Fostering Champions of Change
“making improvement routine in Grampian”
We are a team
We take risks
We learn from failure
We celebrate each others success
We Aim Big!
Jenny Ingram, Head of Service Improvement, NHS Grampian [email protected]
Our Approach
•
Had been delivering Quality
Improvement (QI) development
for various groups ranging from
½ day to a collaborative model.
•
Head of Service Improvement
and Improvement Advisor
support both the Scottish
Improvement Skills (SIS) and
Scottish Improvement Leaders
(ScIL) programmes.
•
To provide consistency we
adapted some of our existing
tools to fit with SIS and ScIL.
•
Resulted in development of a
more formalised approach to
building QI capacity within
Grampian.
Building Sustainable QI Capacity
½ day session on
improvement and human
factors now built into the
supervisory management
programme led by L&D
Delivering our own QI
Practitioner Level
Programmes as defined by
the NES QI Curriculum
Framework
Grampian
Quality Hub
I day QI session run for
Consultants now
extending into induction
for Senior Medical Staff.
Supporting Clinical
Development Fellows.
Building organisational improvement
capacity which will harness and focus
leadership and professional skills on
effecting the step changes and
actions set out in our strategic plans.
Head of OD is a key part of
the QI Hub re our Talent
Management Framework
and improvement skill
building.
Working with RGU re
delivery of QI including a
post-graduate module.
Built QI skills for 23
multidisciplinary teams
(110 + staff) over four
learning sessions as part
of our Older People in
Acute Care
Collaborative.
AHP QI Practitioner Programme Overview
15th
Pre-Work
Application &
Selection
April-May
LS 1
& 16th June
17th
Action Period
Personal Learning
Mentoring
Support
LS 2
& 18th Aug
LS 4
Dec
LS 3
th
26 & 27th Oct
Action Period
Personal Learning
Mentoring Support
7th
Action Period
Personal Learning
Mentoring Support
Self-Assessment
LS 5
23rd & 24th Feb
Action Period
Personal Learning
Mentoring Support
Poster Development
session (Jan 16)
Next
Steps
Agreed
Learning Session 1
Learning Session 2
Learning Session 3
Learning Session 4
Learning Session 5
• NHSScotland’s
Improvement Journey.
• Understanding the 3-Step
Improvement Framework
• Recognising the steps for
improvement.
• Stakeholder analysis.
• Project Improvement
Charters.
• The Model For
Improvement.
• Personal Journey of an AHP
Improvement Advisor (NHS
Shetland).
• Developing Driver
Diagrams including use of
cascading driver
diagrams.
• PDSA/Tests of Change.
• The phases of
improvement.
• Testing for the next stage.
• Understanding the Lens
of Profound Knowledge.
• Measurement for
improvement.
• Knowledge Network
Masterclass.
• Sharing project
reflections from testing,
learning , barriers and
actions.
• Understanding random
and non-random
variation.
• Quality Measurement
analysis.
• Managing barriers and
breakthroughs.
• Human Factors.
• Tactical decision
making.
• Communicating your
improvement story.
• Skill self-assessment.
• Leading and managing
change supported by
NHSG Organisational
Development Manager.
- Introduction to MBTI
types.
- Exploration of own type
with feedback on own
report.
- Effective Team Working
- Exploring strategies to
work with others.
- Behaviour Change in
individuals &
organisations.
- Z Problem Solving
Model.
• From testing to
implementation & spread.
• Holding the gains.
• Practical application of the
CLEAR mentoring model.
• Self-assessment skills
revisited.
• Next steps agreed.
Participants showcase their
work in a poster event for
an invited audience of Lead
AHPs & Senior Leaders.
Outcomes & Learning
The style, format and timing of the learning sessions and mentoring support
facilitated and accelerated participants skill development.
Utilising internal staff to support mentoring worked (i.e. IA, SPSP Programme
Manager, Moray AHP Lead) to focus the cohort and provide advice.
The materials were well received, built nicely with each session and mixed with our
own provided a consistent approach in delivering national approaches locally.
A half day learning session with the AHP Leads built further understanding of
improvement science, supported these projects and has identified need for other
improvement work and education.
ALL participants completed an improvement project, demonstrated results and were
able to showcase a QI poster on their work.
Practitioner Outcomes
“ This has empowered me & my team to make
changes happen”
Combined Self-Assessment
Score
“Investing in doing not telling has proved to work”
Leading & Managing Change
120
100
80
60
40
20
0
Jun-15
Oct-15
Date
Feb-16
Combined Self-Assessment
Score
Understanding Variation
“Results
have shown
others the
value of this
approach”
“Valued the
space &
time to
think”
350
300
250
200
150
100
50
0
“A wave of change is happening”
“On a professional level it has enabled me to develop
skills & knowledge that allows me to have QI
conversations with colleagues out with the scope of
my project.”
Combined Self-Assessment
Score
Jun-15
Oct-15
Date
Feb-16
Human Side Of Change
100
80
60
40
20
0
Jun-15
Oct-15
Date
Feb-16
Project Outcomes
•
Occupational Therapy clinical
time released by introducing a
structured Board Round tool.
•
Decreased wait time for outpatient radiography.
•
Improved SLT attendance by
introducing an initial parent
appointment by telephone.
•
Increase in SVQ Assessors
supporting Healthcare Support
Workers.
•
Increased mobilisation of older
people within 12 hrs of
admission.
•
A clinical supervision case
review programme for
Orthotists.
•
Improved access to nutritional
care for Learning Disabilities
clients within a residential
setting.
“Great, an initiative that will help our
development and clinical practice”
Project Outcomes
•
Increased person-centred
Dietetic consultations with
improved quality markers
completed.
•
Improved utilisation of voice
therapy clinic with quality
focused patient sessions.
•
Increased completion rate of
Pulmonary Rehab classes via a
person-centred approach.
•
Introduction of a falls selfassessment tool in Acute has
increased accurate referrals to
community staff.
•
Improved quality of dental
imaging with a MDT approach.
•
Increased early referral to
Paediatric Physiotherapy with a
self-referral process for parents.
DNA rates reduced.
•
Introduction of exercise groups;
reduced wait time and
empowered patients.
“ Being back in a group is better after having the stroke because if
you concentrate too much on the 1:1 stuff you get tied up within
yourself and you get angry annoyed, confused, stuff like that. But if
you have other distractions you seem to get a lot better and you do
not think of the task you are doing. I think for myself”
What Next?
The cohort identified that
they wished to continue to
further their development
and this is underway.
We are running our local
version of SIS from May 16.
There are a further three
AHP’s on the first cohort.
Cohort two is being finalised
with Cohort 1 supporting.
We are utilising Quality
Improvement Facilitators to
support teaching.
Acute Services and the three
Integrated Joint Boards are
determining their approach to
and requirement for the
development of a QI
infrastructure.
To build further capacity for
AHPs and link to key
deliverables an MSK six
month collaborative is
planned for August.
The Grampian Quality Hub
has been approved by the
Senior Leadership Team.
Supporting Continuous Improvement In Grampian
We are committed to creating the environment and effective frameworks and systems that are applicable in
all settings to continuously improve the care and services we deliver sustainably over time.
Strategic Change Group
Grampian Quality Hub
Grampian Quality Hub
We believe that quality is the responsibility of
every employee and promoting a culture of
continuous improvement will allow
organisations to do the right things at the
right time, every time.
• Working directly with individuals, teams and service areas to improve
the quality of care and services delivered on objectives and priorities
agreed by the Strategic Change Group.
• Establishing and managing a Quality Improvement (QI) Network across
the North East of Scotland to share learning and promote collaborative
working, empowering staff and teams to make improvements.
• Promoting QI methodology and developing and delivering a range of QI
learning and development opportunities for all levels of staff.
Change
the
world
Create the
conditions
AIM: The Grampian Quality Hub (GQH) will support, facilitate and
contribute to improving the health and care system for the population of
the North East of Scotland by:
• Establishing links with neighbouring Health Boards and Health and Social
Care Partnerships in the North of Scotland and wider to share and learn.
Make the
improvement
Innovation Hub
Research & Development
Creating an approach to innovation for
the health and social care system in the
North East of Scotland that stimulates
and releases the potential of staff to
contribute to change at all levels.
Ensuring research in Grampian is
conducted to high scientific, ethical
and financial standards by providing
guidance and support to researchers
throughout the whole process.
Acute Services and Heath & Social Care Partnerships Improvement Infrastructure
Providing Leadership to drive, create the conditions for and align support to deliver
improvement priorities at a local level.
Improvement Priorities
• Four strategic themes: prevention, self-management, planned
care, unscheduled care.
• National Improvement Programmes e.g. Patient Safety, Early
Years, Six Essential Actions, Delivering Outpatient Integration
Together (DOIT).
• Local agreed priorities for service redesign.
• Improvement Collaboratives (e.g. Older People in Acute Care,
Discharge Collaborative Work).
Building Improvement Capacity
• Range of QI development opportunities offered locally (from ½
day to 9 day QI Practitioner Lead).
• Co-ordination & support for national QI Programmes.
• Lead role for the annual Quality & Safety event.
• Network of QI Practitioners meeting quarterly.
Fostering Our
Champions
Of Change
“There is a superhero in all
of us we just need the
courage to put on the cape”