Making your improvements last ckmf 2015
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Presentation for the Canadian Knowledge Mobilisation Forum 2015. Theme of the session was sustainability and this presentation detailed work done to develop a reflective tool for improvement teams to influence their projects sustainability and create lasting impact on patient care.
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Making your improvements last ckmf 2015
- 1. Collaboration for Leadership in Applied Health Research and Care Northwest London The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Northwest London is hosted by Chelsea and Westminster Hospital NHS Foundation Trust and academically led by Imperial College London, in partnership with Northwest London Making Your Improvements Last: A New Approach to Reflect Upon Sustainability Laura Lennox PhD Student and Research Assistant
- 2. NIHR CLAHRC Northwest London What is the problem? • Many improvement initiatives don’t have a lasting impact on care. • Only 1/3 achieve long term success and show evidence of spread.1
- 3. NIHR CLAHRC Northwest London The NHS III Sustainability Model • Allowed teams to identify risks • Helped to focus conversations But… • Time consuming • Inaccessible language • Missing factors Past Experience
- 4. NIHR CLAHRC Northwest London Developing a New Approach
- 5. NIHR CLAHRC Northwest London The Long Term Success Tool Team members reflect upon factors and enter ratings on WISH Ratings collated for team and overall report produced Team discussion and planning Take action to mitigate risks
- 6. NIHR CLAHRC Northwest London Factors for Long Term Success Commitment to the improvement Evidence of benefits Alignment with political & financial environment Alignment with organisational strategies and priorities Leadership Progress monitored for feedback and learning Resources in place Team functioning Involvement Robust and adaptable processes Support for ImprovementSkills & capabilities
- 7. NIHR CLAHRC Northwest London Overall ratings: “Lack of engagement/contribution from senior managers in community services. No specialist nurse yet.” “Do not have necessary staff therefore need to recruit more staff.”
- 8. NIHR CLAHRC Northwest London Summary • The Long Term Success approach emphasises the importance of continuous planning, reflection, and action. • The tool can provide a mechanism for shared learning and tacit knowledge translation.
- 9. NIHR CLAHRC Northwest London Discussion Question 1. How are people attempting to influence sustainability across diverse settings with the use of tools?
- 10. NIHR CLAHRC Northwest London References 1. NHS Modernisation Agency. Complexity of sustaining healthcare improvements: what have we learned so far : Research into Practice report 13. 2004. 2. Maher L, Gustafson D, Evans A. Sustainability Model and guide. Coventry, UK: NHS Institute for Innovation and Improvement; 2005. 3. Doyle C et al. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement. Implement Sci. Implementation Science; 2013;8(1):127.
Editor's Notes
- Pleased to be here today to speak to you about the work we have been doing at CLAHRC to help our teams plan for achieving LTS.
- At CLAHRC we support teams to improve care by implementing evidence based interventions in to care Improvement projects can follow many different trajectories. It is very hard to predict which path a project will take but there is evidence that only 1/3 of projects maintained the improvement and showed evidence of spreading the improvement. This means 2/3 of initiatives went back to old ways of working or we not adopted by others in the organisation. Means there is large variation in patient care, some getting the most up to date evidence based care while others not. This also means that systems are running less efficiently and wasting valuable resources. And finally its damaging to future improvement. Staff, patient and public opinion of such initiatives decline and community trust and support for future programmes diminish. Its not good enough and we know its complex so we need to do whatever we can to support our teams to achieve long term success. Applying evidence into practice in a way that ensures lasting change can be challenging. While many improvement initiatives show benefits at an early stage, often benefits fail to be sustained in the longer term. It has been suggested that action can be taken to increase the likelihood of sustainability by using models, frameworks and tools. This work investigates application of a new approach, ‘The Long Term Success Tool’ which has been designed with stakeholders and aims to support teams in reflecting upon sustainability.
- As many of you may know previously we used the NHS III sustainability model. People did find some elements of the old model beneficial. But we need to address the issues identified from past experience some of which outlined in Doyle paper- Sustainability not an issue in the early stages of project, too many questions, terminology inadequate. New model should include: political and economic environment, patient and public engagement
- This has been an ongoing journey throughout the last year and the new approach developed with input from many of your as partners and team members. Facilitated group discussions and interviews (n=12) with stakeholders were conducted to gather perspectives on value and design as well as the clarity and relevance of a new approach. A pilot version was trialed with stakeholders (n=84) and then rolled out to 4 improvement teams for use in practice. Tool data reports were extracted and analyzed. Observation explored tool application and impact on processes.
- Provides a structured review of factors identified as being important to long-term success Allows teams to gain different perspectives on these factors Stimulates discussion to address potential risks and create action plans 1. Team members enter scores (Quarterly) on WISH. They teams individually score 12 factors that have been identified to impact long term success. They also have the opportunity within the tool to highlight any potential actions or comments for specific factors. 2. Bring together multiple views. Scores collated for team and overall report available which includes an overall chart highlighting areas of risks and areas where the team is doing well. 3. This report is then used to frame a future discuss at a future meeting where teams can discuss scores and plan actions as needed. 4. Agree action
- Now I mentioned that the tool provides a review of key factors and I will just show a snap shot of the included factors. None of these should be a surprise, this is just about having teams think about the wide breadth of influences for LTS. All of which can be broken down into smaller questions to capture the complexity of each factor. For example…. Asks about personal commitment to the project. Belief in the evidence and the ability of the project to improve processes and outcomes. Does the project have a shared aim?
- This slide is animated! Initial analysis has shown that the tool has enabled teams to identify risks in the early stages of project development, such as communicating evidence of benefits for the initiatives, setting up monitoring systems and obtaining adequate resources (Fig 1). Observation of team discussions has shown that the tool has enabled teams to uncover multiple areas where shared learning is needed and prompted in-depth discussion to manage and mitigate identified issues. Show the team the overall chart and see what they think. -any surprises? Where is the team doing well? Commitment to the improvement, skills and capabilities of those involved There are also areas where there are differing opinions-in involvement and support for improvement. This is interesting to see as it helps the team think about what they may know that others don’t and vice versa. And then there are areas that may need some work- Resources in place, evidence of benefits There is a lot to potentially talk about but just taking two examples we can see why people may have scored this way… Do not have necessary staff therefore need to recruit more staff. Lack of engagement/contribution from senior managers Brent community services. No specialist nurse yet in Brent. The CCG's have not attended the meetings. It is not clear what staffing equipment etc. is currently needed. Awaiting meeting from commissioning to know they will support the projects. I'm not sure how much resources are available I realise this is a small example but the implications for cumulative ah ha moments can’t be under estimated. Bringing these issues to the surface and actively managing them will impact the project.
- Planning for long term success is complex but actively managing factors can help teams. We believe this updated approach will aid teams in planning for long term success. -emphasises the importance of continuous cycles of planning, reflection and taking action. Addresses past issues: Less time consuming Accessible language Broader set of factors The development of the CLAHRC long term success tool has reinforced the importance of designing a tool not only for stakeholders but with stakeholders (Johnson, 2004). Throughout development the value of checking-in and receiving ongoing feedback from those who will use the tool cannot be underestimated. Had the tool been designed in isolation, the issues addressed in each stage may have gone unnoticed. Because this tool has been designed with responds to user needs and will work in their settings.