Webinar basic service improvement tools and techniques


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NHS Improving Quality held a webinar about basic service improvement tools and techniques for strategic clinical network and mental health teams with little or no service improvement experience. The aim was to raise awareness and gauge future training needs.

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Webinar basic service improvement tools and techniques

  1. 1. Welcome! We will start shortly, but are waiting for people to join, don’t worry if you can’t hear anything yet. Before we start we will be going through some E-Seminar housekeeping items, so that everyone can participate fully in the online meeting If you are having difficulties joining the meeting please call Alyson Banks-Davies on 0116 295 0044 NHS Improving Quality Service Improvement Tools Overview for Mental Health teams
  2. 2. 1. Welcome & Introduction 2. Housekeeping 3. Achieving Excellence in Mental Health 4. The NHS Change Model 5. Benefits of Delivering High Quality Care 6. Process Mapping 7. Demand and Capacity 8. Measurement for Improvement 9. Clients/Patients, Carers and Public Involvement 10. Engagement, Getting Started and Sustainability 11. Case Studies Coming Online 12. Questions & Answers 13. Other Resources and e-Learning 14. What’s Next AGENDA
  3. 3. NHS Improving Quality Service Improvement Tools Overview for Mental Health Teams Jeri Hawkins Elaine Kemp www.nhsiq.nhs.uk/ Welcome and Introduction Anita Hayes Programme Delivery Lead End of Life Care, Mental Health and Dementia
  4. 4. • During the E-Seminar we will mute all delegate’s lines throughout the presentation. • If at other times you are in a noisy environment please mute your line by pressing the mute button on your screen (this can be found on the right hand side of the screen) • If you would like to ask a question please use the raise hand button (this can be found on the right hand side of the screen) • This is an interactive session, please add your comments, and thoughts into the chat box as we go through the presentation. • At the Q&A session, type your question into the chat, or raise your hand, we will un-mute all lines during the Q&A. • If you are having any technical problems, send a message to the Host via the chat panel or call Alyson Banks-Davies on 0116 295 0044 • We will now start recording this Webinar
  5. 5. Achieving Excellence in Mental Health
  6. 6. The NHS Change Model Today – • Process mapping • Demand and Capacity • Measurement for improvement • Patient and public involvement • Engagement and ‘getting started’ and sustainability Where is NHS working now? - Crisis support - Cardiovascular physical Health Checks
  7. 7. Process Mapping
  8. 8. Process map of the pathway for an in-patient to receive CBT for psychosis. Bayney R APT 2005;11:305-314 ©2005 by The Royal College of Psychiatrists
  9. 9. 4
  10. 10. 4
  11. 11. DEMAND AND CAPACITY Demand – How much work we are asked to do - referrals Backlog – Work we have been as yet unable to do – waiting lists Capacity – The amount of work we should be able to do – beds Waste – The amount of capacity lost – cancellations, DNA’s Activity – What we actually delivered
  12. 12.  Demand, capacity, activity and backlog need to be measured in the same units for the same period of time  Don’t compare unless they are measured in the same unit of time  It is important to compare on a single graph and the same measures must be used for each • When you: - have a completed process map, identified the long delays and understand the variation - need to focus improvement on flow and prove a variance between demand and capacity Examples: • Reducing the time from receipt of referral to first assessment appointment for CMHT • Improving the transition time between liaison psychiatry assessment in the ED and provision of appropriate further services, eg inpatient specialist bed When to look at demand and capacity
  13. 13. A Few benefits of looking at demand and capacity • Flow can be improved by reducing the variation in capacity and ensuring that the capacity meets the variations in demand, particularly where there is a constraint (bottleneck) in the process • Balancing demand and capacity can help reduce errors by ensuring staff are not working in an environment where there is a constant backlog • Most delays and inefficiencies in the healthcare system are not the result of excess demand or the shortage of resources. The key issue is a mismatch between when capacity is available and when demand presents to a service.
  14. 14. Demand and Capacity Top Tips • Always compare like with like – e.g. time as a unit of measure • Start simple and use existing data where possible • If no data exists complete a snap shot audit • Be aware of the impact on other services of efforts to deal with backlogs (surges of work) and focus on the whole journey • Even in a well designed process flow will be affected by capacity and demand • Make sure clinical and administrative processes are aligned
  15. 15. “You can’t fatten a cow by weighing it” (Palestinian proverb) Improvement is not about measurement, but…….. How do we know if a change is an improvement? “If you can’t measure it, you can’t improve it” Measurement for improvement 16
  16. 16. Measurement throughout the project cycle Project Identification Getting a baseline Did project make a difference Will project sustain Evaluating worth of the project A P DS A P DS A P DS A P DS A P DS 17
  17. 17. 7 Repeat steps 4-6 7 Steps to measurement 1 Decide Aim 2 Choose Measures 3 Define Measures 4 Collect Data 5 Analyse & Present 6 Review Measures 18
  18. 18. The improvement process WaitingTime 0 200 150 100 50 250 Performance Report Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Act Plan DoStudy Special causes present - unpredictable Process predictable (within control limits) Process improvement
  19. 19. To identify whether we are meeting service requirements: How do we know that we are providing the services/products that our service users and carers require? To help us understand our processes: To confirm what we know or reveal what we don't know: Do we know where the problems are? To ensure decisions are based on fact, not emotion: Are our decisions based on well-documented facts and figures or on intuition and gut feelings? To show where improvement needs to be made: Where can we do better? How can we improve? To show if improvements actually happened: Do we have a clear picture? To reveal problems that bias, emotion, and longevity cover up: If we have been doing our job for a long time without measurements, we might assume incorrectly that things are going well. (They may or may not be, but, without measurements, there is no way to tell.) To identify whether others are meeting our requirements: Do people giving us a service know if our requirements are being met? 20 Some Benefits of Measurement
  20. 20. 1. All your gut should tell you is when to eat 2. Measurement is not the goal; improvement is 3. Remember that variation exists 4. Define what you are collecting clearly 5. It is better to measure a few simple things well than to develop many complex metrics and measure them badly 6. A few key measures plotted over time is all you really need to know if there has been an improvement 7. Only interpret data using statistically significant measures 8. Statistical Process Control was designed to be used with PDSA cycles - use it for all stages of your project Measurement Top Tips 21
  21. 21. Clients/Patients, Carers and Public Involvement http://www.nhsiq.nhs.uk/improvement-programmes/experience-of-care.aspx
  22. 22. The secret of getting ahead is getting started. The secret of getting started is breaking your complex overwhelming tasks into small manageable tasks, and then starting on the first one. Mark Twain Engagement, getting started and sustainability
  23. 23. The work before the work…. • Stakeholder profiling • Engagement and working with groups
  24. 24. The work before the work…. • How to manage the project • Sustainability
  25. 25. 3 Case Studies coming online….
  26. 26. 3 Next case study …. Webinar: Wednesday 23rd July, 10am
  27. 27. 3 • Any Questions? If you have a question, either type it into the chat box or raise you hand and we will unmute your line so you can ask us directly.
  28. 28. Other resources and e-Learning http://mentalhealthpartnerships.com/ Mental Health Innovation Hub http://www.yhpho.org.uk/default.aspx?RID=191242 Mental Health Dementia and Neurology Intelligence Network http://www.jcpmh.info/ Joint Commissioning Panel for Mental Health. Co-chaired by RC Psych/RC GP. http://www.wardipedia.org/ Ideas, examples, information and research about therapeutic inpatient mental health care http://www.rcpsych.ac.uk/workinpsychiatry/qualityimprovement.aspx Royal College of Psychiatrists College Centre for Quality Improvement (Note: Access to resources may require membership or subscriptions) http://www.piramhids.com/home.aspx Positive and innovative resources: A Mental Health Interactive Database (Scotland) http://www.icptoolkit.org/home.aspx Integrated Care Pathways for Mental Health (Scotland)
  29. 29. What Next? • We are going to run a poll (insert explanation) to find out if you have any service improvement training needs • We would also like to hear if you have good examples of service improvement
  30. 30. 3 Thank you A link to this webinar will be sent out to you shortly along with a link to the slides which will be made available through our website