2. Change is great- you go first! Tony Martin Practice Business Manager July 2008 Hebden Bridge Group Practice

3. Change or Improvement Why? How? What? What’s my role in it? Why can’t it just go away? Why can’t you just go away? Hebden Bridge Group Practice

4. 19k patients 9 partners 3 sites 44 staff (33wte) 10% of Calderdale Hebden Bridge Group Practice

5. Finance QOF / DES / LES Human Resources Practice Based Commissioning Service Provision Risk “Growing the business” Competition Culture Hebden Bridge Group Practice

6. Does that sound familiar? What’s important to the person next to you? What’s in it for them? Are they comfortable? How much do you need them? How much do they need you? Hebden Bridge Group Practice

7. So what’s important? Improving health Hebden Bridge Group Practice

8. So how is what’s important delivered? People Process Hebden Bridge Group Practice

9. Access Quality Finance Business Plan Hebden Bridge Group Practice

10. We must…… A. Understand the present B. Understand the desired future Get from A to B Hebden Bridge Group Practice

11. “Every system is perfectly designed to deliver the results it gets” Don Berwick Institute of Healthcare Improvement Boston Hebden Bridge Group Practice

12. The KISS Principle…… K eep I t S imple S tupid! Hebden Bridge Group Practice

13. It’s all the same….. Service Improvement Quality Management Lean Kaizen (but not Kaiaku) Common Sense Hebden Bridge Group Practice

14. The People The NHS is unique Stakeholders (sorry) Encouragement and support Patients, patients, patients Hebden Bridge Group Practice

15. Process is King (or Queen) “..we achieve excellent results with mediocre people using brilliant processes” Fujio Cho- Chief Executive,Toyota Hebden Bridge Group Practice

16. Extended Hours Recruit Nurse Practitioner PBCQOFGP Training Capacity Processes Roles and Resp. Training needs analysis

17. Understanding Processes What’s the real problem Bottlenecks, constraints and hand- offs Complexity Opportunities The theory is… Hebden Bridge Group Practice

18. Process Mapping What’s really going on- no individual knows Stakeholders- team building! Understand the problem before you design the solution Hebden Bridge Group Practice

19. A process map for a blood test GP requests a blood test Patient takes form reception Patient makes appt Patient attends appt Patient has blood taken Blood goes to hospital Result back to GP Patient rings for result Patient informed of results Patient waits in queue Hebden Bridge Group Practice

20. Plan Set objectives Pose questions & make predictions Plan to carry out the cycle (who, what, where when) Do Carry out the plan Document problems and unexpected observations Begin analysis of the data Study Complete the analysis of data Compare data to predictions Summarise what was learned Act Decide what changes are to be made Next cycle Hebden Bridge Group Practice

21. The effect is… You understand what the problem is – not what you think it is The solution is shared and owned It’s more likely to work Future problems become “smaller” Improvement becomes “routine” Hebden Bridge Group Practice

22. It works……. Theatres Outpatients Pathology Referral letters Diabetes Nursing appointments Practice Training Hebden Bridge Group Practice

23. LEARNING LESSONS WITH WINNIE THE POOH: A.A. Milne “Here is Edward Bear, coming downstairs now, bump, bump, bump on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it”. Hebden Bridge Group Practice