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IGNITE! Building Blocks of Continuous Improvement Part 1 #QIBBF
1. Dr. Peter Chamberlain
BSc MBChB MRCP MRCGP
General Practitioner
Clinical Commissioner
Health Foundation Quality
Improvement fellow
@drpjchamberlain
The Building Blocks to Effective
Continuous Quality Improvement
Across an Organisation (#QIBBF)
2. Inputs leading to Building Blocks Framework
1 IHI training programs
• IA program / Patient safety officer / HSPH
• Fellows seminars
2 15 site visits to highly effective organisations
3 Cross examination of other frameworks
4 Presentations internationally renowned leaders for critique &
iterative feedback
• IHI mentors, health executives
• The Health Foundation
• Kings Fund
5 Testing: Face value and score thresholds (2 organisations)
6 Testing: Collaborative scoring mechanism (1 NHS organisation)
7 Testing: Applicability with variety (15 NHS organisations)
8 Testing: Longitudinal use with coaching support (3 NHS
organisations)
5. Attributes of Highly Reliable
Organizations (Studer)
"…exceptionally consistent in accomplishing their
goals and avoiding potentially catastrophic errors"
1. Sensitive to operations
2. Reluctance to accept "simple" explanations for
problems
3. Have a preoccupation with failure
4. Defer to ‘expertise’ at the front line
5. Display resilience and relentlessness
7. The Trajectory
“Sustainable competitive advantage has to be
won by creating the internal capacity to
improve and innovate – fast and without let
up. Simply put, today’s leading organizations outrace
their competition by outlearning them.”
Time
Outcome
Steve Spear
8. Mechanism – (what)
(seed)
Context - (where)
(soil)
Process – (how)
(Gardener: Light, water)
Outcome
Motivation – (why)
Mo + Me + C + P = O
13. Without this we won’t have the right values to continually improve
Learning
System
Essentials
Person &
Family
Centered
Care
Person and Family Centered Care
Cultural &
Infrastructure
Essentials
14. Without this we won’t have the right values to continually improve
Family as a
unit of care
Partnership in
Personalized
Care
“What’s the
matter?” to
“what matters
to me”
System Co-design
Representation
Stories & Voices
Learning
System
Essentials
Person &
Family
Centered
Care
Person and Family Centered Care
Cultural &
Infrastructure
Essentials
18. Personalized Care Clinic
- ‘family consult area’
Family Wellness Warriors
KP “My Health”
Co-design, representation,
Stories & Voices
Family as a unit of care
Partnership in
Personalized Care
What matters
to me
20. Without this we won’t have the right values to continually improve
Learning
System
Essentials
Person &
Family
Centered
Care
Cultural &
Infrastructure
Essentials
Cultural & Infrastructure Essentials
21. Without this we won’t have the right values to continually improve
Valued
Workforce &
Psychological
Safety
‘Team’ ethos:
Clinical &
Informatics
Integration
Increasing staff
capacity
& capability in
QI & innovation
Learning
System
Essentials
Person &
Family
Centered
Care
Leadership
with relentless
focus who
connect with
the ‘front line’
Cultural &
Infrastructure
Essentials
Cultural & Infrastructure Essentials
22. We believe that the time
has come for business to
stop looking at people as
resources and to start
looking at them as human
beings..
..Put your staff first, your
customers second & your
shareholders third – you
will benefit all three.
And finally, Improvement Capability which undergirds all the rest and is about building practical improvement capability based on the science of improvement into every organization, health care executive, and professional, while driving innovation to dramatically improve performance at all levels of the health care system.
Comment:
Insatiable appetite to improve
Do not seek to negate outcomes through benchmarking data
Only require individual patient stories to stimulate system improvemnent
High reliability organizations (Struder) are:
- Sensitive to operations.
Reluctance to accept "simple" explanations for problems
Have a preoccupation with failure
Defer to ‘expertise’ at the front line
Display resilience and relentlessness
Comment:
Insatiable appetite to improve
Do not seek to negate outcomes through benchmarking data
Only require individual patient stories to stimulate system improvement
Ensuring clinicians who have intimate knowledge of the patient are put at the center of decision making
BETH ISRAEL: HUMAN FIRST
At the heart of everything we do is a fervent belief that before patients are patients, they are people…
St. Bart’s Patient Focus Group
Shared Decision Making: A service improvement project based on the concept that the patient is an equal partner in every decision about their health care
Group work to explore:
- What it felt like not to be listened to
- Compared to an occasion where they had been listened to
In relation to their admission in St. Barts:
- What were the positives
- What were the challenges
- How could their experience be improved
“Vecna® was founded on the idea that people matter….
The model focuses on the following 9 staff engagement enablers:
Working relationships – do staff feel supported?
Recognition – do staff feel valued?
Resources – do staff have the resources they need to work effectively?
Clarity – do staff understand what’s going on in their role/team/the Trust?
Perceived fairness – do staff feel processes and treatment is fair?
Personal Development – do staff have development opportunities?
Influence – do staff feel involved in change and decisions?
Mindset – do staff feel proud and optimistic about the future? 9. Trust – are staff empowered to do their job?
NATS Prestwick
Strategic approach to safety
Just Culture protocol
Safety Culture program
Culture surveys
Leadership
Mentoring, coaching..
Max and Caroline
Loss of psychological safety – major warning sign see Mid Staffs
Jim Collins HBR 2005 - Level 5 leadership: Executive an executive in whom extreme personal humility blends paradoxically with intense professional will.
He identifies the characteristics common to Level 5 leaders: humility, will, ferocious resolve, and the tendency to give credit to others while assigning blame to themselves (aka - take responsibility, for everything)
Good to great
Management Based Walk Arounds
http://www.hsph.harvard.edu/news/press-releases/management-by-walking-around-programs-in-hospitals-may-do-more-harm-than-good/
Singer and Tucker
They found that senior managers in work areas in the study allocated too much time to analyzing which problems to solve and not enough time taking action, resulting in a negative impact on perceptions of improvement among nurses. Senior managers’ presence on the front lines was only helpful when it enabled active problem solving.
“MBWA can backfire if management fails to meet staff expectations raised by the program,” said Tucker. “When MBWA is successful, it’s the action-taking that results from the program, rather than the mere physical presence of the senior managers, that positively impacts frontline staff performance. Rather than generating large numbers of safety reports without the ability to act on them, organizations should take action on known problems and build capacity for solving more.”
4. High reliability organizations defer to expertise.
Leaders at high reliability organizations listen to people who have the most developed knowledge of the task at hand. Sometimes, those individuals might not have the most seniority, but they are still encouraged to voice their concerns, ideas and input — regardless of hierarchy. If leaders and supervisors don't listen to staff about processes and operations within the hospital, it is practically impossible for the organization to develop a culture of high reliability.
Gary Kaplan, Gemba rounds – Make it authentic
Tuesday project overview
INTEGRATION from 30,000 feet
> Financial structure, Informatics, Clinical all focused to enable success of the same TEAM ie “KP”