about making changes that result in lasting improvement not just making changes because something needs replaced or has run its course.
Share openly and steal shamelessly. There are so many pockets of great work that others don’t hear about.
You aren’t starting at the beginning – there is so much evidence about what we should be doing. The innovation comes from making it work in your unique context. It’s still new if it’s new to you
Prioritise. Resources are finite so focus on the areas with greatest potential impact which will bring about the greatest improvement for your children
Impact
Resource use
Variation
Willingness of workers

15. Q2. How do we know that a change is an improvement?
Improvement is not
just about measurement
However… without measurement you will never be able to answer the question

16. Why do you need data for improvement?
To understand what needs improved
To understand variation
For testing changes
For monitoring progress
To tell the story of your improvement journey
How will we know that a change is an improvement?
To understand what needs improved – need understanding of the current system
To understand and reduce variation – so the differences that occur and the reasons why they happen
For testing changes – remember, you need to be able to measure whether the test has the predicted effect
For monitoring progress– these would be more global measures for your project
To tell the story of your improvement journey – very important especially if you want to scale up
The last two are where we’re focussing here – measures for your project…

17. Tips for effective measures
Plot data over time – annotate
Seek useful not perfection
Integrate measurement into daily routine
Use qualitative and quantitative data

18. Why are you collecting data?
Research?
Judgment?
Improvement?

19. Aggregated Data
Tells us very little
about the
improvement journey

20. Plot data over time
Median = 9

21. This is what you need for a PDSA measure – nothing more
This is what you need for a PDSA measure – nothing more. WE have seen lots of examples of children in nursery school and up, creating run charts in a classroom setting. Don’t wia tfor perfect or the right computer programme to start if you can manually record data.
If you have a clear aim then you know what you need to record to answer that question, How will we know that change is an improvement?

22. Testing Changes

23.  Do  Study  Act  Plan  Do  Study  Act
Northwest Improvement Initiative
Act
Adapt, Adopt or Abandon?
Plan
Purpose, Predict & Prepare Do
Data
Study
Reflect & Record
“What will happen if we try something different?”
“What’s next? ”
The Model For Improvement – WHAT CHANGE CAN WE MAKE THAT WILL RESULT IN IMPROVEMENT?
The Doing Part – PDSA
Think Big, Start Small
Test Often – Learn Rapidly
Plan – be clear and predict
Do – carry out as per the Plan
Study – against the predication and evaluate what actually happened and why
Act – Abandon / Adapt / Adopt
Adapt – keep going, learning and building confidence
Four parts of the cycle:
Plan:
Decide what change you will make, who will do it, and when it will be done. Formulate an hypothesis about what you think will happen when you try the change. What do you expect will happen?
Identify data that you can collect (either quantitative or qualitative) that will allow you to evaluate the result of the test.
Do:
Carry out the plan. Record any problems and spot new ideas. Collect data.
Study:
Make sure that you leave time for reflection about your test. Use the data and the experience of those carrying out the test to discuss what happened. Did you get the results you expected? If not, why not? Did anything unexpected happen during the test?
Act:
Given what you learned during the test, what will your next test be? Will you make refinements to the change? Abandon it? Keep the change and try it on a larger scale?
In the spirit of science, there really is no such thing as a 'failed experiment.' Any test that yields valid data is a valid test. Adam Savage
“Let’s try it!”
“Did it work?”
© R. Scoville & I.H.I.

24. Your Challenge Rapid Cycle Improvement
Aim To design the furthest flying paper airplane in the room Measure Distance of each flight Changes Design prototype planes Test with multiple cycles

25. Exercise Instructions:
In tables :
Step 1:
Assign roles
Paper Plane Engineer (To build paper plane)
Expert Consultants (Support building Plane/Provide Advice)
Air Traffic Controller (Record distance)
Pilot (To throw plane in corridor and report back to group)
Step 2:
Build paper plane
Using the A4 paper on tables – create one paper plane
Make sure to add a name/number to make it identifiable
Step 3:
Test it out
Record the distance on your charts
Amend if necessary, and test again

26. Run Chart to Measure Performance
Pointy nose
narrow wings
Nose weight
Pointy nose
Narrow wings
Pointy nose
narrow wings
Stand on chair
Pointy nose
Broad wings

27. Discussion
Q. How could you use the Model for Improvement in your practice/service/organisation?

28. Breakout Objectives
Provide an introductory overview to the Model for Improvement
Introduce the framework of the 3 critical questions that can help drive your quality improvement work:
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in improvement?
Introduce the Plan, Do, Study, Act, tool and how it supports making an improvement

29. So… ... and prepare to scale! So in summary
Over next day and half – you will see lots of different examples of how the Model for Improvement is being used across services/third sector.
Use opportunity to seek out areas of interest: storyboards/network/ IA/CYPIC link in CPP.
Additional QI Capacity building opportunities.
Think BIG (by developing a comprehensive practical theory of change (a Driver Diagram)
Start small (by testing using prediction and data collection)
And prepare for scale so that all the young people who would benefit from each of our changes can receive that benefit.
... and prepare to scale!

30. Lunch, Storyboards, App support
Thank you
Now:
12:00-13:00
Lunch, Storyboards, App support
Hall 1
Intro –
Hello my name is and intro everyone else
Health & Safety –
Fire Drill
Toilets
Tweet –
Using #CYPIC
Link to the session via ‘insert title of app’