QUALITY IMPROVEMENT
PROGRAMME
Leading to improve: improving to lead
Welcome
 Sandra Boosey – Quality Improvement Manager &
Coach
 01803 656086
 [email protected]
Expectations
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Active participation – share your experiences
Safe Environment – Chatham House rules
Equal Voice
Don’t take anything to heart!
Take things back to your workplace
Have a larf!
Challenges and Changes
Our NHS…
 Launched 5 July 1948
 Core principals  That it meet the needs of everyone
 That it be free at the point of delivery
 That it be based on clinical need, not ability to pay.
Progress
 Waiting lists vastly reduced
 Greater use of technology, changing the face of
medicine
 Faster mobility of patients and improved outcomes
 Changing professional roles
 Increase in screening and detection
Our world…
 Living longer
 Lifestyle choices
 Financial austerity
The future
 Focus on preventative rather than reactive health
 Linking community, primary and acute services for
seamless care
 Balancing the books
The challenge
“It is not the strongest of the species that
survive, nor the most intelligent, but the one
most responsive to change”
Charles Darwin
Meeting the challenge
 Continue to build the culture of team working,
innovation and quality improvement initiatives.
 Ensure we follow a common improvement
methodology
 Pursue a sustainable, community wide improvement
programme to meet the demographic and financial
pressures.
Q
Key principles of quality
improvement
 Puts the patient at the heart of all improvement work
 Empowers those doing the job to lead the changes
 Clear, measurable objectives
PATIENT
Choices?
The definition of insanity is doing the
same thing over and over again and
expecting different results.
Albert Einstein ??
Setting the scene
Economic crisis!
 A new set of symbols has replaced the current numbers 1 – 10
 We need to learn them as quickly as possible.
 Our world as we know it, depends on each of us to do our best!
READY?!
© Tim Pettry, 2008
8. Now wait
for 45
seconds.
30
15
seconds
left
Let’s do it!
1. 4. -
7. -
45
20
35
42
41
43
44
2
1
3
4
5
9. 2. -
That was easy!
6. 5. 10. 3. © Tim Pettry, 2008
Take 45
seconds to
memorize
these new
symbols for
the
numbers
1 – 10.
Write down as many of the
new symbols as you can
remember?
© Tim Pettry, 2008
Check your answers
1. -
6. -
2. -
7. -
3. -
8. -
4. -
9. -
5. -
10. © Tim Pettry, 2008
X
Discussion
 How many people got all 10 symbols correct?
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9?
8?
7?
6?
5 and below?
 Were you distracted by the countdown on the left?
 Are there ever distractions when we are trying to
learn?
© Tim Pettry, 2008
Discussion continued
 Which symbols do most people get right?
 10 – Its different and it represents the Roman numeral “10”
 5 – Its different
 7 – Its similar to the number 7
 Most people look for a pattern and have difficulty
finding it in a short amount of time.
 We are looking at the pieces rather than the whole.
 This is sometimes referred to as “Silo Thinking”
© Tim Pettry, 2008
Now, for you linear thinkers…
1
2
3
4
5
6
7
8
9
10
X
Does this help?
© Tim Pettry, 2008
CQI thinking!
Is this radical
thinking?
No, everyone
is familiar with
this.
So it must be
Common
Sense!
How many
of you
thought of
this?
The outline around each number
represents the new symbol!
1
2
3
4
5
6
7
8
9
10 - X
© Tim Pettry, 2008
Systems View
Continuous
Quality
Improvement
thinking is all
about learning
to see how
things are
connected
within an
overall system.
Successful change
How can we make change successful?
Communication
Stakeholder
support
Keeping the
patient at the
heart of all
we do – what
do they
value?
Effective
planning
23
Clear
objectives
Controlled
scope
The need for clarity….
“the biggest problem in communication is the illusion
that it has taken place”
George Bernard Shaw
What is changing?
 How often have you heard:
 “We’re changing the whole way we book our patients”
 “We’re developing a world-class orthopaedic service”
 Need a clear, concise one-minute statement that will be the
core of people’s understanding of the change
 Sell the problem before you try to sell the solution.
To leave the comfort of the status quo,
most individuals need to believe that the
change is truly imperative and that there
is a more attractive alternative’
Silversin/Kornacki
Are the benefits of change always
apparent?
 “This telephone has too many shortcomings to be
seriously considered as a means of communication.
The device is inherently of no value to us.”
(Internal memo, Western Union, 1876)
 “Worldwide demand for cars will never exceed one
million, primarily because of a limitation in the
number of available chauffeurs”
(Research prediction, Mercedes Benz, 1900)
Communication is made up of...
Communication is made up of...
5%
38%
VOICE
57%
VISUAL
‘It ain’t what you say, it’s the way that you say it’
Time spent communicating
Not
Communicating
30%
Communicating
70%
Speaking
30%
Reading
16%
Listening
45%
Writing
9%
Based on the research of: Adler, R., Rosenfeld, L. and Proctor, R. (2001)
Interplay: the process of interpersonal communicating (8th edn), Fort Worth,
TX: Harcourt
Understanding people
How do we understand where
people are?
 We need to understand:
 Their perception of the past, present & future
 What their past experience of change was
 What will they be losing?
 What will they be gaining?
 What their expectations are?
 What are their coping mechanisms?
Kubler-Ross change curve
The main stages of transition
Stage 1 – Shock and Denial
Stage 2 – Anger and Depression
Stage 3 – Acceptance and Integration
Each person reacts individually to change and will travel at
their own speed through these phases.
People will forget what you said…
They will forget what you did but they
will never forget how you made them
feel.
Maya Angelou
Recognition
 Few of us live in the same reality. Each person has
developed their own view of reality, through their thinking
and life experience.
 The key to good communication is learning to respect and
understand the other person’s reality.
 At the same time we must be aware of our own preferences
and thinking styles.
Definition
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There are 4 flipcharts with key words on.
Go to the flipchart which you think best describes you
Go with your gut instinct
Discuss how you feel about change
GO!
Peopleorientated
Friendly
Supportive
Good
listener
Nurturing
Caring/
helpful
Empathetic (35%)
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Team players
Dependable
Patient
Supportive and nurturing
Focus on family and relationships
Caring
Expressive
Harmonious
How to interact with a blue
personality
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Tell WHY first
Socialise before mentioning business
Talk about options and other people
Be clear about the reason for change as they can find it
unsettling
 Offer them the detail
 Acknowledge their input
Development areas for ‘blues’
 Try and maintain objectivity in decision making
 Try and initiate action and stick to goals and
objectives.
 Become more assertive
 Be less oversensitive
 Limit the extent to which you pull others into your
personal matters and try and keep communication to
business
Industrious
Confident
Likes being
straight
forward
Goalorientated
‘Eager
Beaver’
Frank/
Candid
Driven (15%)
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Strong leaders
Fast paced thinkers
Risk takers
Purposeful
Drivers
Strong willed
Less patient
Energetic
Competitive
How to interact with a red
personality
 Tell WHAT first
 Get down to business quickly
 Be succinct and precise – give them facts and avoid the
detail.
 Don’t ramble and stick to the purpose.
 Talk to them about results and outcomes, they need to
hear this to make quick decisions
 Use their time efficiently
 Be confident
Development areas for ‘reds’
 Listen.
 Gain greater patience
 Be sensitive to others’ needs and how you communicate
with them
 Be more flexible
 Pay more attention to detail
 Build cooperation and talk about other people’s ideas.
 Learn to make social small-talk!
Enjoys a
good laugh
Imaginative
Energetic
Creative
Selfdirected
Enthusiastic
Ideaorientated
Expressive (15%)
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Dynamic
Creative
Good humoured
Likes breaking rules
Spontaneous
Open-minded
Conceptual
How to interact with a yellow
personality
 Tell WHO first
 Be friendly and show an interest in them before going into
business.
 Keep it fast paced and support creativity and intuition.
 Be informal and non-threatening
 Don’t overload with facts and figures – talk the big picture,
not detail.
 Easily bored so look for non-verbal signs that you may be
losing their attention
 Inject humour into the conversation and be enthusiastic.
Development areas for ‘yellows’
 Slow down and consider the facts and feelings of
others.
 Develop organisation skills
 Understand the importance of detail
 Improve ability to follow through projects
 Improve time awareness
Attentive
Analytical
Organised
Accurate/
precise
Logical
Meticulous
Task
orientated
Analytical (35%)
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Detail orientated
Precise
Controlled
Likes to do things right the first time
Completer/finisher
Ordered
Thorough
More details the better!
How to interact with a green
personality
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Tell HOW first.
Be factual, specific and logical with your approach.
Be prepared for lots of questions
Don’t exaggerate claims or use testimonials – they like facts and
figures
Don’t be too emotional
Listening is important to Greens, so listen carefully to what they
have to say as they verbalise their thoughts through questioning
thoroughly.
Give the time to respond as they are slower paced thinkers
Be formal in your approach as they tend to be very business like.
Development areas for ‘greens’
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Be more open with your feelings
Be more optimistic
Be more open to change and trying new things
Try to be less sensitive to criticism
Work Style
Driver
Expressive
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•
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•
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•
•
•
•
‘Just do it!’
Works in priority order
Does several things at once
Intense, driven
Generates ideas
‘Let’s all do it!’
Unstructured
Lots of people interaction
Makes lists of people to call and
places to go
Analytical
Amiable
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•
•
•
‘Do it right or not at all!’
Thorough, attentive to detail
Step by step procedures
Concentrates on one thing at a time,
pensive
‘We’re great!’
Easy going, cooperative
Always willing to be of service
Goes with the flow
No strong sense of urgency
Strengths & Weaknesses
TYPE
STRENGTH
POTENTIAL WEAKNESS
Driver
Independent
Has trouble operating with others
Decisive
Does not take time to consider other perspectives
Determined
Domineering; too focused on doing it ‘my way’
Good
communicator
Talks too much
Enthusiastic
Comes on too strong
Imaginative
Dreamer; unrealistic
Thinking
Excludes feelings from decisions
Thorough
Goes too far; perfectionist
Disciplined
Too rigid or demanding of self/others
Supportive
Tends to conform to wishes of others
Patient
No time boundaries; things do not get done
Diplomatic
Not assertive or directive
Expressive
Analytical
Amiable
Change and learning
Panic Zone
Comfort Zone
No learning
No change
•people close up
•they freeze
•they don’t learn
Change and learning
Panic Zone
Comfort Zone
No learning
No change
Discomfort Zone
•uncertainty
•learning
•people close up
•they freeze
•they don’t learn
Fears
Driver
Expressive
• Being taken advantage of
• Loss of control
• Being bored
• Rejection
Analytical
Amiable
• Being criticised
• Quick decisions
• Being alone
• Loss of security
Under stress
Driver
Expressive
• Is energised
• Will become assertive
• Seeks control
• Rises to the challenge at first, but
may get stressed
• May flip to the dark side!
Analytical
Amiable
• Gets over-focused on detail
• May withdraw
• Worries, so try to avoid hassle
• Keeps head down, chats to mates
• Seeks chocolate!
Under Extreme Stress
Driver
Expressive
• Will become autocratic
• Will become offensive or sarcastic
and attack.
Analytical
Amiable
• Will withdraw
• Will submit
Behaviour Zones
DRIVER
EXPRESSIVE
Normal
Under stress
ANALYTICAL
Under
extreme
stress
AMIABLE
Working together
DRIVER
EXPRESSIVE
Mutual
overlap
ANALYTICAL
Broad
comfort
zones
AMIABLE
Working under stress
DRIVER
Reduced
comfort
zones
ANALYTICAL
EXPRESSIVE
Little
mutual
overlap
AMIABLE
Working under extreme stress
DRIVER
Minimal
comfort
zones
ANALYTICAL
EXPRESSIVE
Disjoint
(no overlap)
AMIABLE
Personality types
 We are all different and react in different ways
 We need to recognise the importance of how we
process information and appear to others
 We need to be aware of how others do this and try and
adjust accordingly
 Give and take and understanding can make
communication and change a lot easier
‘
People responsible for planning and
implementing change often forget that while
the first task of change management is to
understand the destination and how to get
there, the first task of transition management
is to convince people to leave home.’
William Bridges
The Three Questions
1. Who’s going to lose what?
2. What is changing?
3. What will actually be different because of the
change?
For more information…
Thank you!