IGNITE! Building Blocks of Continuous Improvement Part 1 #QIBBF
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Dr Pete Chamberlain presents the #QIBBF - the effective continuous quality improvement across and organisation. This is part 1 or 2.
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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
- 10. Cultural & Infrastructure Essentials Learning System Essentials Person & Family Centered Care The principles to direct continuous improvement The mechanisms to sustain continuous improvement The foundations to support continuous improvement
- 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
- 15. Co-design, representation, Stories & Voices Family as a unit of care Partnership in Personalized Care What matters to me
- 16. Co-design, representation, Stories & Voices Family as a unit of care Partnership in Personalized Care What matters to me
- 17. Co-design, representation, Stories & Voices Family as a unit of care Partnership in Personalized Care What matters to me www.myopennotes.org
- 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
- 19. 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.
- 23. “Vecna® was founded on the idea that people matter….
- 26. • Staff sickness 10% • Financial surplus • 30% drop deaths 2009-13 • Achieved 18w waits across all specialities
- 28. Alaska Native Medical Center Values-Driven System Design R E L A T I O N S H I P
- 29. Weekly “Standup”
- 30. CLINICAL INFORMATICS FINANCIAL CLINICAL KP Health Plan EPIC Physician Group Organisation
Editor's Notes
- 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
- THE HIGH VELOCITY EDGE
- THE HIGH VELOCITY EDGE
- + Bate + Rycroft-Malone Kanter/ Shortell (Garderner)
- DIGNITY / RESPECT / COMPASSION
- DIGNITY / RESPECT / COMPASSION
- 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”