This document discusses improving quality and service for allied health professionals through understanding systems and measuring outcomes. It notes that while there is evidence of hard work and leadership, there is limited measurement of outcomes and impact. The document advocates defining problems and desired outcomes with stakeholders, understanding how changes fit into the system, measuring baselines and results of changes, and sharing improvements across organizations. It provides examples of services that could better measure costs savings, sustained healthy behaviors, and population-level outcomes. The document emphasizes that data is critical to understand initial conditions and quality improvement efforts.

1. Quality and Service Improvement
Workshop
Are we invisible or is it just our
data that's missing?
Dr Sally Fowler Davis
Y&H AHP Event 3rd June

2. A brief introduction
• I'm an Allied Health Professional
• I've a clinical and management background in
mental health services
• I took a Doctorate in Business Administration
part time
• I've been in academic practice for around 20
years as a lecturer, consultant and recently
researcher
• Quality and service improvement interests me
because it's all about patterns and processes
and making organisations work better

3. In this workshop I am assuming
that ......
• Everyone is familiar with micro systems
change (......although we will remind ourselves about that )
• That we want to increase the visibility and
profile of AHP services? (although we need to question
what we are drawing attention to....)
• That we are developing services in
consultation with patients, and other
stakeholders (if not, this may need a separate session of its own)

4. What are we trying to
accomplish?
How will we know that a
change is an improvement?
What changes can we make that will
result in the improvements we seek ?
Act Plan
Study Do
The Model for Quality Improvement.
Aims
Measurement
Ideas, evidence,
hunches,
other people etc.
The
three
fundamental
questions for
improvement
The fourth
question:
how to make changes
Langley, Nolan et al (1996)6/5/2015 4

5. The challenge of bringing about
improvement across whole systems
Highlighting the
contractual
relationship
Highlighting the
population
effect

6. Understanding Systems
“Every system is perfectly designed to get
the results it gets.
If we want better outcomes, we must change
something in the system.
To do this we need to understand our
systems.” Paul Batalden
also important- Don Berwick
https://www.gov.uk/government/publications/berwick-review-into-patient-safety

7. Achieving visibility for AHP services
within the whole system by
• Define the problem with all stakeholders
involved:
• What are we trying to achieve?
• How does it fit into the big picture?
• What changes can we make?
• What changes will we make?
• Check the changes: sustainability
• Spread…encourage others to change
Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009),
The improvement guide: a practical approach to enhancing organizational performance, 2nd ed.
Josses Bass Publishers, San Francisco

8. There seems to be so much
evidence of hard work
commitment and leadership ......
and relatively very little in terms of
measurement of outcomes and more
importantly IMPACT

9. Some examples
• There are some brilliant podiatry services
treating peripheral vascular disease, but
limited evidence of cost savings in
amputations
• There are Physiotherapy Musculoskeletal
services with 5 day RtT and excellent patient
satisfaction scores but no evidence of
patients sustaining healthy exercise regimes

10. More examples
• There are children's services with Speech
Therapy that are starting to measure
Foundation Stage communication
achievement
• There are almost no frailty services that
measure the success of re-ablement or
falls management in terms of population
outcomes

11. Data and information are a critically
important to understand the initial
baseline and quality improvement
• In God we trust.
All others bring data.”
W. E. Deming

12. • Here is a 6 minute presentation to
summarise the measurement of
improvement and it finishes by discussing
when to stop measuring.
• http://www.institute.nhs.uk/productive_gen
eral_practice/general/knowing_how_we_ar
e_doing.html
Measuring the process and
outcomes of change

13. To end – a note of realism
• John Rodwell Andre Gulyas , (2015) "Psychological contract breach
among allied health professionals", Journal of Health Organization
and Management, Vol. 29 Iss 3 pp. 393 – 412
• http://dx.doi.org/10.1108/JHOM-05-2013-0107
• AHPs are a rare resource and vital to successful
healthcare delivery so hold your organisation to account
with data on your performance