Quality, Innovation, Productivity and Prevention in Primary CareNHSScotlandEvent
What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS
Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.
Getting started at the national level from demonstration to spreadProqualis
Apresentação de Derek Freeley durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
Derek Freeley é Vice Presidente Executivo do Institute for Healthcare Improvement (IHI), tem responsabilidades executivas por conduzir estratégias do IHI em cinco áreas de atuação: desenvolvimento de habilidade; cuidado centrado no paciente e família; segurança do paciente; qualidade; custo e valor; e grande foco em populações. Antes de integrar a equipe do IHI em 2013, foi diretor geral de saúde e assistência social e diretor executivo do National Health Service (NHS) na Escócia.
An introduction on Evidence-Based Clinical Practice Guidelines in Health Care Organizations
Brief on Alexandria Center for EBCPGs in Alexandria University Hospitals, Egypt
By Dr. Yasser Sami Abdel Dayem Amer, MBBCh, MS 2013
Special Thanks to
Prof Dr Mahmoud Elzalabany
Prof Dr Tarek Omar
Prof Dr Nabil Dowidar
Prof Dr Afaf Gaber
How is quality faring? Priorities and impact on the frontlineQualityWatch
A presentation given to the QualityWatch 2015 annual conference by Professor Tim Evans, Medical Director and Responsible Officer, Royal Brompton and Harefield NHS Foundation Trust.
Network, Technology, and Data: Missing Pieces of the Puzzle for Clinical Tria...Health Catalyst
There is a massive shortfall in the enrollment and accrual of patients for clinical trials. Identifying the “right patients for the right trials at the right time” is a growing concern for providers, pharmaceutical companies, and clinical research organizations. In this webinar, we will discuss the evolution of clinical trials, including how to break barriers to enable successful clinical research as a care option, how clinical research impacts patient satisfaction and revenue, and more.
Quality, Innovation, Productivity and Prevention in Primary CareNHSScotlandEvent
What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS
Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.
Getting started at the national level from demonstration to spreadProqualis
Apresentação de Derek Freeley durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil.
Derek Freeley é Vice Presidente Executivo do Institute for Healthcare Improvement (IHI), tem responsabilidades executivas por conduzir estratégias do IHI em cinco áreas de atuação: desenvolvimento de habilidade; cuidado centrado no paciente e família; segurança do paciente; qualidade; custo e valor; e grande foco em populações. Antes de integrar a equipe do IHI em 2013, foi diretor geral de saúde e assistência social e diretor executivo do National Health Service (NHS) na Escócia.
An introduction on Evidence-Based Clinical Practice Guidelines in Health Care Organizations
Brief on Alexandria Center for EBCPGs in Alexandria University Hospitals, Egypt
By Dr. Yasser Sami Abdel Dayem Amer, MBBCh, MS 2013
Special Thanks to
Prof Dr Mahmoud Elzalabany
Prof Dr Tarek Omar
Prof Dr Nabil Dowidar
Prof Dr Afaf Gaber
How is quality faring? Priorities and impact on the frontlineQualityWatch
A presentation given to the QualityWatch 2015 annual conference by Professor Tim Evans, Medical Director and Responsible Officer, Royal Brompton and Harefield NHS Foundation Trust.
Network, Technology, and Data: Missing Pieces of the Puzzle for Clinical Tria...Health Catalyst
There is a massive shortfall in the enrollment and accrual of patients for clinical trials. Identifying the “right patients for the right trials at the right time” is a growing concern for providers, pharmaceutical companies, and clinical research organizations. In this webinar, we will discuss the evolution of clinical trials, including how to break barriers to enable successful clinical research as a care option, how clinical research impacts patient satisfaction and revenue, and more.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. The next hour (or so…)
• What‟s the problem we were trying to
solve?
• How did we tackle it?
• What has been achieved so far?
• How are we expanding the approach?
• Why might this matter to you?
3. The 3-step Improvement Framework for
Scotland’s public services
Vision, aim and context.
1) Change
the
world
Culture, capacity
And challenge.
How much and by
2) Create the conditions when?
3) Make the improvement
Implementation, measur
ement and improvement
4. Q?
In your pack
The six questions to be asked of EVERY change programme:
1) Does everyone in the system know what we are trying to
achieve?
2) Are we prioritising the improvements likely to have the biggest
impact on the aim and stopping those that have little impact?
3) Is everyone clear about the means of securing improvement
towards our aim?
4) Are we able to measure and report progress on our aim?
5) Do we know how and where to deploy resources when
improvement is slower than required?
6) Do we have a way of testing and innovating and then spreading
new learning?
7. Which HC professional would you
want to go to?
96
94
92
90
88 Patient
Satisfaction
86
84
82
Practice Practice Practice
A B C
8. Which HC professional would you
want to go to?
96
94
92
90
Patient
88
Satisfaction
86
Accommodated
84
Appointments
82
80
Practice Practice Practice
A B C
9. Which HC professional would you
want to go to?
96
94
92
Patient
90
Satisfaction
88
Accommodated
86
Appointments
84
% of people back
82
to full functioning
80
Practice Practice Practice
A B C
10. Which HC professional would you
want to go to?
95
90 Patient
Satisfaction
85
Accommodated
80
Appointments
% of people back
75 to full functioning
Harm-free care
70
Practice Practice Practice
A B C
13. Current level of Harm
USA 3.7% of admissions
44-98,000 deaths
Australia 16% of admissions
250,000 adverse events
50,000 permanent disability
10,000 deaths
Denmark 9% of admissions
N.Z. 10% of admissions
UK 11% of admissions
850,000 adverse events
DoH ECRI 2002 Knox K et al
15. Global Trigger Tool Reviews
3 Exemplar 40 Bed rural 10 Hospital 7 Hospital Multi-state
Hospitals Hospital (300 Research System Tertiary
(900 notes) notes) Project (240 (3000 notes) System
notes) (2000 notes)
Events/1000 83 90 NA 119 86
Days
Events/100 45 40 37 41 38
admissions
Admissions 32% 30% 30% 29% 30%
with
adverse
events
16. Mid-Staffs
Families have described “Third World”
conditions at the trust, with some patients
drinking water from vases because they were
so thirsty and others screaming in pain.
The Healthcare Commission launched an
inquiry after concerns were raised about
higher-than-normal death rates in emergency
care, in particular at Stafford Hospital.
The trust argued that the anomalies were due
to problems with its recording of data rather
than the quality of care for patients, the report
said.
Times online March 2009
20. “quality improvement”
The combined and unceasing efforts of
everyone – health care
professionals, patients and their
families, researchers, payers, planners,
administrators, educators – to make
changes that will lead to
better patient outcome, better system
performance, and better professional
development.
Batalden P, Davidoff F. Qual. Saf. Health Care 2007;16;2-3
21. Policy Options
• Do what we‟ve always done
• Let‟s get more data
• Run a pilot project
• Run a campaign
• Let Boards and hospitals decide what to
do
• Run a mandatory national improvement
programme
22. So why did Scotland go
national?
• The context was right
• Our size helped
• Clinicians and managers were receptive
• A good match with „values‟
• The evidence was good enough – the
Tayside effect
• It felt like the right thing to do
23. Q1-6
Our response to the 6 Questions
The six questions to be asked of EVERY change programme:
1) Does everyone in the system know what we are trying to
achieve?
2) Are we prioritising the improvements likely to have the biggest
impact on the aim and stopping those that have little impact?
3) Is everyone clear about the means of securing improvement
towards our aim?
4) Are we able to measure and report progress on our aim?
5) Do we know how and where to deploy resources when
improvement is slower than required?
6) Do we have a way of testing and innovating and then spreading
new learning?
24. It‟s complicated….
Too bad all the people who know how to run
the country are busy driving cabs and
cutting hair.
-- George Burns
25. “Conquering the world on horseback is easy: it
is dismounting and governing that is hard”
Genghis Khan
28. Q3
IHI Breakthrough Series Collaborative
Q6
Select Participants (10-100 teams)
Topic
(develop
mission) Prework
Develop Dissemination
P P P
Framework A D A D Publications,
A D
& Changes Congress. etc.
Expert S S S
Meeting LS 1 LS 2 Holding
Planning LS 3
Group AP1 AP2 AP3* the Gains
Supports *AP3 –continue
reporting data as
LS – Learning Session Email (listserv) Phone Conferences needed to
document success
AP – Action Period Visits Assessments
Monthly Team Reports
29. Aim
Measures
Changes
Execution
The Improvement Guide, API
30. Q2
Q3 How has the frontline done it?
• Get goals. • Get the facts.
• Get bold. • Get to the field.
• Get together. • Get a clock.
• Get a model (and • Get the numbers.
stick with it) • Get the stories.
• Get patients and
families
31. Q2
Outcome Aims
Q3
• Mortality: 15% reduction
• Adverse Events: 30% reduction
• Ventilator Associated Pneumonia: 0 or 300 days
between
• Central Line Bloodstream Infection: 0 or 300 days
between
• Blood Sugars w/in Range (ITU/HDU): 80% or > w/in
range
• MRSA Bloodstream Infection: 30% reduction
• Crash Calls: 30% reduction
34. Q4
Scotland – 7% reduction in HSMR
1.5
1.3
Standardised Mortality Ratio
1.0
0.8
0.5
Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan-
Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar
2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010* 2011p
35. Q4
1.5 1.5
1.3
Standardised Mortality Ratio
1.3
Standardised Mortality Ratio
1.0
1.0
0.8
0.8
0.5
Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan-
Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar
2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010* 2011p 0.5
Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan-
Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar
2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010* 2011p
1.5
1.5
Standardised Mortality Ratio
1.3
1.3
Standardised Mortality Ratio
1.0
1.0
0.8
0.8
0.5
Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- 0.5
Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan-
2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010* 2011p Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar
2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010* 2011p
1.5 1.5
1.3
Q5 Standardised Mortality Ratio
1.3
Standardised Mortality Ratio
1.0
1.0
0.8
0.8
0.5
0.5 Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan-
Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar
Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar 2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010* 2011p
2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010* 2011p
HSMR results
2008-2011
37. Q4
Central line infection rate
(per thousand line days)
12
10 March 2011:
zero central line infections
8
in whole country
6
4
2
0
08
09
10
11
8
9
0
1
8
9
0
1
8
9
0
l-0
l-0
l-1
l-1
r- 0
r- 0
r- 1
r- 1
-0
-0
-1
n-
n-
n-
n-
ct
ct
ct
Ju
Ju
Ju
Ju
Ap
Ap
Ap
Ap
Ja
Ja
Ja
Ja
O
O
O
41. How has NHSScotland done it?
Policy Leadership Execution
Structure Process Outcome
Donabedian, A.
Explorations in Quality Assessment and
Monitoring. Volume I: The Definition of Quality
and Approaches to its Assessment.1980.
48. What patients see as high quality
healthcare?
• caring and compassionate health
services;
• collaborating effectively with
clinicians, patients and others;
• confidence and trust in health services;
• providing a clean care environment;
• improving access and the continuity of
care;
• delivering clinical excellence
49.
50. Q2
The Healthcare Quality Strategy for Scotland
• Person-Centred - Mutually beneficial partnerships between
patients, their families, and those delivering healthcare services
which respect individual needs and values, and which demonstrate
compassion, continuity, clear communication, and shared decision
making.
• Effective - The most appropriate
treatments, interventions, support, and services will be provided at
the right time to everyone who will benefit, and wasteful or harmful
variation will be eradicated.
• Safe - There will be no avoidable injury or harm to patients from
healthcare they receive, and an appropriate clean and safe
environment will be provided for the delivery of healthcare services
at all times.
51. The 3-step improvement
framework for
Scotland’s public services
“Do not be content with mediocrity.
Do your job so well that nobody could do it better.”
Martin Luther king Jr.
52. The 3-step Improvement Framework for
Scotland’s public services
Macro system –
1) Change Vision, aim and context.
the
world
Meso system –
Culture, capacity
And challenge.
How much and by
2) Create the conditions
when?
Micro system –
Implementation, measur
3) Make the improvement ement and improvement
53. Step 1; Changing the world – an evidence base
•This is the macro-system‟s role: vision, strategy and building coalitions. “Aims
create systems” – W. Edwards Deming
•It must establish a vision, a theory of reform, an engagement strategy and an
understanding of context both of people and places – then improvement is likely.
Kotter‟s eight steps for change offers a framework for work at this level
54. Step 1; (in our context) – 7 points to change the world
• A compelling vision
• A story
• Actions/ Stepping stones
• Securing the improvement
• Engaging the workforce
• Making the change work locally (everywhere)
• Resilience and authorisation provided by a
guiding coalition
55. Step 2; Creating the conditions
•This is the meso-system‟s role: Capacity and capability building,
•It must communicate the changes, empower the citizens and
workforce, model and change the culture.
The six questions to be asked of EVERY change programme:
1) Does everyone in the system know what we are trying to
achieve?
2) Are we prioritising the improvements likely to have the biggest
impact on the aim and stopping those that have little impact?
3) Is everyone clear about the means of securing improvement
towards our aim?
4) Are we able to measure and report progress on our aim?
5) Do we know how and where to deploy resources when
improvement is slower than required?
6) Do we have a way of testing and innovating and then spreading
new learning?
56. Step 2; Creating the conditions
The public services improvement bundle
The six questions to be asked of EVERY change
programme:
1) Aim? yes/no
2) Correct changes? yes/no
3) Clear change theory? yes/no
4) Measurement? yes/no
5) Capability? yes/no
6) Spread plan? yes/no
Only proceed if all six are yes – all-or-none measurement.
57. Step 3; Executing the change
•This is the micro-system‟s role: all improvement is local.
•Will and ideas are not enough at this level – we need execution. We need
a theory of change and the ability to test and implement the changes.
• There are many change theories
and models. We must choose a
small number of improvement
methods and stick with them for
the long haul.
• They must all be based on the
simple formula of aims/measures
and changes.
• Our selection may be;
Collaboratives
Benchmarking and
competition
User/ Community
empowerment
Performance management
• The choice must be explicit and
evidenced.
59. "Quality is never an accident;
it is always the result of high
intention, sincere
effort, intelligent direction and
skillful execution; it
represents the wise choice of
many alternatives.”
1941, William A. Foster
60.
61. 3 lessons in 3 minutes
• Pay attention to culture
– Changing „our‟ world
– Inclusive – workforce
– Various approaches available
• Leadership attention – walkarounds
• Improvement vs performance
– Organising for quality
– Data
– Can we test the approach elsewhere?