Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
SlideShare a Scribd company logo
Practical Tools for Transformational
Change
ICIC16 Barcelona
Elizabeth Bradbury, Director AQuA
Nicki McNaney, AQuA Affiliate
Objectives
• Explore approaches to behavioural and
technical change
• Discuss use and alignment of improvement
tools and techniques
• Explore building improvement capability
across systems
2
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
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
AQuA’s System Integration
Framework
© AQuA Action 2012
Integration to Improve
• Safety
• Experience
• Effectiveness
• Population health
• Use of resources
Service and
Care Model
Design
Service User
and Carer
Engagement
Leadership
Workforce
• Role design
• Skills
• Capacity
Information
and
Information
Technology
Financial and
Contractual
Mechanisms
Culture
Healthcare
value
Governance
6
Integrated
Teams
Integrated
Services
Integrated
Systems
Focus on population
outcomes and system
enablers
Focus on redesigning
integrated clinical and
support services
Focus on redesigning
direct care for
patients and carers in
all settings
Understanding Integrated
Systems
Developing
Theoretical Model
7
Complexity
Science
Large Scale
Change
Improvement
Science
System
Leadership
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?
Behavioural
Technical
Improvement and change
management skills
10
Integrated
Teams
Integrated
Services
Integrated
Systems
Focus on population
outcomes and system
enablers
System development
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
Leading in complexity
12
A good enough plan
13Source: Integrated Care for Older People in Salford
Salford’s Integrated Care Model and Operational Plan, June 2011
14
Measures
Integrated Care for Older People in Salford
Salford’s Integrated Care Model and Operational Plan, June 2011
Simple rules or minimum
specifications
Making better decisions:
• Boundary rules (inclusion/exclusion)
• Prioritising rules (consider alternatives)
• Stopping rules (investments and innovations)
Doing things better:
• How to rules
• Co-ordination rules (flocking)
• Timing rules
Source: Eisenhardt, K. and Ascherman, S.W. (2015)
16
In pairs:
Agree 3 simple rules for designing a new
model of integrated care
17
Integrated
Teams
Integrated
Services
Integrated
Systems
Focus on redesigning
integrated clinical and
support services
Service development
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
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?
Understanding value in the
eyes of the customer
Kano
Model
21
Integrated
Teams
Integrated
Services
Integrated
Systems
Focus on redesigning
direct care for
patients and carers in
all settings
Microsystems improvement
• 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
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
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
Bright
idea!
Lots of small scale changes
– test to find out what works
Improvement
Improvement
Improvement
Improvement
?
Multiple PDSA Cycles
Hunches
theories
ideas
Changes that
result in
improvement
A P
S D
A P
S D
A
PS
D
A
PS
D
A P
S D
A P
S D
D S
P A
D S
P A
DATA
Need to start small!!
Source: Bromford, P (2015)
Building system capability
28
Concept of two jobs
29
Leadership and
culture
Patient flow and
pathways
Clinical
Microsystems
improvement
Source: Bojestig, Jonkoping CC Sweden
Improvement approach
Organisation –
‘big dot’
Programme
Project
Source: Bojestig, Jonkoping CC Sweden
Planning and execution
Tracking
through PMO
Mesosystem
Macrosystem
Microsystem
Source: Bojestig, Jonkoping CC Sweden
Strategic aims and measures
Mesosystem
Macrosystem
Microsystem
Source: Bojestig, Jonkoping CC Sweden
Improvement capability
Leader
Advanced
Practitioner
or expert
(0.5%)
Practitioner (5%)
Foundation (Everyone)
How are you building
system capability?
34
Further Information
www.AQuAnw.nhs.uk
AQuA@srft.nhs.uk
Elizabeth.Bradbury@srft.nhs.uk
NickiMcNaney@gmail.com
Twitter: @AQuA_Inform

More Related Content

1.6 practical tools for transformational change - bradbury and mc naney (453)