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Aberdeen CityFormat for Workstreams sessionsIntroductions at your tableImprovement Bootcamp overview and other improvement journeysComponents of a learning system how does our work stack up?Workstream presentations 30 mins each including Q&ATable top reflection on own learning and application of improvement methodology2The Bootcamp Experience : from this..

So, what is bootcamp? It is an exciting 2 day programme on Improvement Science which allows Bootcampers become immersed in deep learning about improvement science methodology

The programme covers a variety of themed topics including systems thinking, project planning, application of the model for improvement, developing measures for improvement and human factors

It is delivered by out IHI IA colleagues and EYC IAs and follow up coaching is available to ensure these newly developed improvers are able to apply the methods in their improvement work and also support others in its use.

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The Bootcamp Experience : to this

Spending 2 days concentrating on the Improvement Science principles and theories is a great experience, however the real learning begins when Bootcampers return to their CPP and begin to apply the principles in their practice. It is then that the pieces begin to fit together and the hugely valuable learning through application in practice begins.

You are going to hear from colleagues, like you, who have either been to bootcamp themselves and have been beginning to apply their new knowledge to improvement work in their practice.

We also have a few presenters in these workstream sessions who have not been to bootcamp but who have been working hard to adopt the methodology in their practice and have a learning experience to share with us.

4Components of a Learning System System level measuresExplicit theory or rationale for system changesSegmentation of the populationLearn by testing changes sequentiallyUse informative cases: Act for the individual learn for the population Learning during scale-up and spread with a production plan to go to scalePeriodic reviewPeople to manage and oversee the learning systemFrom Tom Nolan PhD, IHI

5The components of learning system were covered in the plenary session Opportunity for the big team in the room to consider the elements, reflect on the work presented and their own work in terms of components covered or not that will inform the work going forward.IAs can you also let us know if the team in the room come up with any interventions that will inform our upcoming discussions about key changes for the EYC ie the big ticket items that would accelerate progression towards the aims if they were done at scale.5Workstream Breakout Day 2 Aberdeen3rd. largest city in Scotland.

Population = 220, 420.

70, 198 are aged 0-25.

6AberdeenThe economy is dominated by the Oil Industry.

Despite the healthy state of Aberdeens economy, the gap between the affluent and our most vulnerable citizens is evident.

7Current project Early intervention:

Allocation of Health Plan Indicator by 16 weeks of pregnancy

WhyA Pathway of Care for Vulnerable Families(0-3)

Initial Snap ShotTOTAL NO. OF CASENOTESHPI - YESHPI - NOCOMPARISON Antenatal - 202 (10%)18 (90%)Matched predictionPostnatal - 405 (12%)35 (88%)Matched predictionOVERALL TOTAL7 (12%)53 (88%)Matched prediction

Key wins in presented areas of workImproved communication

Improved understanding of GIRFEC

Improved social risk assessment in pregnancy

More frequent shorter meetings have led to better communication move from monthly to weekly was met with some scepticism initially but shorter more frequent protected time for contact led to much improved communication between MW & HV. Better engagement - This has worked consistently well on a weekly basis and has yielded good results with social risk assessments being reviewed jointly and HPIs revised as a result of information sharing. Improved understanding of GIRFEC The midwifes knowledge of GIRFEC and the tools available to support & enable robust social risk assessment in pregnancy has significantly improved as a direct result of engaging in this change. Midwife reports increased personal confidence in using the tools and much better understanding of the importance & relevance of better social risk assessment. This has helped her to better understand her public health role and see her part in earlier recognition of vulnerability which enables better planning and interventions. Earlier engagement MW involving women more actively in the assessment. MW described it as potentially opening a can of worms but a real recognition that if we were to give children the best possible start in life it was exactly what was needed and this earlier recognition, discussion and engagement could effectively reduce the need for higher tariff interventions further down the line and improve outcomes for children & families. Workable tools & assessment documents Previously social assessments were being made on gut instinct alone with no real evidence to support assessments and allocation of HPI. Introduction of Tools which have really been tested and refined in response to feedback has meant that these tools rather than being enforced into practice have been embraced and welcomed precisely because they work for the practitioner. National tool has been refined to speak to midwives so that the language makes sense and aligns itself to the national SWHMR document. Time taken to use the tools has also been measured and with continued use is getting slicker. Result Significantly improved quality midwife reports added value and as a result has improved the quality of her consultations with women in pregnancy.CONFIDENCE Real positive finding that midwife reports week on week a growing confidence around undertaking social risk assessments. Also confidence on the part of workstream lead in relation to not only using the improvement methodology but a confidence to take a different approach and step away from the this is how we have always done things attitude. This does have its challenges, however, as buy in and ownership from others is critical.

11Earlier engagement with women and families

Development of Assessment Tools

Improved quality andCONFIDENCE

Key wins in presented areas of workKey lessonsLeadership

Ownership from wider team

Workstream Leads capacity

Collaboration has to become the norm.

We need to grow our own Improvement Coaches

Be brave!

Key lessons

Developing Measurement - Key WinsThe initial snap shot

Real Time Data

1. It was really important to be more focussed on what we are trying to accomplish this meant gathering snap shot data on how we were doing in order to understand what our test of change needed to be.2. This required a clear aim what, how and by when help us to clarify our overall stretch aim for the PDSA3. We needed to be clear that whatever measures we decided on these measures would allow us to demonstrate whether the change was an improvement.4. Results speak for themselves and generate interest

15Real time picture

Highlights whats working well

Demonstrates whether the change was an improvement

Developing Measurement - Lessons Learnt16Make data collection easy

Involve the frontline staff in design

Have a plan and dont be afraid

Keep it simple!

Developing Measurement - Lessons LearntResults do the talking

Builds confidence

Engages others

Encourages ownership and accountability

Small scale delivers results

Testing Key WinsTest, Test, Test!

Study & Act QUICKLY

Be focused & persistent!

Invest time to reap rewards

Testing Key Wins19Stay focussed and understand where you want to be

Start small dont try to solve the worries of the world

Dont be distracted by others frustrations

Testing Lessons LearntTest under different conditions

Spread

The so what factor

The Next 3-6 Months..TABLE DISCUSSIONWho are individuals and/or teams currently working on in this area? Are they currently using Quality Improvement methods/PDSA cycles to guide their learning?Reflecting on the emerging knowledge within this area, what are some potential tests of change you could run that might accelerate your work?

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