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Get safety, improvement, transformation out of their boxes: inter-dependent not independent approaches

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Get safety, improvement, transformation out of their boxes: inter-dependent not independent approaches. Presentation at International Forum of Quality and Safety in Healthcare, (virtual) Copenhagen, 6 November 2020 by Helen Bevan, Sasha Karakusevic, Leigh Kendall, Diane Ketley

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Get safety, improvement, transformation out of their boxes: inter-dependent not independent approaches

  1. 1. Get safety, improvement, transformation out of their boxes: inter-dependent not independent approaches to change #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  2. 2. Hello and welcome Please say hello Type in ‘conversations’ box what 3 words describe your best insights from the forum. @HorizonsNHS #Quality2020
  3. 3. Helen Bevan Sasha Karakusevic Leigh Kendall Diane Ketley #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall NHS Horizons is a small team within NHS England and NHS Improvement that provides design and delivery support on practical approaches to large-scale change
  4. 4. Does this really matter to patients and clinical teams #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  5. 5. What is it like to be a patient on a complex pathway? #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  6. 6. So how many questions would you be asked on your patient journey? Poll 0-100 100-500 500-1000 1000+ #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  7. 7. Leigh and Hugo's Story • I had HELLP syndrome at 24 weeks' pregnant. • (A rare, life-threatening pregnancy complication) • Blue-lighted to a hospital two hours away from home • My baby son – Hugo - born while I was under general anaesthetic • I was in the adult intensive care, and Hugo was in neonatal intensive care – literally at opposite ends of the hospital. • Being 16 weeks premature, Hugo was critically ill – staff in either unit would not facilitate us meeting. #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  8. 8. Can we improve on these scenarios? How would you use safety, improvement and transformation approaches to improve these scenarios? We will put you in to breakout rooms to discuss your thoughts for around 10 minutes At the end of your discussion consider How much did you agree? How certain were you about what to do next? #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  9. 9. How much agreement was there between you? 1- 5 How certain were you about the next steps to take? 1-5 (1 = Low 5 = High) High does not mean good and low does not mean bad
  10. 10. Our approach needs to fit our context Adapted from Ralph Stacey@HorizonsNHS #Quality2020 5 1 1
  11. 11. The answer isn't behind you Wasgij “ Cone-gestion”
  12. 12. Perhaps the biggest challenge is to change how we see the world
  13. 13. Focus our effort on high- impact issues
  14. 14. 4.6m shortage 40m shortage Talent wasted
  15. 15.  what you learn with agency [the power to make a difference, individually and collectively] is different from what you learn without agency even if it is the same information  Etienne Wenger Lankelly Chase workshop, October 2019 #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  16. 16. #Quality2020 @HorizonsNHS
  17. 17. “Complexity thinking adds a real-world, multi- dimensional appreciation of the system…but it does not make it easier to effect change; in fact the opposite is true. Even though this makes our ambitions to improve healthcare infuriatingly more difficult, we must grapple with the world we actually inhabit, not the one we wish we did” Braithwaite, Churruca, Long et al BMC Medicine 2018 Choosing Complexity #Quality2020 @HorizonsNHS
  18. 18. What do we need to focus on to embrace complexity? #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  19. 19. What if we apply the principles of spread and adoption to safety, improvement and transformation? …dynamic, reciprocal interacting, iterative and evolving activity...not linear and mechanistic …developmental, contextualised, adaptive, learning and social process More information at http://horizonsnhs.com/programmes-of-work/spread-and-innovation/ #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  20. 20. How do we connect with others to work better together? #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  21. 21. to make Taking the Power is the ability to produce intended effects Bertrand Russell change happen #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  22. 22. Find the 3% “super-connectors”! Source: Organisational Network Analysis by Innovisor Just 3% of people in the organisation or system typically influence 85% of the other people .Influencers #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  23. 23. Don’t underestimate the power of social as a source of information to drive change #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  24. 24. What does this mean for me? - Build your connections and relationships - Be a model of trust and positive behaviours - Always, always follow up Be a superconnector - Get their insights - Engage them in change - Stay connected for the long haul Find your superconnectors #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  25. 25. Leigh and Hugo’s Story – What Happened Next? • Hugo and I finally met 36 hours after he was born. NICU, maternity, and ICU were simply unable to communicate effectively with one another. • The clinical care we both received was exemplary – they saved my life, and gave us 35 precious days with Hugo. • After Hugo died, I submitted a formal complaint to the hospital about my experience in ICU. • The response I received was dismissive – so I set to work. #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  26. 26. #HugosLegacy was created – requesting meetings with health care professionals, connecting with people on social media, writing a blog, writing articles for national publications. Campaigning, speaking at the Houses of Parliament and House of Lords #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  27. 27. Nobody’s Patient project #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  28. 28. Nobody’s Patient workshop at St George’s Hospital, September 2016 #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  29. 29. • I used my power to make things happen; • I utilised social media as a force for change; to have conversations, find the superconnectors, spread good practice • Interdependent approaches, taking things out of their boxes included NICU, OBGYN, anaesthetists, theatre staff, and others. Moving from “well this is how we’ve always worked” to realising talking to one another and collaborating How I made this happen #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  30. 30. Breakout How can we build on people's desire to get more things right? When you come back please share your ideas in the conversation space 5 minutes #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  31. 31. Sharing power #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  32. 32. Launch Event Project P Falls assessment service Film making #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  33. 33. People own what they help to create.. Bottom up not top down • Frontline engagement • Co-creation • Going where the energy is • Flexible and emergent……. • Virtual / Social media AndConnecting the system to itself • AACE – Chief Executives Support • NHSE (Ambulance improvement programme) • Other groups where we can (learn and share) • People with an interest and/or passion Approach based on Myron’s Maxims Find your allies…… #Quality2020 @HorizonsNHS
  34. 34. Basis of national falls guidance for ambulance services, details Association of Ambulance Chief Executives Falls Initiative and WAST Falls Pathway #Quality2020 @HorizonsNHS
  35. 35. • WAST falls framework development is driven by patient safety and patient experience • Using QI methods • Transforming how parts of the system work and interrelate • Complexity – working with emergence https://nhshorizons.passle.net/post/102ghnd/complexity-and-system-convening-a-lightbulb-moment https://youtu.be/XpJauiWQYkw?t=1 Safety, improvement and transformation working together @ClaireRoche19 @ihbaines #Quality2020 @HorizonsNHS
  36. 36. • Designs a plan • Accountability within a governance system • Ensures that delivery milestones are met • Deals with risk and ensures that barriers are overcome • Works with emergence • Builds commitment to a collective goal • Builds relationships • Seeks win/wins • Makes sense of things for adopters: the why? • Enables spread across a whole system Independent Complicated Interdependent Complex PROGRAMME MANAGEMENT SYSTEM CONVENING Working with complexity needs an enabling leadership style More information at http://horizonsnhs.com/programmes-of-work/spread-and-innovation/ #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  37. 37. Creating time and space for transformation
  38. 38. 1 2 3 4
  39. 39. Which is the odd one out? 1 2 3 4
  40. 40. Structures are often designed to deliver current processes efficiently They cannot be guaranteed to deliver major transformation programmes Changing the whole structure is a big task (that might not produce the expected result) Think about where the boundaries are Break the task down to contain the it and manage anxiety Build alliances Make sure you have a process to build connections between the elements Act to create time to probe, sense and respond Key Points #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  41. 41. Creating the right kind of spaces to work together
  42. 42. The era of the unconference We are witnessing the collapse of expertise and rise of collaborative sensemaking David Holzmer Source of image: ACCA #Quality2020 @HorizonsNHS
  43. 43. #Quality2020 @HorizonsNHS
  44. 44. for an Accelerated Design Event (ADE) •Co-designed •Facilitated •Dynamic •Adaptive •Connective •Playful Source: The Value Web/ MG Taylor • Iterative • Integrative • Collaborative • Self-organising • Emergent #Quality2020 @HorizonsNHS
  45. 45. Our vaccination coverage is not high enough. We need to redesign the system…
  46. 46. 49 | We used Future Backwards to build a shared understanding • Become more aware of other perspectives and to become more aware of our own perspective • Reveal historical perceptions of the past • Enable more diverse thinking • Navigate in an uncertain world • Understand hopes and aspirations as well as fears and concerns Where we came from #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  47. 47. 50 | What your room will create in 5 stages Where we came from https://wiki.sensemaker-suite.com/index.php/Future_backwards #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  48. 48. #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  49. 49. • Flexible offer and access for vulnerable groups • Education and training to support communication • Stakeholder input into design • Designing delivery and commissioning for optimum access/uptake The themes that emerged #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  50. 50. #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  51. 51. Work as imagined Work as done #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  52. 52. #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  53. 53. Creating space for creativity Source of data: Nick Milton http://www.nickmilton.com/2014/10/why- knowledge-transfer-through.html Social connection/discussion is 14 times more effective than written word/best practice databases/toolkits etc. Source of image: www.happiness-one-quote-time.blogspot.com #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  54. 54. There are 10540 children who aren’t vaccinated Let’s start our work here. #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  55. 55. Breakout What creative methods are you using to bring people together? 5 minutes When you come back, please summarise your thoughts ready for the conversation space. Please do not press return/send until we ask you to.... #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  56. 56. Creating a positive environment for change #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  57. 57. Where is the power for change in the system? Here And here Where are expert functions roles like safety, improvement and transformation based? Here The places in the system to focus if we want change to happen quickly and at scale Support change to happen (without having the power to make change happen directly) Source: Mintzberg’s five components of an organisation #Quality2020 @HorizonsNHS
  58. 58. Beneficial changes arising from Covid that people in the NHS would like to amplify: Source: #OurNHSPeople tweet chat, August 2020 Key themes • There are leaders everywhere in the system • Distributed leadership – people being able to take on tasks based on what people needed, rather than banding or status • Bringing people together - out of silos • Making new connections with people across their organisations, and across the system #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  59. 59. Thursday 15 March #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  60. 60. Your reflections What 3 words describe our jobs to be done?
  61. 61. Remove the blockages
  62. 62. Whatever we do, we do it together #Quality2020 @HorizonsNHS @HelenBevan @Karas01 @DianeKetley @LeighAKendall
  63. 63. #GPforwardview Thankyou
  64. 64. Our film on crowdsourcing https://www.youtube.com/watch?v=YKWIfMrV92c

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