1. Accelerating the Pace and Scale of Improvement Session M11 2014 IHI/BMJ International Forum, Paris April 9, 2014 Amy Compton-Phillips Kaiser Permanente Goran Henriks Qulturum Pedro Delgado IHI

2. Aims 1. Understand the concept of Quality and Innovation Centres and think critically about how it might take shape in different contexts 2. Develop ideas about supporting quality improvement and innovation in your own region or system 3. Understand how to begin to develop a quality and innovation centre to serve your region or area

3. Our time together 1.30 - 1:45 Intro & Structure 1.45 - 2.30 Qulturum 2.30 - 2.45 Reflections 3.00 - 3.15Break 3.20 - 4.20KP 4.20 - 4.30 Closing

4. A global trend

8. IHI’s Triple Aim Population health Per Capita Cost Experience of Care

9. What is a Quality and Innovation Center? A leading resource and driving force for system-wide, transformative health and healthcare improvement in a system or region (intentionality; commitment; infrastructure)

10. Role of a QIC 1. Leadership and resources in a system or region for focused and sustained attention to improving quality Discover, test, and spread innovations and best practices Build QI capacity and scientific thinking 2. Spark & support (system/regional/national) initiatives & demonstrate impact Build relationships, establish links, and connect people (physically and virtually) to learn, improve and innovate Offer technical and content expertise Identify and coordinate disparate improvement activities Influence policy and practice in their context

11. To support a system or region to achieve transformative health and healthcare improvement Aim Primary Drivers Secondary Drivers Generating will for improvement in a region Innovating in quality improvement Executing quality improvement ideas Fostering a robust organizational infrastructure Ability to identify and measure gaps Editorial and publishing skills and/or resources Ability to convene a wide array of stakeholders Methods for harvesting innovations Methods for developing innovations Methods to build improvement capacity / capability Process to test new ideas Capabilities in spread and scale-up Capabilities in data management and measurement Process for evaluating improvement ideas Staffing and operations plans to facilitate QI work IT to support QI work Structures and strategies for internal and external communications The mission, vision, values and strategic plan all guide the work of the organization Quality and Innovation Center Driver Diagram

12. WILL IDEAS EXECUTION Where are you as a QIC? A development tool

13. 10 Lessons (1-5) 1. Constancy of purpose 2. Ambitious aims and pace of change 3. Transparency and pursuit of reliability 4. Measurement for improvement 5. Skills, time and space for improving

14. 14 What Improvement Skills are Needed for Each Role? Experts Operational Leaders (Executives) Change Agents (Middle Managers, Stewards, project leads) Everyone (Staff, Supervisors, UBT lead triad) Setting goals and measures Identifying problems Mapping process Testing change Simple waste reduction Simple standardization Team behaviors Setting goals and measures Identifying problems Mapping process Sequencing tests of change Simple understanding variation Implementation and spread Simple waste reduction Simple standardization Setting direction and big goals Execution leadership Portfolio selection and management Managing oversight of improvement Being a champion and sponsor Understanding variation to lead Managing implementation and spread Analysis, prioritization of portfolios Deep statistical process control Deep improvement methods Leadership team advisory re portfolio selection, process Effective plans for implementation and spread

15. 10 Lessons (6-10) 6. Co-design and co-production(patients) 7. Exploration beyond healthcare for ideas 8. Behave their way to a culture change 9. Measure financial impact of initiatives 10. Celebrate success—and reward it

16. “Based on our performance, we can confidently and conservatively expect to harvest at least a 5:1 return on investment for value creation work”

17. A mobile, transparent world Every 9.6 min 2m per min; x3 in 3 years

18. Ref: ILN’s Care Anywhere

19. O + A = R L = T + P

20. “There are painters who transform the sun into a yellow spot, but there are others who with the help of their art and their intelligence, transform a yellow spot into sun”