1. A METHOD TO OUR MADNESS: OUR THEORY OF HOW IMPROVEMENT HAPPENS Ninon Lewis and David Williams Institute for Healthcare Improvement Early Years Collaborative: Learning Session 4

2. COMPONENTS OF A LEARNING SYSTEM 1.System level measures 2.Explicit theory or rationale for system changes 3.Segmentation of the population 4.Learn by testing changes sequentially 5.Use informative cases: “Act for the individual learn for the population” 6.Learning during scale-up and spread with a production plan to go to scale 7.Periodic review 8.People to manage and oversee the learning system Source: Tom Nolan PhD, Associates in Process in Improvement

3. SESSION OBJECTIVES Explore Stephen Covey’s “Big Rocks Theory” as a guide to understanding how we can prioritize our work Connect the Big Rocks theory to the seven Early Years Collaborative key change areas Explore a four-part execution strategy for EYC improvement efforts within key changes

4. Place the big rocks first… Video Credit: The Seven Big Rocks Productivity System

5. Early Years Aim Early Intervention in Maternity Services Attachment and Child Development Beyond Maternity Services Continuity of Care in Transitions Between Services 27 - 30 Month Child Health Review Developing Parents' Skills Family Engagement to Support Early Learning Income Maximisation KEY CHANGES

6. A FRAMEWORK FOR EXECUTION

7. CPP EXECUTION STRATEGY Setting Breakthrough Performance Goals Developing a Portfolio of Projects to Support the Goals Deploying Resources to the Projects That Are Appropriate for the Aim Establishing an Oversight and Learning System to Increase the Chance of Producing the Intended Results

8. Setting Breakthrough Performance Goals Early Intervention in Maternity Services Breakthrough Performance Goal #1 Breakthrough Performance Goal #2 Attachment and Child Development beyond maternity services Breakthrough Performance Goal #1 Breakthrough Performance Goal #2 Breakthrough Performance Goal #3 Continuity of Care in Transitions Between Services Breakthrough Performance Goal #1 27 - 30 Month Child Health Review Breakthrough Performance Goal #1 Developing Parents' Skills Breakthrough Performance Goal #1 Breakthrough Performance Goal #2 Family Engagement to Support Early Learning Breakthrough Performance Goal #1 Income Maximisation Breakthrough Performance Goal #1 Breakthrough Performance Goal #3 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 12345678910111213141516171819202122232425 weeks Percent

9. PORTFOLIO OF MEASURES

10. DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS A portfolio is a collection of projects that will together move our stretch aims. Your portfolio will be informed by a broad view of what you and other partners can do. There’s a lot in your portfolio already.

11. DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS Early Years Aim Early Intervention in Maternity Services Project Attachment and Child Development Beyond Maternity services Project Income Maximisation Project 27 - 30 Month Child Health Review Project Developing Parents' Skills Project

12. DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS Early Years Aim Early Intervention in Maternity Services Project Attachment and Child Development Beyond Maternity services Project Income Maximisation Project 27 - 30 Month Child Health Review Project Developing Parents' Skills Project

13. DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS Early Years Aim Early Intervention in Maternity Services Project Attachment and Child Development Beyond Maternity services Project Income Maximisation Project 27 - 30 Month Child Health Review Project Developing Parents' Skills Project

14. DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS Early Years Aim Early Intervention in Maternity Services Project Attachment and Child Development Beyond Maternity services Project Income Maximisation Project 27 - 30 Month Child Health Review Project Developing Parents' Skills Project

15. Children have all the developmental skills and abilities expected of a 27-30 month old Societal Issues Child’s physical & mental health and emotional development Carer’s physical & mental health and skills Level of education Improved sharing of information Improved joint working Improved early identification Detailed Aim: 85% of all children within each CPP have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review by end-2016 Misuse of alcohol & drugs Health Improved child’s dental health Improving child nutrition Poverty Quality Of Home Environment Domestic Abuse & Violence Nutrition Disabilities & Mental health Attachment Improved stability / permanence for LAC Improved money management Improved management, planning and quality of services Improved family centred response Improved leadership, culture and planning Improved teamwork, communication, skills and collaboration Improving brain development and physical play Parenting skills & knowledge WORKSTREAM 2 (1 year to 30 months) Identification & reasons for current resilience Aim 1⁰1⁰ 2⁰2⁰ Theory of what drives developmental milestones Theory of what actions will ensure developmental milestones are reached Workforce Issues Transport, Community Capacity & Cultures Early Learning & Play Access To Services Employment Additional Support Version: 06/03/2013 R Where project ideas come from!

16. DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS A portfolio is a collection of projects that will together move our stretch aims. Your portfolio will be informed by a broad view of what you and other partners can do. There’s a lot in your portfolio already. Use a driver diagram or logic model to show how the portfolio hangs together You can annotate with system and project measures

17. Aim Statement: Improve what? By how much? By When Change Ideas Every project wants a charter Measure(s) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 12345678910111213141516171819202122232425 weeks Percent

18. SAMPLE PROJECT CHARTER (LOCATED ON EYC EXTRANET)

19. What’s in your CPP’s Portfolio of Projects? What key changes do they belong to? Are there any key changes without project activity? AT YOUR TABLES…

20. CPP STAFFING Deploying Resources to the Projects That Are Appropriate for the Aim Establishing an Oversight and Learning System to Increase the Chance of Producing the Intended Results

21. SAMPLE CPP STAFFING MODEL

23. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 12345678910111213141516171819202122232425 weeks Percent 1 2 3 4 5 6

24. SAMPLE CPP STAFFING MODEL

26. Considering this model… How are your resources deployed? What are the gaps? What does your CPP need to develop going forward? AT YOUR TABLES…

27. REPEATED USE OF THE PDSA CYCLE Hunches Theories Ideas Changes That Result in Improvement AP SD A P S D AP SD D S P A DATA Very Small Scale Test Follow-up Tests Wide-Scale Tests of Change Implementation of Change 1) What are we trying to accomplish? 2) How will we know that a change is an improvement? 3) What change can we make that will result in improvement? Sequential building of knowledge under a wide range of conditions 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 12345678910111213141516171819202122232425 weeks Percent 1 2 3 4 5 6

28. A P S D A P S D A P S D D S P A A P S D A P S D A P S D D S P A A P S D A P S D A P S D D S P A A P S D A P S D A P S D D S P A Early Intervention in Maternity Services Project(s) Attachment and Child Development beyond maternity services Project(s) Developing parents' skills Project(s) Continuity of care in transitions between services Project(s) A P S D A P S D A P S D D S P A 27 - 30 month Child Health review Project(s) AIM: BIG DOT EARLY YEARS

29. Change Concepts, Theories, Ideas Attachment and Child Development beyond maternity services 27 - 30 month Child Health review Early Intervention in Maternity Services Continuity of care in transitions between services MULTIPLE KEY CHANGES FOR A SINGLE AIM

30. Thank You!