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Making It Stick: Planning for Sustainability

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This presentation was delivered at Quality Forum 2017 by Andrew Wray.

For more information, visit www.QualityForum.ca

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Making It Stick: Planning for Sustainability

  1. 1. MAKING IT STICK: PLANNING FOR SUSTAINABILITY Andrew Wray Quality Forum 2017
  2. 2. Presenter Disclosure Presenter: Andrew Wray Relationships with commercial interests: – Nothing to disclose
  3. 3. What sorts of things have prevented you from sustaining improvements? Speed Networking
  4. 4. Definitions • Spread - When best practice is disseminated consistently and reliably across a whole system, and involves the implementation of proven interventions1 • Sustainability - When new ways of working and improved outcomes become the norm2 • Scale – Delivering improvement across an entire organization or system simultaneously3
  5. 5. “Adoption, adaptation, scale-up, spread, and sustainability are ill-defined, undertheorised, and little-researched implementation science concepts”5 “…near absence of studies focusing primarily on the sustainability of complex service innovations”6
  6. 6. ASSUMPTION • Looking for a permanent new way of working
  7. 7. Perspective • Sustainability is not a post-implementation activity. • We should be addressing sustainability: 1) Planning the change 2) Change process 3) Embedding and ensuring success
  8. 8. Three key factors • Context • Intervention • People
  9. 9. 1) Planning for Sustainability • Efforts planned without strategies for making the changes permanent are unlikely to stick by chance. • The un-sustainable change may temporarily help – but can do damage in the long term • Consideration to sustainability should be included at the outset of any initiative.
  10. 10. NHS Sustainability Model • A diagnostic tool • 10 factors critical to sustainability – People – Process – Organization • Versatile in application
  11. 11. ©NHS Institute for Innovation and Improvement 2006
  12. 12. • In addition to helping patients, are there other benefits? • Does the change reduce waste, duplication and added effort? • Will it make things run more smoothly? • Will staff notice a difference in their daily working lives? Benefits beyond helping patients ©NHS Institute for Innovation and Improvement 2006
  13. 13. • Are benefits to patients, staff and the organisation visible? • Do staff believe in the benefits? • Can all staff describe the benefits clearly? • Is there evidence that this type of change has been achieved elsewhere? Credibility of the benefits ©NHS Institute for Innovation and Improvement 2006
  14. 14. • Can the process overcome internal pressures and continually improve? • Does the change continue to meet ongoing needs effectively? • Does the change rely on an individual or group of people, technology, finance etc to keep it going? • Can it keep going when these are removed? Adaptability of improved process ©NHS Institute for Innovation and Improvement 2006
  15. 15. • Does the change require special monitoring systems to identify improvement? • Is this data already collected and is it easily accessible? • Is there a feedback system to reinforce benefits and progress and initiate action? • Are the results of the change communicated to patients, staff, and the organisation? Effectiveness of the system to monitor progress ©NHS Institute for Innovation and Improvement 2006
  16. 16. • Do staff play a part in innovation, design & implementation of change? • Have they used their ideas to inform the change process from the very beginning? • Is there a training & dev infrastructure to identify gaps in skills & knowledge and are staff educated and trained to take change forward? Staff involvement and training to sustain the process ©NHS Institute for Innovation and Improvement 2006
  17. 17. • Are staff encouraged to express their ideas and is their input taken on board? • Are staff able to run small-scale tests (PDSA) based on their ideas, to see if additional improvements should be recommended? • Do staff think that the change is a better way of doing things that they want to preserve for the future? Staff attitudes towards sustaining the change ©NHS Institute for Innovation and Improvement 2006
  18. 18. • Are the senior leaders trustworthy, influential, respected and believable? • Are they involved in the initiative, do they understand it and do they promote it? • Are they respected by their peers and can they influence others to get on board? • Are they taking personal responsibility & giving time to help ensure the change is sustained? Senior leadership engagement ©NHS Institute for Innovation and Improvement 2006
  19. 19. • Are the clinical leaders trustworthy, influential, respected and believable? • Are they involved in the initiative, do they understand it and do they promote it? • Are they respected by their peers and can they influence others to get on board? • Are they taking personal responsibility & giving time to help ensure the change is sustained? Clinical leadership engagement ©NHS Institute for Innovation and Improvement 2006
  20. 20. • Has the organisation successfully sustained improvement in the past? • Are the goals of the change clear and shared? • Is it contributing to the overall organisational aims. • Is change important to the organisation and its leadership? • Does your organisation have a ‘can do’ culture? Fit with the organisation’s strategic aims and culture ©NHS Institute for Innovation and Improvement 2006
  21. 21. • Do you have enough good quality, trained staff? • Are there enough facilities and equipment to support the new process? • Are new requirements built into job descriptions? • Are there policies and procedures supporting the new way of working? • Is there a communication system in place? Infrastructure for sustainability ©NHS Institute for Innovation and Improvement 2006
  22. 22. Scoring the Sustainability Model • Some general guidance on overall scores – > 35: Re-evaluate project – 35-55: Some concerns to be addressed – 55 +: Cause for optimism • Nothing is inherently unsustainable – It provides opportunities for improvement
  23. 23. 2) The Change Process • After planning an improvement project, we must test the interventions • Sustainability is a key consideration to the way interventions are designed and introduced
  24. 24. Reference: The Improvement Guide, 2nd ed. Langley, Moen, Nolan, Nolan, Norman & Provost, p. 24
  25. 25. The Change Process • How we work with people • The nature of the changes • The context in which the change occurs
  26. 26. 3) Making it Stick • Once we have a successful intervention(s) in place, we need to transition from a new way of working to THE way of working. • Same three factors at play – People – Context – Change
  27. 27. Key Considerations • Resource • Embedding • Fidelity • Monitoring for sustainability
  28. 28. Resources • Often need extra resources for the improvement process • Financial and human • Key is to distinguish between the change process and the intervention
  29. 29. Impact of Change on Workload/ Capacity Workload Time Baseline Zone of change Post implementation of change Unchanged More workload/ less capacity Less workload/ more capacity
  30. 30. Cumulative Impact of Change Time Workload Unsustainable Acceptable Ideal 34
  31. 31. Embedding the Change • Change job descriptions • Integrate into orientations • Document procedures • Include in patient education • Transition from project lead to operational lead
  32. 32. Fidelity • To avoid “drift” – we need to ensure that the key components of the change are maintained. • We need to have learned what the key features are.
  33. 33. Monitoring for Sustainability • Ongoing measurement of the improvement process – Frequency and sample may reduce • Integrate into electronic systems

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