1. Fostering Champions of Change
“making improvement routine in Grampian”
We are a team
We take risks
We learn from failure
We celebrate each others success
We Aim Big!
Jenny Ingram, Head of Service Improvement, NHS Grampian

2. Our Approach
Had been delivering Quality Improvement (QI) development for various groups ranging from ½ day to a collaborative model.
Head of Service Improvement and Improvement Advisor support both the Scottish Improvement Skills (SIS) and Scottish Improvement Leaders (ScIL) programmes.
To provide consistency we adapted some of our existing tools to fit with SIS and ScIL.
Resulted in development of a more formalised approach to building QI capacity within Grampian.

3. Building Sustainable QI Capacity
½ day session on improvement and human factors now built into the supervisory management programme led by L&D
I day QI session run for Consultants now extending into induction for Senior Medical Staff.
Supporting Clinical Development Fellows.
Head of OD is a key part of the QI Hub re our Talent Management Framework and improvement skill building.
Built QI skills for 23 multidisciplinary teams (110 + staff) over four learning sessions as part of our Older People in Acute Care Collaborative.
Working with RGU re delivery of QI including a post-graduate module.
Delivering our own QI Practitioner Level Programmes as defined by the NES QI Curriculum Framework
Grampian
Quality Hub
Building organisational improvement capacity which will harness and focus leadership and professional skills on effecting the step changes and actions set out in our strategic plans.

4. AHP QI Practitioner Programme Overview
LS 1
15th & 16th June
Action Period
Personal Learning
Mentoring Support
LS 2
17th & 18th Aug
LS 3
26th & 27th Oct
Self-Assessment
LS 5
23rd & 24th Feb
LS 4
7th Dec
Pre-Work
Application & Selection
April-May
Action Period
Personal Learning
Mentoring Support
Poster Development session (Jan 16)
Next
Steps Agreed
Learning Session 1
Learning Session 2
Learning Session 3
Learning Session 4
Learning Session 5
NHSScotland’s
Improvement Journey.
Understanding the 3-Step
Improvement Framework
Recognising the steps for
improvement.
Stakeholder analysis.
Project Improvement
Charters.
The Model For
Improvement.
Personal Journey of an AHP
Improvement Advisor (NHS
Shetland).
Developing Driver
Diagrams including use of
cascading driver
diagrams.
PDSA/Tests of Change.
The phases of improvement.
Testing for the next stage.
Understanding the Lens
of Profound Knowledge.
Measurement for
Knowledge Network
Masterclass.
Sharing project
reflections from testing,
learning , barriers and
actions.
Understanding random
and non-random
variation.
Quality Measurement
analysis.
Managing barriers and
breakthroughs.
Human Factors.
Tactical decision
making.
Communicating your
improvement story.
Skill self-assessment.
Leading and managing
change supported by
NHSG Organisational
Development Manager.
- Introduction to MBTI
types.
- Exploration of own type
with feedback on own
report.
- Effective Team Working
- Exploring strategies to
work with others.
- Behaviour Change in
individuals &
organisations.
- Z Problem Solving
Model.
From testing to
implementation & spread.
Holding the gains.
Practical application of the
CLEAR mentoring model.
Self-assessment skills
revisited.
Next steps agreed.
Participants showcase their
work in a poster event for an invited audience of Lead AHPs & Senior Leaders.
Commissioned and supported by Associate Director of AHPs & Moray Lead AHP (ScIL Cohort 1).
Programme developed and delivered by Head of Service Improvement with additional mentoring
support for the cohort from IA (SPSP Fellow), SPSP Programme Manager (ScIL), AHP ScIL.
Cohort of 13 AHPs from across the professions and Sectors within NHS Grampian

5. Outcomes & Learning
The style, format and timing of the learning sessions and mentoring support facilitated and accelerated participants skill development.
Utilising internal staff to support mentoring worked (i.e. IA, SPSP Programme Manager, Moray AHP Lead) to focus the cohort and provide advice.
The materials were well received, built nicely with each session and mixed with our own provided a consistent approach in delivering national approaches locally.
A half day learning session with the AHP Leads built further understanding of improvement science, supported these projects and has identified need for other improvement work and education.
ALL participants completed an improvement project, demonstrated results and were able to showcase a QI poster on their work.

6. Practitioner Outcomes
“Investing in doing not telling has proved to work”
“ This has empowered me & my team to make changes happen”
“Results have shown others the value of this approach”
“Valued the space & time to think”
“A wave of change is happening”
“On a professional level it has enabled me to develop skills & knowledge that allows me to have QI conversations with colleagues out with the scope of my project.”

7. Project Outcomes
Occupational Therapy clinical time released by introducing a structured Board Round tool.
Decreased wait time for out- patient radiography.
Improved SLT attendance by introducing an initial parent appointment by telephone.
Increase in SVQ Assessors supporting Healthcare Support Workers.
Increased mobilisation of older people within 12 hrs of admission.
A clinical supervision case review programme for Orthotists.
Improved access to nutritional care for Learning Disabilities clients within a residential setting.
“Great, an initiative that will help our
development and clinical practice”

8. Project Outcomes
Increased person-centred Dietetic consultations with improved quality markers completed.
Improved utilisation of voice therapy clinic with quality focused patient sessions.
Increased completion rate of Pulmonary Rehab classes via a person-centred approach.
Introduction of a falls self- assessment tool in Acute has increased accurate referrals to community staff.
Improved quality of dental imaging with a MDT approach.
Increased early referral to Paediatric Physiotherapy with a self-referral process for parents. DNA rates reduced.
Introduction of exercise groups; reduced wait time and empowered patients.
“ Being back in a group is better after having the stroke because if you concentrate too much on the 1:1 stuff you get tied up within yourself and you get angry annoyed, confused, stuff like that. But if you have other distractions you seem to get a lot better and you do not think of the task you are doing. I think for myself”

9. What Next?
The cohort identified that they wished to continue to further their development and this is underway.
Cohort two is being finalised with Cohort 1 supporting. We are utilising Quality Improvement Facilitators to support teaching.
To build further capacity for AHPs and link to key deliverables an MSK six month collaborative is planned for August.
We are running our local version of SIS from May 16. There are a further three AHP’s on the first cohort.
Acute Services and the three Integrated Joint Boards are determining their approach to and requirement for the development of a QI infrastructure.
The Grampian Quality Hub has been approved by the Senior Leadership Team.

10. Supporting Continuous Improvement In Grampian Strategic Change Group
We are committed to creating the environment and effective frameworks and systems that are applicable in all settings to continuously improve the care and services we deliver sustainably over time.
Strategic Change Group
Grampian Quality Hub
AIM: The Grampian Quality Hub (GQH) will support, facilitate and contribute to improving the health and care system for the population of the North East of Scotland by:
Working directly with individuals, teams and service areas to improve
the quality of care and services delivered on objectives and priorities
agreed by the Strategic Change Group.
Establishing and managing a Quality Improvement (QI) Network across
the North East of Scotland to share learning and promote collaborative
working, empowering staff and teams to make improvements.
Promoting QI methodology and developing and delivering a range of QI
learning and development opportunities for all levels of staff.
Establishing links with neighbouring Health Boards and Health and Social
Care Partnerships in the North of Scotland and wider to share and learn.
Acute Services and Heath & Social Care Partnerships Improvement Infrastructure
Providing Leadership to drive, create the conditions for and align support to deliver improvement priorities at a local level.
Innovation Hub
Creating an approach to innovation for the health and social care system in the North East of Scotland that stimulates and releases the potential of staff to contribute to change at all levels.
Research & Development
Ensuring research in Grampian is conducted to high scientific, ethical and financial standards by providing guidance and support to researchers throughout the whole process.
Grampian Quality Hub
We believe that quality is the responsibility of every employee and promoting a culture of continuous improvement will allow organisations to do the right things at the right time, every time.
Make the improvement
Create the conditions
Change the world
Improvement Priorities
Four strategic themes: prevention, self-management, planned
care, unscheduled care.
National Improvement Programmes e.g. Patient Safety, Early
Years, Six Essential Actions, Delivering Outpatient Integration
Together (DOIT).
Local agreed priorities for service redesign.
Improvement Collaboratives (e.g. Older People in Acute Care,
Discharge Collaborative Work).
Building Improvement Capacity
Range of QI development opportunities offered locally (from ½
day to 9 day QI Practitioner Lead).
Co-ordination & support for national QI Programmes.
Lead role for the annual Quality & Safety event.
Network of QI Practitioners meeting quarterly.

11. Fostering Our Champions
Of Change
“There is a superhero in all
of us we just need the courage to put on the cape”