2. All working life in NHS Diagnostic Radiographer and teacher Improvement roles since 1994 BPR Leicester Royal Infirmary 1994 - 1999 National Patients ‘Access Team 1999 - 2002 NHS Modernisation Agency 2002 – 2005 NHS Institute for Innovation and Improvement 2005 -2008 Awarded OBE for services to NHS 2003 Visiting Professor University of Derby 2008 Jean.penny@btinternet.com

3. 3 Knowledge of Systems Theory of knowledge Knowledge about Variation Knowledge of Psychology W Edwards Deming (1994) The New Economics

4. Value the differences!

7. IE I ntrovert E xtrovert NS i N tuitive S ensing TF T hinking F eeling PJ P erception J udging

10. If you don’t know what an Extravert is thinking you have not listened If you don’t know what an Introvert is thinking you have not asked Isabel Briggs Myers

11. ‘If it’s important to extraverts, they will quickly show it. If it’s important to Introverts they will often hide it, at least until they feel it will be treated with respect’ LaVonne Neff One of a kind

12. S E N S I N G INTUITION

14. A frequent mistake intuitive types make in communicating about change is to assume that the amount of information that convinced them of the need for change will be sufficient for the sensing type Sue G Clancy Developing leaders

15. Feeling DecisionsThinking Decisions

17.  T’s business before relationship what makes sense  F’srelationship before business what matters is harmony

18. ‘I tell people that thinking and feeling are like two TV channels or radio stations. You can tune into logical content or what people care about. If you only listen to one channel, you’re missing a lot of good information Catherine Fitzgerald

19. Hmmm... Keeping options open Making decisions

22. Perceivers try to avoid pain through adapting and harmonising with the environment. Judgers seek to avoid painful experiences through judging and controlling their environment Isabelle Briggs Myers and Peter B Myers

23. ISTJISFJINFJINTJ ISTPISFPINFPINTP ESTPESFPENFPENTP ESTJESFJENFJENTJ

24.  Librarians E / I  Sales reps E / I  Chemists (lab) E / I  Accountants S / N  Policemen S / N  Psychiatrists S / N Counsellors T / F Clergy T / F EngineersT / F Journalists J / P Judges J / P ActorsJ / P

25.  differences between people are natural: not something you can change  all type preferences are positive: no aspect of preference is better or worse  the other persons preference may be directly opposite to your natural preference  the other persons preferences are clues as to how they want to be worked with / related to  their behaviour may have nothing to do with their type preference

26.  It is a measure of preferences – not skills, abilities or behaviour  There are no better or worse types – all types have strengths and weaknesses  Everyone uses both aspects of each dimension – but it takes more energy to use non-preferred dimensions  Your reported type can be overwritten by you because you are the best judge of your own personality type  Use the MBTI as a starting point for discussion and understanding, not an end in itself

27. Civilisation is the encouragement of differences Mohatma Gandhi

28. Value the differences! But no stereotyping or excuses!!

29. “All models are wrong but some are useful” W Deming

30. 30 1. Set Direction: Mission, Vision and Strategy Make the status quo uncomfortable Make the future attractive 3. Build Will Plan for improvement Set aims/allocate resources Measure system performance Provide encouragement Make financial linkages Learn subject matter 5. Execute Change Use Model for Improvement for design and redesign Review and guide key initiatives Spread ideas Communicate results Sustain improved levels of performance 4. Generate Ideas Understand organisation as a system Read and scan widely, learning from other industries and disciplines Benchmark to find ideas Listen to patients Invest in research and development Manage knowledge 2. Establish the Foundation Prepare personally Choose and align the senior team Build relationships Develop future leaders Reframe operating values Build improvement capability Source: Robert Lloyd Executive Director Performance Improvement Institute for Healthcare Improvement January 16, 2007

31. Macro Meso Micro ©Profound Knowledge Products, Inc. 2008 All Rights Reserved

32. Ask yourself What are the problems that cause the bigger problem? What are you trying to achieve? (aim for each driver) How will you know a change is an improvement ? (outcome measures for each driver ) Drivers Which in turn contribute directly to the ‘bigger’ aim Aim The ‘big’ dots Ask yourself What is the big (possibly strategic) problem you are addressing? What are you trying to achieve? (aim) How will you know a change is an improvement ? (outcome measures) Ask yourself What changes can you make that will result in the improvement you seek? What are the change ideas / interventions/ solutions to test with PDSA cycles before implementing? How will you know a change is an improvement? (process measures for each intervention) Intervention 1 Intervention 2 Intervention 3 Intervention 1 Intervention 2 Intervention 3 Intervention 1 Intervention 2 Intervention 3 Interventions The ‘small’ frontline dots Contribute directly to the drivers

33. 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? Model for Improvement ActPlan StudyDo Understanding the problem. Knowing what you’re trying to do - clear and desirable aims and objectives Measuring processes and outcomes What have others done? What hunches do we have? What can we learn as we go along? Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The improvement guide: a practical approach to enhancing organisational performance 2 nd ed, Jossey Bass Publishers, San Francisco

34. Sharing Achievements and reflections on what you have done What went well? What are you pleased with? What could have been better? What has disappointed you? Surprises: good and bad! Who / what has helped / not helped What have you learnt What would you do differently next time? Learning from others Look at the poster What was the problem? Who was the team? What was the aim? What change ideas were tested? (PDSA cycles) What are the improvement measures?

36. Stepping stones  Off beat ideas and wild scenarios can serve as catalysts or mental stepping stones to help us make an intuitive leap to a really good idea http://www.institute.nhs.uk/building_capability/new_model _for_transforming_the_nhs/thinking_differently_guide Attention Escape Movement

37. Imagination Creativity Doing and changing Innovation 400 ideas generated 75 ideas harvested 20 ideas developed 8 ideas tested 4 ideas implemented Impact £s/outcome Attention Escape Movement

39.  The improvement itself and any changes in practice OR  Continuous improvement and a commitment to finding a better way of working – a culture change Complexity of sustaining healthcare improvements: what have we learned so far (2004) NHS Modernisation Agency, Research into Practice report 13

40. Performance Time Good Bad BeforeNowLater Idea ?

41. Sustainability is when new ways of working and improved outcomes become the norm Sustainability is when  not only have the process and outcome changed  but the thinking and attitudes behind them are fundamentally altered  and the systems surrounding them are transformed in support.

44.  An easy to use tool to help NHS improvement teams: ◦ Identify & understand key barriers to sustainability for their specific situation ◦ Know what they can do to overcome those barriers ◦ Monitor progress toward sustainability over time ©NHS Institute for Innovation and Improvement 2006 To predict the likelihood of sustainability

45. Create a plan before, during and after implementation of your improvement initiative Lynne Maher, David Gustafson, Alyson Evans ©NHS Institute for Innovation and Improvement 2006 The ten factors of sustainability

46.  Process: ◦ Benefits beyond helping patients – making job easier ◦ Credibility of evidence – obvious, evidence based, believed ◦ Adaptability of improved process – continuous improvement ◦ Effectiveness of system to monitor process – communication of results  Staff ◦ Staff involvement and training to sustain process ◦ Staff attitudes towards sustaining change - involvement and empowerment ◦ Senior leadership engagement – responsibility and advice ◦ Clinical leadership engagement – responsibility and advice  Organisation ◦ Fit with organisation’s strategic aims and culture – history of improvement, consistency of improvement goals with strategic aims ◦ Infrastructure for sustainability – staff, facilities, equipment

47. A score of 55 or over offers reasons for optimism Scores below this suggest you need to take some action Work on improving the two factors that have the biggest potential for improvement Re score in about 6-8 weeks ©NHS Institute for Innovation and Improvement 2006

48. 2 4 6 8 10 12 14 16 0 Adaptability Of improved process Benefits beyond helping patients Credibility of the evidence Effective system to monitor progress Fit with orgs strategic aims and culture Infrastru- ture for sustainability ©NHS Institute for Innovation and Improvement 2006 Staff behaviours towards sustaining change Senior leadership engagement Clinical leadership engagement Staff involvement and training to sustain process Process Staff Organisation

49. 2 4 6 8 10 12 14 16 0 Adaptability Of improved process Benefits beyond helping patients Credibility of the evidence Effective system to monitor progress Fit with orgs strategic aims and culture Infrastru- ture for sustainability ©NHS Institute for Innovation and Improvement 2006 Staff behaviours towards sustaining change Senior leadership engagement Clinical leadership engagement Staff involvement and training to sustain process Process Staff Organisation

50. Think about your work based improvement activity and consider the factors of sustainability  Where are your strengths?  What areas do you need to work on?

51.  Leadership  People who influence (at all levels)  Support at senior level  Ownership of initiative  Effective relationships (multi-professional)  Staff engagement  Incentives  Readiness of improvement  Local context  Nature of initiative  Evidence of improvements  Process of implementation  Integration into practice  Dedicates resources Note: No rank order Relative importance of each factor varies from one initiative to another The New Improvement Wheel (2005) NHS Modernisation Agency Research into Practice report 14

52. Spread means that the learning that takes place in any part of the organisation is actively shared and acted upon by all parts of the organisation i.e. that others have adopted Efforts will meet only limited success if one views the process as that of spreading best practices Spread is an active term and indicates ‘push’ Spread is the result of the adoption process, not the other way round Adoption is a receptive word and indicates ‘pull’

53.  Sending ◦ Describe the new practice ◦ Target the potential implementers ◦ Communicate  Receiving ◦ Matching opportunity to current processes, systems or practices ◦ Deciding whether to adopt or reject  Implementing ◦ Re-inventing new ways ◦ Unlearning old ways ◦ Monitoring progress Fraser S (2002) Accelerating the spread of good practice, Kingsham Press UK The idea and the people

54.  Relative advantage ◦ How clear and how much is this new idea/practice better then current situation?  Compatibility ◦ How closely does new idea/practice reflect beliefs and values of adopter(s)?  Complexity ◦ How easy is it to understand the new practice/idea?  Communicability ◦ How easily can it be shared with others?  Observability ◦ How visible is the new practice or idea and its results?  Trailability ◦ How easy is it to test the new idea?  Reversibility ◦ How easily can the adopter revert to the old ways?  Uncertainty ◦ How certain can an adopter be of positive results from the change? Fraser S (2002) Accelerating the spread of good practice, Kingsham Press UK

55. Solution / change in organisation A Change principle Solution / change in organisation B

56.  The concept of resistance to change is negative and emotionally draining  We all change naturally; at our own pace with our own rationale  Don’t speak of ‘us’ and ‘them’ ◦ consider the ‘What’s in it for me’ factor  Spread can be better understood through ‘attractors’  How can I make my change more naturally attractive to others?

57. Innovators Early Adopters Early Majority Late Majority Laggards Rogers E (2003) Diffusion of Innovations 5 th ed New York: Free Press 2.5%13.5%34% 16%  Roger’s adopter categories are based on studies of when an individual adopted a specific innovation  Nearly everyone is a “laggard” at some time; with a very rational reason!

58.  Think quietly by your self for a few minutes  Then find two others and share

60. Ask yourself What are the problems that cause the bigger problem? What are you trying to achieve? (aim for each driver) How will you know a change is an improvement ? (outcome measures for each driver ) Drivers Which in turn contribute directly to the ‘bigger’ aim Aim The ‘big’ dots Ask yourself What is the big (possibly strategic) problem you are addressing? What are you trying to achieve? (aim) How will you know a change is an improvement ? (outcome measures) Ask yourself What changes can you make that will result in the improvement you seek? What are the change ideas / interventions/ solutions to test with PDSA cycles before implementing? How will you know a change is an improvement? (process measures for each intervention) Intervention 1 Intervention 2 Intervention 3 Intervention 1 Intervention 2 Intervention 3 Intervention 1 Intervention 2 Intervention 3 Interventions The ‘small’ frontline dots Contribute directly to the drivers

61. 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? Model for Improvement ActPlan StudyDo Understanding the problem. Knowing what you’re trying to do - clear and desirable aims and objectives Measuring processes and outcomes What have others done? What hunches do we have? What can we learn as we go along? Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The improvement guide: a practical approach to enhancing organisational performance 2 nd ed, Jossey Bass Publishers, San Francisco

62. 62 Knowledge of Systems Theory of knowledge Knowledge about Variation Knowledge of Psychology W Edwards Deming (1994) The New Economics

63. Value the differences!