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Building the will for a safer
culture in the NHS - thinking
differently about Patient
Safety
Creating a system
devoted to
...
Todays session:
• Set out the emerging plans for improving patient
safety in England
• Look at some theory around large sc...
Mid Staffordshire NHS Trust
Public Inquiry report
published Feb 13
Julie Bailey of Cure the NHS Campaign stands
outside St...
Key messages from the Francis Inquiry –
290 recommendations, 4,000 pages
• This was a system failure as well as failure of...
QualityBetter
Old Way
(Quality Assurance)
QualityBetter Worse
New Way
(Quality Improvement)
Action taken
on all
occurrence...
‘’The most important single change in the NHS in response to this report would
be for it to become, more than ever before,...
Design Rules – some examples from the Design Day event
A system devoted to continual
learning and improvement
National v l...
8
The Patient Safety Collaborative for England
A system devoted to continual
learning and improvement
Key features:
 Lear...
9
• AHSN footprint
• 2-5m population
• Central and local funding
allocated for patient safety
• Quality Improvement expert...
Patient safety improvement – 3 strands
10
Patient safety collaboratives – core priorities outlined by NHS England
A system devoted to continual
learning and improve...
@helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
Creating a patient safety movement:
four things we can learn from t...
Emerging themes in large scale change
Foundation Emerging direction
Organisation Community
Power through hierarchy Power t...
What are the implications for improvement leaders?
• From “doing” improvement to “connecting” for improvement at scale
• R...
@helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
Most large scale change fails to
achieve its objectives
Source: McKinsey Performance Transformation Survey, 3000 responden...
@helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
Factor 1:
Focus on the physiology of change
as much as the anatomy
Anatomy of change Physiology of change
Definition The shape and processes of
the system; detailed analysis;
how the compon...
Anatomy of change Physiology of change
Definition The shape and processes of
the system; detailed analysis;
how the compon...
Anatomy of change Physiology of change
Definition The shape and processes of
the system; detailed analysis;
how the compon...
Intrinsic
motivators
build energy
and creativity
Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
bu...
Intrinsic
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
bu...
Drivers
of extrinsic
motivation
create focus &
momentum for
delivery
Intrinsic
motivators
•connecting to
shared purpose
•e...
Internal
motivators
•connecting to
shared purpose
•engaging, mobilising and
calling to action
•motivational leadership
bui...
@helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
Transformation is not a matter of
intent.........
it is a matter of...
@helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
NHS Change Model
www.changemodel.nhs.uk
@helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
Factor 2:
Build energy for change
@helenbevan #KPHsafety#KHPsafety#KHPsafety
burning platform
versus
burning ambition
@PeterFuda
@helenbevan #KPHsafety#KHPsafety#KHPsafety
Lessons for transformational change
1. In order to sustain
transformational cha...
@helenbevan #KPHsafety#KHPsafety#KHPsafety
You get the best efforts from
others not by lighting a fire
beneath them but by...
@helenbevan #KPHsafety#KHPsafety#KHPsafety
Task
Talk to the person next to you
• What is “my burning ambition” for Improvi...
@helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
Factor 3:
Frame to connect with hearts and
minds
@helenbevan #KPHsafety#KHPsafety#KHPsafety
Framing
Is the process by which leaders construct, articulate
and put across th...
@helenbevan #KPHsafety#KHPsafety#KHPsafety#KHPsafety
If we want people to take action, we have to
connect with their emoti...
@helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
Factor 4:
build shared purpose
@helenbevan #KPHsafety#KHPsafety#KHPsafety
“A shared sense of
corporate purpose,
grounded in universal
values, is the high...
@helenbevan #KPHsafety#KHPsafety#KHPsafety
We know that ...
• Shared purpose is a common thread in successful
change progr...
@helenbevan #KPHsafety#KHPsafety#KHPsafety
From compliance to commitment
“We come from a culture of compliance
and top dow...
@helenbevan #KPHsafety#KHPsafety#KHPsafety
....the last era of management was about how
much performance we could extract ...
Framework for Operational Excellence
©Alan Frankel and IHI 2013
“How” is still work in progress
• We need to create a “mass movement” for safety
in England
• A great Improvement Programm...
THINGS TO MAKE
CHANGE HAPPEN
Where are we now?
Where are we going?
How are we going to get
there?
1.
2.
3.
3
Improving hea...
Improving health outcomes across England by providing improvement and change expertise
Slides Courtesy of Janet Williamson...
Improving health outcomes across England by providing improvement and change expertise
If you can’t describe the
pathway a...
Improving health outcomes across England by providing improvement and change expertise
Be clear what your
ideal looks like...
Improving health outcomes across England by providing improvement and change expertise
Focus on the vital few
things not l...
Improving health outcomes across England by providing improvement and change expertise
Know your improvement
methodology
4...
Improving health outcomes across England by providing improvement and change expertise
Understand the context5.
Today is a...
Improving health outcomes across England by providing improvement and change expertise
Building relationships and building...
Improving health outcomes across England by providing improvement and change expertise
Every day, seek to learn
and contin...
Improving health outcomes across England by providing improvement and change expertise
Improvement requires
personal resil...
Improving health outcomes across England by providing improvement and change expertise
Once you operationalise things you ...
Improving health outcomes across England by providing improvement and change expertise
Happy staff make happy improvers10.
Improving health outcomes across England by providing improvement and change expertise
SUMMARY
Stand in the patient/carer ...
Improving health outcomes across England by providing improvement and change expertise
Pennine acute trust and aqua celebration event   fiona thow
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Pennine acute trust and aqua celebration event fiona thow

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NHS Improving Quality was invited to take part in a recently held event that celebrated the work that is being done in partnership between the Pennine Acute Hospitals NHS Trust and AQuA to deliver a Quality Improvement Methodologies Programme (QuIMP).

Gillian Phazey, Learning and Organisational Development Manager at Pennine Acute Hospitals NHS Trust explains:

'The Learning and Organisational Development and Governance teams at the Pennine Acute Hospitals NHS Trust have been working collaboratively with AQuA to deliver a Quality Improvement Methodologies Programme (QuIMP) to support staff in developing knowledge and skills in this topic. The programme has been specifically designed to support colleagues wanting to gain an introduction to the fundamentals and concepts of quality improvement. So far, two cohorts of staff, from clinical and non-clinical areas of the Trust have completed the programme, and have completed quality improvement projects in their own work area to apply their knowledge. On 17th July a celebration event was held for cohort 2 where staff presented their work in poster or presentation form, the aim of which is to share and spread learning across the Trust. Projects were wide ranging, from introducing new processes to reduce complaints and drug errors, to improving patient experience by implementing new tools and techniques. The day was a great success with the Chief Executive and Chief Nurse in attendance. The Trust is highly supportive of this approach in equipping staff with these important techniques, and the programme supports not only our internal quality agenda and objectives, but more widely responds to the recommendations of the Berwick report. The next cohort is starting in September this year.'

Fiona Thow, Patient Safety Collaborative Delivery Lead at NHS Improving Quality delivered a keynote speech, (link to presentation slides) providing a national perspective on the plans for improving patient safety and took the opportunity to introduce the national safety collaboratives. She also highlighted the need for organisations and individuals to think differently about safety for both patients and staff.

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Transcript of "Pennine acute trust and aqua celebration event fiona thow"

  1. 1. Building the will for a safer culture in the NHS - thinking differently about Patient Safety Creating a system devoted to continual learning and improvement
  2. 2. Todays session: • Set out the emerging plans for improving patient safety in England • Look at some theory around large scale change • Consider the issues and challenges in designing a national improvement programme, if change happens at the microsystem level Please ask questions or make your point at any time – let’s have a discussion not a lecture! 2
  3. 3. Mid Staffordshire NHS Trust Public Inquiry report published Feb 13 Julie Bailey of Cure the NHS Campaign stands outside Stafford Civic Centre
  4. 4. Key messages from the Francis Inquiry – 290 recommendations, 4,000 pages • This was a system failure as well as failure of an individual organisation • No single recommendation should be regarded as the solution to the many concerns identified • A fundamental change in culture is required across the NHS • We need to secure the engagement of every single person serving patients in the change that needs to happen
  5. 5. QualityBetter Old Way (Quality Assurance) QualityBetter Worse New Way (Quality Improvement) Action taken on all occurrences Reject defectives Old Way, New Way Source: Robert Lloyd, Ph.D. Requirement, Specification or Threshold No action taken here Worse
  6. 6. ‘’The most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.’’ ‘’Our most important recommendations for the way forward envision the NHS as a learning organisation, fully committed to the following:’’  Placing the quality of patient care, especially patient safety, above all other aims:  Engaging, empowering, and hearing patients and carers throughout the entire system and at all times:  Fostering whole-heartedly the growth and development of all staff, including their ability and support to improve the processes in which they work:  Embracing transparency unequivocally and everywhere, in the service of accountability, trust, and the growth of knowledge. Don Berwick Findings A system devoted to continual learning and improvement
  7. 7. Design Rules – some examples from the Design Day event A system devoted to continual learning and improvement National v local – building the learning system to support a safety culture & continuous improvement. Building networks that align to local clinical communities Transparent sensible measurement - : “If you’re not measuring you’re not improving, if you are measuring stupidly you are not improving, and if you are only measuring you are not improving” – Mary Dixon Woods. Inclusion – patients equity partnership Preparedness – work before the work – don’t start too soon. Prepare staff, communicate, build in evaluation from the start. Build in capability and embed as part of the day job Leadership, sustainability – what does success look like? Align system drivers
  8. 8. 8 The Patient Safety Collaborative for England A system devoted to continual learning and improvement Key features:  Learning from the past, adapting what works in improvement  Systematic application across England with widespread engagement  Positioned as transformational not transactional change  Set within the context of NHS England’s Patient Safety Plan  Locally led; across all healthcare organisations and all sectors – providers and commissioners  Patient centred  Engaged with clinical staff at all levels  Focused on fewer priorities but at scale to demonstrate results in year one  Using a range of improvement tools, techniques, social movement approaches and capability building
  9. 9. 9 • AHSN footprint • 2-5m population • Central and local funding allocated for patient safety • Quality Improvement expertise and support form NHS IQ available • Linking good practice and sharing learning widely • Shared purpose A system devoted to continual learning and improvement Patient safety collaboratives
  10. 10. Patient safety improvement – 3 strands 10
  11. 11. Patient safety collaboratives – core priorities outlined by NHS England A system devoted to continual learning and improvement Topic area Patient Safety Topic The ‘essentials’ Leadership Measurement NHS Outcomes Framework improvement areas VTE HCAI Pressure Ulcers Maternity Medication Errors Deterioration in children Other major sources of death and severe harm Falls Handover and Discharge Nutrition and hydration AKI Deterioration in adults Sepsis Medical Device Errors Vulnerable groups for whom improving safety is a priority People with Mental Health needs People with Learning Disabilities Children Offenders Acutely ill older people Transition between paediatric and adult care
  12. 12. @helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore Creating a patient safety movement: four things we can learn from the great social movements (Helen Bevan’s Slides)
  13. 13. Emerging themes in large scale change Foundation Emerging direction Organisation Community Power through hierarchy Power through connection Mission and vision Shared purpose Making sense through rational argument Making sense through emotional connection Leadership-driven (top down) innovation Viral (grass-roots driven) creativity Led by expert opinion Allow all talent Engaged patients Passionate users Clinical networks Mass communities Tried and tested, based on experience “Net Generation” principles Transactions Relationships
  14. 14. What are the implications for improvement leaders? • From “doing” improvement to “connecting” for improvement at scale • Rethinking: • who’s in the improvement community • How we lead change • Metrics of success • New roles • Curators • Relationship leaders • Storytellers • Co-creators • New mechanisms for connecting: • Social media • Web seminars • Tweet chats • New methods for leading improvement • open innovation • hacks/hackathons • crowdsourcing • Ideas channels
  15. 15. @helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore
  16. 16. Most large scale change fails to achieve its objectives Source: McKinsey Performance Transformation Survey, 3000 respondents to global, multi-industry survey 70% 25% 5%
  17. 17. @helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore Factor 1: Focus on the physiology of change as much as the anatomy
  18. 18. Anatomy of change Physiology of change Definition The shape and processes of the system; detailed analysis; how the components fit together. The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes and structures to deliver health and healthcare Energy/fuel for change Leadership activities  measurement and evidence  improving clinical systems  reducing waste and variation in healthcare processes  redesigning pathways  creating a higher purpose and deeper meaning for the change process  building commitment to change  connecting with values  creating hope and optimism about the future  calling to actionSource: Crump and Bevan
  19. 19. Anatomy of change Physiology of change Definition The shape and processes of the system; detailed analysis; how the components fit together. The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes and structures to deliver health and healthcare Energy/fuel for change Leadership activities  measurement and evidence  improving clinical systems  reducing waste and variation in healthcare processes  redesigning pathways  creating a higher purpose and deeper meaning for the change process  building commitment to change  connecting with values  creating hope and optimism about the future  calling to actionSource: Crump and Bevan
  20. 20. Anatomy of change Physiology of change Definition The shape and processes of the system; detailed analysis; how the components fit together. The vitality and life-giving forces that enable the system and its people to develop, grow and change. Focus Processes and structures to deliver health and healthcare Energy/fuel for change Leadership activities  measurement and evidence  improving clinical systems  reducing waste and variation in healthcare processes  redesigning pathways  creating a higher purpose and deeper meaning for the change process  building commitment to change  connecting with values  creating hope and optimism about the future  calling to action
  21. 21. Intrinsic motivators build energy and creativity
  22. 22. Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity
  23. 23. Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity create focus & momentum for delivery Drivers of extrinsic motivation
  24. 24. Drivers of extrinsic motivation create focus & momentum for delivery Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity •System drivers & incentives •Payment by results •Performance management •Measurement for accountability
  25. 25. Internal motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity Drivers of extrinsic motivation •System drivers & incentives •Performance management •Measurement for accountability create & focus momentum for delivery
  26. 26. @helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore Transformation is not a matter of intent......... it is a matter of alignment Peter Fuda
  27. 27. @helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore NHS Change Model www.changemodel.nhs.uk
  28. 28. @helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore Factor 2: Build energy for change
  29. 29. @helenbevan #KPHsafety#KHPsafety#KHPsafety burning platform versus burning ambition @PeterFuda
  30. 30. @helenbevan #KPHsafety#KHPsafety#KHPsafety Lessons for transformational change 1. In order to sustain transformational change, we as leaders need to move from a burning platform (fear based urgency) to a burning ambition (shared purpose for a better future) 2. We as leaders need to articulate personal reasons for change as well as organisational reasons 3. If the fire (the energy) goes out, all other factors are redundant @PeterFuda
  31. 31. @helenbevan #KPHsafety#KHPsafety#KHPsafety You get the best efforts from others not by lighting a fire beneath them but by building Source: Bob Nelson
  32. 32. @helenbevan #KPHsafety#KHPsafety#KHPsafety Task Talk to the person next to you • What is “my burning ambition” for Improving Patient Safety • Try to make it personal: tell others why this ambition connects with your personal motivations
  33. 33. @helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore Factor 3: Frame to connect with hearts and minds
  34. 34. @helenbevan #KPHsafety#KHPsafety#KHPsafety Framing Is the process by which leaders construct, articulate and put across their message in a powerful and compelling way in order to win people to their cause and call them to action Snow D A and Benford R D (1992)
  35. 35. @helenbevan #KPHsafety#KHPsafety#KHPsafety#KHPsafety If we want people to take action, we have to connect with their emotions through values action values emotion Source: Marshall Ganz
  36. 36. @helenbevan #KPHsafety#KHPsafety#KHPsafety@weatherbore Factor 4: build shared purpose
  37. 37. @helenbevan #KPHsafety#KHPsafety#KHPsafety “A shared sense of corporate purpose, grounded in universal values, is the highest octane source of fuel for organisational action.” Schwartz and Loehr (2004)
  38. 38. @helenbevan #KPHsafety#KHPsafety#KHPsafety We know that ... • Shared purpose is a common thread in successful change programmes* • Organisations and change initiatives with strong shared purpose consistently outperform those without it.** *What makes change successful in the NHS? Gifford et al 2012 (Roffey Park Institute) **Management Agenda 2013 Boury et al (Roffey Park Institute)
  39. 39. @helenbevan #KPHsafety#KHPsafety#KHPsafety From compliance to commitment “We come from a culture of compliance and top down performance management, … It’s task-orientated to get things done. It needs to be much more about cooperation, about leading across boundaries … Being able to focus on shared purpose in those circumstances is absolutely crucial.” NHS interviewee
  40. 40. @helenbevan #KPHsafety#KHPsafety#KHPsafety ....the last era of management was about how much performance we could extract from people .....the next is all about how much humanity we can inspire Dov Seidman
  41. 41. Framework for Operational Excellence ©Alan Frankel and IHI 2013
  42. 42. “How” is still work in progress • We need to create a “mass movement” for safety in England • A great Improvement Programme is just one part. • We intend to do “lots of lots” – creating networks, sharing good practice, frequent persistent communication and PR, maximising the role of champions / fellows, connecting the dots, social media, building capability, etc -etc. etc. etc. – plus some things we don’t yet know! Hacks, crowdsourcing, MOOCs (thanks Helen)
  43. 43. THINGS TO MAKE CHANGE HAPPEN Where are we now? Where are we going? How are we going to get there? 1. 2. 3. 3 Improving health outcomes across England by providing improvement and change expertise
  44. 44. Improving health outcomes across England by providing improvement and change expertise Slides Courtesy of Janet Williamson Director of Programmes, NHS IQ
  45. 45. Improving health outcomes across England by providing improvement and change expertise If you can’t describe the pathway and walk it, you can’t change it. I hear and I forget, I see and I remember, I do and I understand. Confucius, Chinese philosopher & reformer 1.
  46. 46. Improving health outcomes across England by providing improvement and change expertise Be clear what your ideal looks like 2. Be BOLD, be ambitious
  47. 47. Improving health outcomes across England by providing improvement and change expertise Focus on the vital few things not long lists 3.
  48. 48. Improving health outcomes across England by providing improvement and change expertise Know your improvement methodology 4. It does not matter which approach, but stick to it Don’t move into doing until you have baseline, you have data and you are clear about the issues you are trying to solve
  49. 49. Improving health outcomes across England by providing improvement and change expertise Understand the context5. Today is about doing more and differently but with the same or less money
  50. 50. Improving health outcomes across England by providing improvement and change expertise Building relationships and building capability from the start 6. Redesigning the process, the pathway and the structures is easy, the biggest challenge is winning hearts and minds and changing behaviour
  51. 51. Improving health outcomes across England by providing improvement and change expertise Every day, seek to learn and continue to learn 7.
  52. 52. Improving health outcomes across England by providing improvement and change expertise Improvement requires personal resilience 8.
  53. 53. Improving health outcomes across England by providing improvement and change expertise Once you operationalise things you are not in an improvement roll, so STOP 9.
  54. 54. Improving health outcomes across England by providing improvement and change expertise Happy staff make happy improvers10.
  55. 55. Improving health outcomes across England by providing improvement and change expertise SUMMARY Stand in the patient/carer shoes Go see Go search out Do change together Focus on key things Involve all Learn
  56. 56. Improving health outcomes across England by providing improvement and change expertise
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