Part 2 of Dr Peter Chamberlain's discussion of the #QIBBF - the building blocks of continuous improvement.

1. A Virtual Ward
• Common purpose
• Common route/referral pathway
• Communication ‘hard wired’
• Co-location
• Cross cover of roles
• Coordination of roles

2. QI
Leaders
Improvement
Advisors
“Coaches”
All Staff
“Dosing
Formula”
WTE dedicated
Improvement
0.05% > 50% WTE
0.5% 10-50% WTE
5% 5-10% WTE
50% 1-5% WTE
Level Training
Strategic/
Expert
+1 year
Advanced Months -
Year
Intermediate Weeks -
Month
Basic Hours -
Days
CAPACITY CAPABILITY
Institute/QIS
Frontline

4. “Stop THINKING outside the box, start GOING outside the box…”

5. Without this we won’t have the right values to continually improve
Learning
System
Essentials
Person &
Family
Centered
Care
Learning System Essentials
Cultural &
Infrastructure
Essentials

6. Without this we won’t have the right values to continually improve
Comprehensive
‘capture’
process:
Issues, events
& feedback
System
diagnostics
across the
continuum
Model for
Improvement
active at the
frontline
Real time
transparent
measurement &
understanding of
variability
Learning
System
Essentials
Person &
Family
Centered
Care
Learning System Essentials
Cultural &
Infrastructure
Essentials

7. Organisation
Division
Ward
System
diagnostics
across the
continuum

8. System
diagnostics
across the
continuum
What is
actually
going on in
your
system?

9. System
diagnostics
across the
continuum
Current
“5 why’s”
Future

10. System
diagnostics
across the
continuum
Aim
Measures
Change Concepts

11. System
diagnostics
across the
continuum
From “Trial and error” to “Trial and learn”

12. System
diagnostics
across the
continuum

13. System
diagnostics
across the
continuum
Chile School Register
Ward Outcomes
Children receiving bedtime story

14. System
diagnostics
across the
continuum
URGENT CARE TEAM DASHBOARD
15
20
25
30
35
Apr-13
Jun-13
Aug-13
Oct-13
Dec-13
Feb-14
Apr-14
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Unplanned Admissions / 1000 population
(>64y) (O#1)
Number/month
Month
Number/month
25
27
29
31
33
35
37
39
41
43
45
Apr-13
Jun-13
Aug-13
Oct-13
Dec-13
Feb-14
Apr-14
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Type 1 A&E attendances / 1000 population
(>64y) (O#2)
Month
0
20
40
60
80
100
120
140
Apr-14
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Oct-16
Dec-16
NWAS cat green conveyances from care
homes (O#3)
Conveyancespermonth
Month
5
6
6
7
7
8
8
9
9
10
10
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Patient & Family Experience Score (O#4)
Scoreoutof10
Month
0
10
20
30
40
50
60
70
80
90
100
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Mean response time (mins) (P#2)
Minutes
Month
0
2
4
6
8
10
12
14
16
18
20
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Number conversions to acute trust - %on
graph (P#3)
Month
%
0
20
40
60
80
100
120
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Average LOS under UCT team (P#4)
Month
Hours
0
20
40
60
80
100
120
140
160
180
200
Jul-14
Sep-14
Nov-14
Jan-15
Mar-15
May-15
Jul-15
Sep-15
Nov-15
Jan-16
Mar-16
May-16
Jul-16
CICT new referrals (B#1)
Number/month
Month
Number/month
0
10
20
30
40
50
60
70
80
90
100
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
CICT 95% Centile LOS (B#2)
Days
Month
0
5
10
15
20
25
30
35
40
45
50
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Referral Source (P#6)
Month
Numberper
0
20
40
60
80
100
120
140
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
New patients seen(activity) (P#1)
Month
Newpatientsseen
0
2
4
6
8
10
12
14
16
18
20
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
Oct-15
Dec-15
Feb-16
Apr-16
Jun-16
Aug-16
Potential & Actual Safety Events [DATIX]
(P#5)
Month
Numberpermonth

15. Comprehensive
‘capture’
process:
Issues, events
& feedback
System
diagnostics
across the
continuum
Model for
Improvement
active at the
frontline
Real time
transparent
measurement &
understanding of
variability
Learning System Actions
DEMOSTRATE
DELIVER
DO
DEVELOP
DIAGNOSE
DISCOVER

16. Cycle time
Comprehensive
‘capture’
process:
Issues, events
& feedback
System
diagnostics
across the
continuum
Model for
Improvement
active at the
frontline
Real time
transparent
measurement &
understanding of
variability
Learning System Effectiveness
Proximity to the frontline
Alignment to strategic objectives

17. Without this we won’t have the right values to continually improve
Family as a
unit of care
Partnership in
personalized
care
From “what’s
the matter?” to
“what matters
to me”
System co-design
Representation
Collective Voice
Valued
workforce &
psychological
safety
Compassionate
leadership with
relentless focus
who connect
with the ‘front
line’
Functional
‘Team’ ethos
incl. clinical &
informatics
integration
Increasing staff
capacity
& capability in
QI & innovation
Comprehensive
‘capture’
process:
Issues, events
& feedback
System
diagnostics
across the
continuum
Model for
Improvement
active at the
frontline
Real time
transparent
measurement &
understanding of
variability
Cultural &
Infrastructure
Essentials
Learning
System
Essentials
Person &
Family
Centered
Care
© Dr Peter Chamberlain

18. Without this we won’t have the right values to continually improve
Family as a
unit of care
Partnership in
personalized
care
From “what’s
the matter?” to
“what matters
to me”
System co-design
Representation
Collective Voice
Valued
workforce &
psychological
safety
Compassionate
leadership with
relentless focus
who connect
with the ‘front
line’
Functional
‘Team’ ethos
incl. clinical &
informatics
integration
Increasing staff
capacity
& capability in
QI & innovation
Comprehensive
‘capture’
process:
Issues, events
& feedback
System
diagnostics
across the
continuum
Model for
Improvement
active at the
frontline
Real time
transparent
measurement &
understanding of
variability
Cultural &
Infrastructure
Essentials
Learning
System
Essentials
Person &
Family
Centered
Care
© Dr Peter Chamberlain
Deming’s “System of Profound Knowledge”
S
K P
V

19. Without this we won’t have the right values to continually improve
Family as a
unit of care
Partnership in
personalized
care
From “what’s
the matter?” to
“what matters
to me”
System co-design
Representation
Collective Voice
Valued
workforce &
psychological
safety
Compassionate
leadership with
relentless focus
who connect
with the ‘front
line’
Functional
‘Team’ ethos
incl. clinical &
informatics
integration
Increasing staff
capacity
& capability in
QI & innovation
Cultural &
Infrastructure
Essentials
Learning
System
Essentials
Person &
Family
Centered
Care
© Dr Peter Chamberlain
Without this we won’t have the
mechanisms to sustain continuous
improvement

20. Without this we won’t have the right values to continually improve
Family as a
unit of care
Partnership in
personalized
care
From “what’s
the matter?” to
“what matters
to me”
System co-design
Representation
Collective Voice
Cultural &
Infrastructure
Essentials
Learning
System
Essentials
Person &
Family
Centered
Care
© Dr Peter Chamberlain
Without this we won’t have the
mechanisms to sustain continuous
improvement
Without this we won’t have the foundations
to support continuous improvement

21. Cultural &
Infrastructure
Essentials
Learning
System
Essentials
Person &
Family
Centered
Care
© Dr Peter Chamberlain
Without this we won’t have the
mechanisms to sustain continuous
improvement
Without this we won’t have the foundations
to support continuous improvement
Without this we won’t have the principles
to direct continuous improvement

22. “Going under the bonnet”
Where do we go from here?

23. QI Building blocks Framework
1 2 3 4 5
Is coded data
collected and
collated
automatically in
real time ie. within
one time unit of
specified analysis
(shorter time unit
the better,
maximum time unit
1 month)
Does data on
projects/ work
streams
consistently cover a
family of
meaningful
measures including
outcome, process
and balancing
measures?
Is there a suite of
system measures
actively in place
aligned to strategic
objectives? Are
these measures
reported on time
on a monthly basis?
Is there evidence of
the identification of
improvement gaps
and QI projects as a
result?
Are projects and
system measures
data consistently
presented in time
series and routinely
analysed using
ratified statistical
process control?
Are data summaries
of live and current
improvement work
are made available
throughout the
organisation within
publically facing
areas either
physically or
electronically?
0-3 0-3 0-3 0-3 0-3

24. /60
/60
/60
-----
180
0 Organisation has not started/ no progress
1 Organisation has started / early progress
2 Organisation has embedded / steady progress
3 Organisation has fully met criteria across whole organisation
QI Building blocks Framework

25. Aims of QI Building Blocks Framework
DIALOGIC (jigsaw)
Help individuals and teams understand &
assimilate key factors required for
continuous quality improvement
DIAGNOSTIC (180 point framework)
Provide pragmatic guidance for
organisations in operationalising their
quality strategy and achieving high
performing organisational status

26. Inputs Activities
Outputs –
Knowledge &
Strategy
Outputs –
Operational
Effectiveness
Outcomes — Impact
Short Term Medium Term Long Term
(1years) (2+years) (3+years)
• QIBBF dialogic &
diagnostic
• AQuA
commitment to
QIBB concept
• Resources to
support QIBB
program
• Networking,
coordination &
promotion
• Academic
expertise
• Senior leadership
involvement in
learning and
deployment
• Organizational &
respect & interest
to learn and apply
• Interest with
people of
influence
• Accessible and
effective
communication
mechanisms
• Engagement with
stakeholder
organisations
online and
workshops
• Testing &
adaptation
• Supported
learning platform
including active
peer involvement
• Accessible
framework, guide
and expert
support
• Connection of
framework to OD
strategies
• Promotion of
QIBB at different
levels on
different
programs
• Formative
evaluation
• Academic
ratification
• New knowledge
applied to
current thinking
• Individuals
understanding
key linkages
between
philosophy,
foundations &
mechanisms
• Reframing of
organisational
quality narrative
& values
• Re-alignment of
organisational
development
plans and
priorities
• Prioritisation of
staff skills and
areas of focus
• Leader and staff
training at
respective levels
• Healthy and key
Vision & Values
embedded in
‘functional ‘DNA’’
• Redefined and
new
transformation
programs
• Changes to
organisational
procedures
• Capacity &
capability
embedded
systematically
• Staff enthusiasm
and motivation
• Revised
measurement,
quality and
performance
systems
• Improved intra
and inter
organisational
relationships
• Assimilation of
core QI methods,
innovation,
integration &
leadership
• Alignment of
organisational
goals and
frontline
improvement
• Continuous
improvement of
systems and
processes
• Improvement in
staff satisfaction,
joy at work &
psychological
safety
• Internal culture
thriving and
healthy
• Shift from
organisational to
system focus
• Evidence of
change from
patient feedback
• Partnership
between public,
patient and
organisation
• Improved
efficiency of use of
resource
• Improvement in
mortality & safety
metrics
• Reduced waiting
times for services
• Equitable service
• Development of
innovative
treatment,
pathways and
services
• Demonstrable
continuous
improvement in
care outcomes
• Improved staff
retention & skill
• Improved financial
balance
• Adoption of
newest advances
• Improvement in
patient reported
experience
measures
ORGANISATIONAL
Excellence in
quality
High performing
organisation
recognition
Clear upward
trajectory in
resilience,
responsiveness &
reputation
Assumptions
Value of quality improvement methodology
Executive support & organisational commitment
Senior leadership capacity to implement
Resources for deployment
Mechanisms for improvement & deployment
External Factors
Activity vs quality agenda / contractual basis
Financial austerity
Political re-organisation
Change in senior leadership
Competing organisational priorities
QUALITY IMPROVEMENT BUILDING BLOCKS FRAMEWORK LOGIC MODEL v01

27. Without this we won’t have the right values to continually improve
Family as a
unit of care
Partnership in
personalized
care
From “what’s
the matter?” to
“what matters
to me”
System co-design
Representation
Collective Voice
Valued
workforce &
psychological
safety
Compassionate
leadership with
relentless focus
who connect
with the ‘front
line’
Functional
‘Team’ ethos
incl. clinical &
informatics
integration
Increasing staff
capacity
& capability in
QI & innovation
Comprehensive
‘capture’
process:
Issues, events
& feedback
System
diagnostics
across the
continuum
Model for
Improvement
active at the
frontline
Real time
transparent
measurement &
understanding of
variability
Cultural &
Infrastructure
Essentials
Learning
System
Essentials
Person &
Family
Centered
Care
© Dr Peter Chamberlain

28. Without this we won’t have the right values to continually improve
Family as a
unit of care
Partnership in
personalized
care
From “what’s
the matter?” to
“what matters
to me”
System co-design
Representation
Collective Voice
Valued
workforce &
psychological
safety
Compassionate
leadership with
relentless focus
who connect
with the ‘front
line’
Functional
‘Team’ ethos
incl. clinical &
informatics
integration
Increasing staff
capacity
& capability in
QI & innovation
Comprehensive
‘capture’
process:
Issues, events
& feedback
System
diagnostics
across the
continuum
Model for
Improvement
active at the
frontline
Real time
transparent
measurement &
understanding of
variability
Cultural &
Infrastructure
Essentials
Learning
System
Essentials
Person &
Family
Centered
Care
© Dr Peter Chamberlain
/

29. © Dr Peter Chamberlain
One year organisational coaching
program and action learning sets