1. Welcome & introductions © 2013 AQuA

2. House keeping

3. Agenda

4. Session aims 1.All attendees & core faculty to meet 2.Confirmation of programme delivery 3.Clarification of programme aims & objectives 4.Review core Quality Improvement 5.Opportunity to review & discuss skills assessments & how this will be reviewed during programme 6.Agreed expectations & commitments (compact) 7.Safety culture questionnaire referenced 8.Safety Culture tool discussed 9.Safety Culture tool contextualized into programme objectives & project objectives

5. Programme Objectives To support your team to develop a shared purpose and vision for safety To support your team to deliver a successful safety improvement project To create an opportunity for teams to learn together in a safe and stimulating environment To provide an expert faculty that offers education, information, innovation and opportunity for teams to challenge and be challenged around safety improvement To utilise best practice, critical thinking and current knowledge to support teams and individuals to stretch and develop their safety and quality improvement capabilities To identify prior knowledge and skills for teams and individuals, to improve this and the ability to apply it within their roles. © 2013 AQuA

6. Overview © 2013 AQuA

7. Kirkpatrick New World

8. Project assessment

9. Toolkit & workbooks When you see this sign a tool or template is available to help you © 2013 AQuA

10. Faculty AQuA –Jodie –Bernie –Clare –Andrea External experts/guest speakers © 2013 AQuA

11. Support Phone calls Visits WebEx

12. Our rules Dialogue; the art of thinking together!

13. Getting to know you Take a pen & piece of paper 5 mins to draw a pig If you have done this before you have 2 options… –Cheat –Don’t cheat!

14. Feedback

15. Compacts

16. Using compacts Reciprocal agreement More than a wish list but less than a contract! It is both an agreed document and a way of working together for mutual advantage It achieves better outcomes for people and communities It establishes clear rules of engagement It provides standards for fair and meaningful consultation

17. Benefits of a compact It advances equality and gives our work a stronger voice It aids embedding and developing good practice It is an agreement that guides and improves relationships It is a framework for better partnership working It is a commitment to work more closely together so that groups are properly involved

18. AQuA Compact Respect for all opinions & perspectives No secrets for safety Core team continuity Programme delivery as planned Toolkits & templates made available Support application of learning to safety project Show, teach try approach Additional support alongside workshops Slides on Portal Support to drive safety improvement projects Utilise your evaluation & feedback to improve our programme

19. Attendees Respect all opinions & perspectives Attend at all sessions Participate in discussions & activities Apply learning to safety project Attend/join on prearranged calls or WebEx sessions Evaluate & feedback to AQuA (2 sides today!) No secrets for safety

20. Write your own compacts In teams agree your own team compacts Identify how you will share this within your organisation Compact agreement

21. Feedback

22. Patient Safety Culture Assessment Tool Why What When Where How

23. Patient Safety Culture Survey Raise staff awareness about patient safety. Diagnose and assess the current status of patient safety culture. Identify strengths and areas for patient safety culture improvement. Examine trends in patient safety culture change over time. Evaluate the cultural impact of patient safety initiatives and interventions. Conduct internal and external comparisons.

24. Feedback

25. Break

26. Quality Improvement Methodology Basics

27. Aims of this session 1.Looking at safety problems I.Remembering to ask what, why, when, where & how? 2.Refresh & review of core QI knowledge & practical application of tools to prepare group for safety improvement I.Setting aims II.Driver diagrams III.Project Charters 3.Encourage teams to describe how their project shows alignment to their safety strategy 4.Support teams to evaluate the strength of the relationship between their project & their organisation safety strategy 5.Teams begin to formalise projects for communication, sustainability & operational requirements 6.Teams refine their projects, generate structure & format to build upon & develop further as the Programme develops

28. Model for Improvement 28

29. Solution V’s Problem © 2014 AQuA

30. But before we start…………… do you really understand the problem?? © 2014 AQuA Solution vs Problem

31. © 2014 AQuA How do you know what needs improving? We benchmark poorly We’re failing our target Patients who complain Our Outcomes are poor Quantitative data Patients we interview Qualitative data Staff feedback

32. © 2014 AQuA

33. Why, why, why?! ‘Results indicate that when preschoolers ask "why" questions, they're not merely trying to prolong conversation, they're trying to get to the bottom of things.’ © 2014 AQuA http://www.sciencedaily.com/releases/2009 /11/091113083254.htm Frazier et al. Preschoolers' Search for Explanatory Information Within Adult-Child Conversation. Child Development, 2009; 80 (6): 1592 DOI

34. Maps © 2014 AQuA Proces s Map Value Stream Map

35. Diagrams © 2014 AQuA Measles / Dot Diagram Spaghett i Fishbone

36. Analysing qualitative data Thematic analysis: Look for the common themes Construct a story around typical findings The power of a good quote

37. Qualitative Data

38. Constructing a Pareto Chart

42. 80% of problems created by these issues

43. Structuring Projects

44. Project Charters A Project Charter is a tool A clear statement of what you intend to achieve, How you are going to measure success What you are going to work on to achieve success. A Charter is a concise outline of a project

45. What should a Charter include? It should answer three questions: 1.What are we trying to accomplish? 2.How do we know that a change is an improvement? 3.What changes can we make that will lead to improvement?

46. Aims

47. Setting an Aim Why do we need an aim? What are the 3 most important pieces of information that should be included in an aim? What are the 3 basic requirements, to enable the aim to be achieved? Adapted from 47

48. Setting an Aim What are you trying to accomplish? How good? By when? For whom(or what system) Safe T imely E ffective E fficient E quitable P atient Centred Crossing the Quality Chasm: A New Health System for the 21st CenturyCrossing the Quality Chasm: A New Health System for the 21st Century, 2001 Institute of Medicine 48

49. Aim Statement GoodBadUgly We aim to reduce harm and improve patient safety for all of our internal and external customers. By June of 2012 we will reduce the incidence of pressure ulcers in the critical care unit by 50%. Our outpatient testing and therapy patient satisfaction scores are in the bottom 10% of the national comparative database we use. As directed by senior management, we need to get the score above the 50 th percentile by the end of the 1 st Quarter of 2012. We will reduce all types of hospital acquired infections. According to the consultant we hired to evaluate our home health services, we need to improve the effectiveness and reliability of home visit assessments and reduce rehospitalisation rates. The board agrees, so we will work on these issues this year. Our most recent data reveal that on the average we only reconcile the medications of 35% of our discharged inpatients. We intend to increase this average to 50% by 1/4/12 and to 75% by 31/8/12. 49

50. Aim Statement Brief rationale. (What’s the problem? Why is it important? What are we going to do about it?) What exactly are you trying to achieve? For whom are you going to improve it for? By how much will you improve it? By when are you aiming to achieve it? Final Aim Statement 50 Adapted from

51. Group Work 51

52. Driver Diagrams

53. Driver Diagrams – why use them? Breaks down any broad aim, graphically, into increasing levels of detailed actions that must or could be done to achieve the stated aim Helps to focus on the cause and effect relationships that exist in complex situations. Well defined drivers that can form the focus of improvement efforts. NHS Tayside 53

54. What are the component parts? Aim or goal of the improvement effort Primary drivers - system components that contribute directly to the chosen aim or goal. Processes, rules of conduct, structure Secondary drivers - elements of the primary drivers and which can be used to create change projects. Components and activities Relationship arrows - show the connection between the primary and secondary drivers. A single secondary driver may impact upon a number of primary drivers NHS Tayside 54

55. 55 Aim Primary Outcome (Measure) Primary Driver Secondary Driver A. B. C. D. Secondary Driver A. B. C. D. Secondary Driver A. B. C. D. Driver Diagram Primary drivers are system components which will contribute to moving the primary outcome. Secondary drivers are elements of the associated primary drivers. They can be used to create projects or change packages that will affect the primary driver.

56. Developing Drivers Dedicate time for team and subject matter experts – ask them to come prepared! Revisit your aim statement. Brainstorm potential Primary Drivers & check –’If I made an improvement in this driver what would it achieve?’ –’If I could influence (or improve) against all of these drivers is there anything else that could go wrong and prevent me achieving my aim?’ For each Primary, brainstorm Secondary Drivers & check Add relationship arrows NHS Tayside 56

57. © 2010 AQuA 57 Aim A reduction in incidents of violence& aggression by 20% in the STAR Unit during 2012/13 Care Planning Environment Workforce A. Raise awareness B. Introduce a SU advanced statement re management of V&A. A. Post all records (agreed actions) of the community meetings in a central area. B. Post a weekly activity programme at a central point on the ward. A. Develop a formal process regarding the planning of social & therapeutic activities. B. Introduce a community meeting. C. Redesign role of staff member – activity co-ordinator. Driver Diagram - STAR Unit Primary drivers are the systems changes which will contribute to achieving the Aim outcome measure. Secondary drivers are interventions associated with primary drivers. They can be used to create projects or change packages that will affect the primary driver. A. Review and compare data – make data easily available to staff.. B. Identify specific times/places/ personnel involved in V&A. C. Provide poster for staff comments re new PDSAs. D. Provide staff with written updates re V&A to inform staff on return from days off. E. Recruit permanent staff to vacant posts. Therapeutic Intervention s Primary Drivers Secondary Drivers

58. 90% of patients in Bay 1 receive their lunch of choice everyday by 12.30 by July 2013 Know what patients want / need for lunch Lunch & equipment arrives on time Ward Staff are available to give out lunch Patients are available to receive lunch Menu cards distributed Choices recorded & communicated Diet requirements understood Numbers established & communicated Time for delivery agreed Access to ward available Allocate lunch duty Complete other tasks prior to lunch arrival Staff appropriately trained Schedule inpatient appts appropriately Appropriately positioned Maintained at appropriate temperature Aim / Outcome Primary Drivers Secondary Drivers 58

59. Feedback

60. Break

61. Helen Baxter Sustainability & spread

62. Next steps

63. Today 1.Complete and return evaluations (2 sides!) please 2.Assess project against scale provided 3.Agree next contacts as a team 4.Decide support from AQuA & contact Clare to arrange this

64. Tomorrow/Monday Refine driver diagrams Discuss & share with other colleagues Share concept of compacts Complete & return safety culture survey

65. Next session Day 2 Tomorrow Same venue Same start time!