AQuA is a NHS health and care quality improvement organisation at the forefront of transforming the safety and quality of healthcare. Over the last five years AQuA has gained a reputation in NW England for helping system leaders apply a systematic approach to transformational change, balancing development of technical improvement and change management skills with creating the environment for behavioural and cultural change.
The workshop content is evidence based, drawn from AQuA’s portfolio of integrated care and transformation programmes. AQuA’s integrated care programmes have been externally evaluated by OPM (Office of Public Management) demonstrating positive benefit for participants. The workshop will include practical examples of AQuA’s work supporting capability and capacity building for transformation as well as evidence from AQuA’s portfolio of quality and safety improvement and integrated care.
Workshop aims:
• Explore approaches to behavioural and technical change across systems
• Share tools to create shared purpose and alignment of change roles
• Discuss how to test, scale, spread and sustain improvements
• Explore how to create a culture for continuous improvement, creating alignment and distributed leadership across systems
Target participants:
Executive directors, senior manager and clinicians, programme directors, OD and improvement specialists, attending as individuals or system leadership teams.
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1.6 practical tools for transformational change - bradbury and mc naney (453)
1. Practical Tools for Transformational
Change
ICIC16 Barcelona
Elizabeth Bradbury, Director AQuA
Nicki McNaney, AQuA Affiliate
2. Objectives
• Explore approaches to behavioural and
technical change
• Discuss use and alignment of improvement
tools and techniques
• Explore building improvement capability
across systems
2
3. Established in 2010 as a NHS health and care quality
improvement organisation. Based in North West England
Members: 73 commissioner and provider organisations
Hosted by Salford Royal Foundation Trust and
accountable to:
- AQuA’s Board
- AQuA members through membership agreements
Extensive work on integration and transformation
www.AQuAnw.nhs.uk
About AQuA
4. AQuA’s Integrated Care and
Transformation Story
4
Leading
System-Level
Integrated Care
Integrated Care
International
Exchange
Programme
Integrated Care
Fellowship
Programme
2014-152012-14
Integration
Discovery
Communities
Transformat-
ional Change
Programme
Integrated
Care & Frailty
Networks
Bespoke
locality
support
Masterclass
series
2015-16
System
Development
2016-17
Bespoke place
based facilitation
and expert
coaching
Masterclass
series
8. 8
What are the integration challenges that
you are trying to solve?
What tools and techniques are you
currently using?
How are you building capability
for transformational change?
11. Emerging Model of
Large Scale Change
Source: Paul Plsek (2008) on behalf of the Academy for Large Scale Change
Identifying
need for
change
Framing/
reframing
the issues
Engaging/
connecting
others
Making
pragmatic
change in
multiple
processes
Attracting
further interest
After some
time
Settling in
Possible outcomes
1. sustainable norm
2. plateau
3. run out of energy
Living with
results and
consequences
Maybe later
Repeats
many
times in
hard to
predict
ways
Time delay
18. Understanding the
patient journey
No one is responsible for the end to end processes
(Value stream)
30 – 70% does not add value to the patient
Up to 50% of process steps involve a handoff leading to
duplication, waste and error
Job roles can be narrow and fragmented
19. Flow analysis
What are the value adding
steps for patients and how
can time in-between be
reduced?
Is the information flow a
problem? Is it generating
Information for Action?
Who has end to end
process responsibility for
high volume elective / non
elective flows?
Who has clinical process
responsibility and how
often does this change?
22. • First step - Reduce defects
• Second Step – Reduce waste (cost)
- doing the right thing, first time and every time
• Third Step – Enhancements or new features
Adapted from Noriaki Kano
Steps for improvement
23. Testing rapid small scale
cycles of change:
Small Steps to Big Leaps
“The secret of getting ahead is getting started.
The secret of getting started is breaking
complex overwhelming tasks into small
manageable tasks, and then starting on the
first one”
Mark Twain
24. What are we trying to
accomplish?
How will we know that a
change is an improvement?
What changes can we make that
will result in the improvements
that we seek ?
Model for improvement
Act Plan
Study Do
aims
Copyright IHI 2000
testing ideas before
implementing changes
measures
change principles &
ideas
25. Bright
idea!
Lots of small scale changes
– test to find out what works
Improvement
Improvement
Improvement
Improvement
?