Keynote presentation delivered on 24th May for the NHS Improvement Falls Collaborative

1. @rosielhunt
Myths, models
and magic
#improvefalls
Rosanna Hunt
Horizons
NHS England

2. @rosielhunt
It took over a century for handwashing to become
mainstream practice and it is still not universal.
We are now beginning to understand the challenge of
spread and scale-up in complex systems.
#improvefalls

3. @rosielhunt
A study of healthcare
interventions from the 1960s
to the 1990s found it took an
average of 17 years until
they became standard care.
Balas, E.A. and Boren, S.A. (2000) ‘Managing clinical knowledge for health care
improvement.’ In Bemmel, J. and McCray, A.T. (Eds.) (2000) ’Yearbook of Medical
Informatics 2000: Patient-Centered Systems.
#improvefalls

4. @rosielhunt
David Albury
Innovation Unit
A leading thinker in the field of spread and
scaling-up innovation
5 myths of spread
#improvefalls

5. @rosielhunt
Myth 1: Scaling-up is about
spreading information
#improvefalls

6. @rosielhunt
Myth 2: Spreading means
transferring from one context to
another
#improvefalls

7. @rosielhunt
Myth 3: Innovation and spread are
separate and sequential processes
#improvefalls

8. @rosielhunt
Myth 4: The more innovations we
come up with the more spread we
will get
#improvefalls

9. @rosielhunt
Myth 5: The key agents of spread are
professionals
#improvefalls

10. @rosielhunt
Talk about the five myths:
Do we do any of these?
#improvefalls

11. @rosielhunt
Talk about the five myths:
Do we do any of them?
Myth 1: Scaling-up is about spreading information
Myth 2: Spreading means transferring from one context to
another
Myth 3: Innovation and spread are separate and sequential
processes
Myth 4: The more innovations we come up with the more
spread we will get
Myth 5: The key agents of spread are professionals
#improvefalls

12. @rosielhunt #improvefalls

13. @rosielhunt
NHS Spread and sustainability
Model
#improvefalls

14. @rosielhunt
Productive Ward spread rapidly
across the NHS and further afield and
is widely cited as an example of large-
scale change

15. @rosielhunt
The Kaiser Permanente
spread model
Collaboratives
#improvefalls

16. @rosielhunt
16
What are we spreading?
How Does
It Work?
 Simplicity
 Cultural Fit
 Business Case
 Tools
 Implementation
Support
 Demonstrated
Sustainability
 Demonstrated
Transfer
 Adaptability
 Unintended
Consequences
Does It Work?
Will It Work
Elsewhere?
 Comparative
Performance
 Outcome vs.
Process
 Improvement
Attributable to
Practice
 Strength of
Evidence
 Logic Model
 Key
Components
 Specific
Processes
 Organizational
Enablers
 Barriers and
Risks
Will It Spread?
© Kaiser Permanente 2016 reproduce by permission only
#improvefalls

17. @rosielhunt
17
Assessing the context
Organizational
Effectiveness
 Staff Skills and
Capacity
 Space and
Equipment
 Technology
 Champion
 Project
Management
 Training
 Measurement
and Monitoring
Alignment and
Sponsorship
Implementation
Infrastructure
 Strategic
Alignment with
Goals and
Priorities
 Sponsorship &
Leadership
 Oversight
Structure
 Operational
Effectiveness
 Relationships
among Units
 Readiness for
Change
Practice
Resources
© Kaiser Permanente 2016 reproduce by permission only
#improvefalls

18. The EAST model
#improvefalls@rosielhunt

19. What is the best way to spread new
knowledge?
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
#improvefalls@rosielhunt

21. “Stages of change”
Transtheoretical model of behaviour
change
Prochaska, DiClemente & Norcross (1992)
#improvefalls
@rosielhunt

22. I am not aware my
smoking is a
problem – I have no
intention to quit
I know my smoking
is a problem – I
want to stop but no
plans yet
I am making plans
& changing things
I do in
preparation.
I have
stopped
smoking!
I am continuing to
not smoke.
I sometimes miss it
– but I am still not
smoking
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
#improvefalls
@rosielhunt

23. The reality of our change situation
 Our tools are often not effective at the stage of change that
most people we work with are at
 It’s hard to engage people in change
 It’s hard to get people to make the changes we want them to
make
 People get irritated, defensive, irrational
 We feel powerless in our ability to lead or facilitate the change
90% of the tools available for health and
care change agents are designed for the
“action” stage
#improvefalls@rosielhunt

24. Talk about what you are
spreading/scaling-up.
What’s going to work for you?
#improvefalls
@rosielhunt

25. @rosielhunt

26. Finding the magic:
Building energy for
change
Psychological
Physical
Spiritual
Social Intellectual
@rosielhunt

27. Building spiritual energy
Where are the projects that align with our purpose?
Could they use us? Lets give them a boost!
Finding
vehicles for
change

28. Resistance to change is personal
@rosielhunt

29. Building psychological energy
• A culture of improvement starts with
personal and individual growth
• What is your personal limitation?
• Build trust by sharing it with colleagues
and getting them to help you grow
Kegan et al (2016) An Everyone Culture: Becoming
a Deliberately Developmental Organization
@rosielhunt

30. Building social energy
@rosielhunt

31. People who are highly connected have
twice as much power to influence
change as people with hierarchical
power
Leandro Herrero
http://t.co/Du6zCbrDBC
@rosielhunt

32. “The QI community’s role is in
creating the learning environments
for studying, adapting, trying out,
sometimes failing but always
refining”.
Don Berwick
IHI, 2017
@rosielhunt

33. Building energy for change through
the creation of learning environments
http://www.patientvoices.org.uk/flv/0032pv384.htm

34. Myths, models
and magic
#improvefalls@rosielhunt
Psychological
Physical
Spiritual
Social Intellectual