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Slide 2 All working life in NHS Diagnostic Radiographer and teacher Improvement roles since 1994 BPR Leicester Royal Infirmary 1994 - 1999 National Patients Access Team 1999 - 2002 NHS Modernisation Agency 2002 2005 NHS Institute for Innovation and Improvement 2005 -2008 Awarded OBE for services to NHS 2003 Visiting Professor University of Derby 2008 Jean.penny@btinternet.com Slide 3 3 Knowledge of Systems Theory of knowledge Knowledge about Variation Knowledge of Psychology W Edwards Deming (1994) The New Economics Slide 4 Value the differences! Slide 5 Slide 6 Slide 7 IE I ntrovert E xtrovert NS i N tuitive S ensing TF T hinking F eeling PJ P erception J udging Slide 8 Slide 9 Slide 10 If you dont know what an Extravert is thinking you have not listened If you dont know what an Introvert is thinking you have not asked Isabel Briggs Myers Slide 11 If its important to extraverts, they will quickly show it. If its important to Introverts they will often hide it, at least until they feel it will be treated with respect LaVonne Neff One of a kind Slide 12 S E N S I N G INTUITION Slide 13 Slide 14 A frequent mistake intuitive types make in communicating about change is to assume that the amount of information that convinced them of the need for change will be sufficient for the sensing type Sue G Clancy Developing leaders Slide 15 Feeling DecisionsThinking Decisions Slide 16 Slide 17 Ts business before relationship what makes sense Fsrelationship before business what matters is harmony Slide 18 I tell people that thinking and feeling are like two TV channels or radio stations. You can tune into logical content or what people care about. If you only listen to one channel, youre missing a lot of good information Catherine Fitzgerald Slide 19 Hmmm... Keeping options open Making decisions Slide 20 Slide 21 Slide 22 Perceivers try to avoid pain through adapting and harmonising with the environment. Judgers seek to avoid painful experiences through judging and controlling their environment Isabelle Briggs Myers and Peter B Myers Slide 23 ISTJISFJINFJINTJ ISTPISFPINFPINTP ESTPESFPENFPENTP ESTJESFJENFJENTJ Slide 24 Librarians E / I Sales reps E / I Chemists (lab) E / I Accountants S / N Policemen S / N Psychiatrists S / N Counsellors T / F Clergy T / F EngineersT / F Journalists J / P Judges J / P ActorsJ / P Slide 25 differences between people are natural: not something you can change all type preferences are positive: no aspect of preference is better or worse the other persons preference may be directly opposite to your natural preference the other persons preferences are clues as to how they want to be worked with / related to their behaviour may have nothing to do with their type preference Slide 26 It is a measure of preferences not skills, abilities or behaviour There are no better or worse types all types have strengths and weaknesses Everyone uses both aspects of each dimension but it takes more energy to use non-preferred dimensions Your reported type can be overwritten by you because you are the best judge of your own personality type Use the MBTI as a starting point for discussion and understanding, not an end in itself Slide 27 Civilisation is the encouragement of differences Mohatma Gandhi Slide 28 Value the differences! But no stereotyping or excuses!! Slide 29 All models are wrong but some are useful W Deming Slide 30 30 1. Set Direction: Mission, Vision and Strategy Make the status quo uncomfortable Make the future attractive 3. Build Will Plan for improvement Set aims/allocate resources Measure system performance Provide encouragement Make financial linkages Learn subject matter 5. Execute Change Use Model for Improvement for design and redesign Review and guide key initiatives Spread ideas Communicate results Sustain improved levels of performance 4. Generate Ideas Understand organisation as a system Read and scan widely, learning from other industries and disciplines Benchmark to find ideas Listen to patients Invest in research and development Manage knowledge 2. Establish the Foundation Prepare personally Choose and align the senior team Build relationships Develop future leaders Reframe operating values Build improvement capability Source: Robert Lloyd Executive Director Performance Improvement Institute for Healthcare Improvement January 16, 2007 Slide 31 Macro Meso Micro Profound Knowledge Products, Inc. 2008 All Rights Reserved Slide 32 Ask yourself What are the problems that cause the bigger problem? What are you trying to achieve? (aim for each driver) How will you know a change is an improvement ? (outcome measures for each driver ) Drivers Which in turn contribute directly to the bigger aim Aim The big dots Ask yourself What is the big (possibly strategic) problem you are addressing? What are you trying to achieve? (aim) How will you know a change is an improvement ? (outcome measures) Ask yourself What changes can you make that will result in the improvement you seek? What are the change ideas / interventions/ solutions to test with PDSA cycles before implementing? How will you know a change is an improvement? (process measures for each intervention) Intervention 1 Intervention 2 Intervention 3 Intervention 1 Intervention 2 Intervention 3 Intervention 1 Intervention 2 Intervention 3 Interventions The small frontline dots Contribute directly to the drivers Slide 33 What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo Understanding the problem. Knowing what youre trying to do - clear and desirable aims and objectives Measuring processes and outcomes What have others done? What hunches do we have? What can we learn as we go along? Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The improvement guide: a practical approach to enhancing organisational performance 2 nd ed, Jossey Bass Publishers, San Francisco Slide 34 Sharing Achievements and reflections on what you have done What went well? What are you pleased with? What could have been better? What has disappointed you? Surprises: good and bad! Who / what has helped / not helped What have you learnt What would you do differently next time? Learning from others Look at the poster What was the problem? Who was the team? What was the aim? What change ideas were tested? (PDSA cycles) What are the improvement measures? Slide 35 Slide 36 Stepping stones Off beat ideas and wild scenarios can serve as catalysts or mental stepping stones to help us make an intuitive leap to a really good idea http://www.institute.nhs.uk/building_capability/new_model _for_transforming_the_nhs/thinking_differently_guide Attention Escape Movement Slide 37 Imagination Creativity Doing and changing Innovation 400 ideas generated 75 ideas harvested 20 ideas developed 8 ideas tested 4 ideas implemented Impact s/outcome Attention Escape Movement Slide 38 Slide 39 The improvement itself and any changes in practice OR Continuous improvement and a commitment to finding a better way of working a culture change Complexity of sustaining healthcare improvements: what have we learned so far (2004) NHS Modernisation Agency, Research into Practice report 13 Slide 40 Performance Time Good Bad BeforeNowLater Idea ? Slide 41 Sustainability is when new ways of working and improved outcomes become the norm Sustainability is when not only have the process and outcome changed but the thinking and attitudes behind them are fundamentally altered and the systems surrounding them are transformed in support. Slide 42 Slide 43 Slide 44 An easy to use tool to help NHS improvement teams: Identify & understand key barriers to sustainability for their specific situation Know what they can do to overcome those barriers Monitor progress toward sustainability over time NHS Institute for Innovation and Improvement 2006 To predict the likelihood of sustainability Slide 45 Create a plan before, during and after implementation of your improvement initiative Lynne Maher, David Gustafson, Alyson Evans NHS Institute for Innovation and Improvement 2006 The ten factors of sustainability Slide 46 Process: Benefits beyond helping patients making job easier Credibility of evidence obvious, evidence based, believed Adaptability of improved process continuous improvement Effectiveness of system to monitor process communication of results Staff Staff involvement and training to sustain process Staff attitudes towards sustaining change - involvement and empowerment Senior leadership engagement responsibility and advice Clinical leadership engagement responsibility and advice Organisation Fit with organisations strategic aims and culture history of improvement, consistency of improvement goals with strategic aims Infrastructure for sustainability staff, facilities, equipment Slide 47 A score of 55 or over offers reasons for optimism Scores below this suggest you need to take some action Work on improving the two factors that have the biggest potential for improvement Re score in about 6-8 weeks NHS Institute for Innovation and Improvement 2006 Slide 48 2 4 6 8 10 12 14 16 0 Adaptability Of improved process Benefits beyond helping patients Credibility of the evidence Effective system to monitor progress Fit with orgs strategic aims and culture Infrastru- ture for sustainability NHS Institute for Innovation and Improvement 2006 Staff behaviours towards sustaining change Senior leadership engagement Clinical leadership engagement Staff involvement and training to sustain process Process Staff Organisation Slide 49 2 4 6 8 10 12 14 16 0 Adaptability Of improved process Benefits beyond helping patients Credibility of the evidence Effective system to monitor progress Fit with orgs strategic aims and culture Infrastru- ture for sustainability NHS Institute for Innovation and Improvement 2006 Staff behaviours towards sustaining change Senior leadership engagement Clinical leadership engagement Staff involvement and training to sustain process Process Staff Organisation Slide 50 Think about your work based improvement activity and consider the factors of sustainability Where are your strengths? What areas do you need to work on? Slide 51 Leadership People who influence (at all levels) Support at senior level Ownership of initiative Effective relationships (multi-professional) Staff engagement Incentives Readiness of improvement Local context Nature of initiative Evidence of improvements Process of implementation Integration into practice Dedicates resources Note: No rank order Relative importance of each factor varies from one initiative to another The New Improvement Wheel (2005) NHS Modernisation Agency Research into Practice report 14 Slide 52 Spread means that the learning that takes place in any part of the organisation is actively shared and acted upon by all parts of the organisation i.e. that others have adopted Efforts will meet only limited success if one views the process as that of spreading best practices Spread is an active term and indicates push Spread is the result of the adoption process, not the other way round Adoption is a receptive word and indicates pull Slide 53 Sending Describe the new practice Target the potential implementers Communicate Receiving Matching opportunity to current processes, systems or practices Deciding whether to adopt or reject Implementing Re-inventing new ways Unlearning old ways Monitoring progress Fraser S (2002) Accelerating the spread of good practice, Kingsham Press UK The idea and the people Slide 54 Relative advantage How clear and how much is this new idea/practice better then current situation? Compatibility How closely does new idea/practice reflect beliefs and values of adopter(s)? Complexity How easy is it to understand the new practice/idea? Communicability How easily can it be shared with others? Observability How visible is the new practice or idea and its results? Trailability How easy is it to test the new idea? Reversibility How easily can the adopter revert to the old ways? Uncertainty How certain can an adopter be of positive results from the change? Fraser S (2002) Accelerating the spread of good practice, Kingsham Press UK Slide 55 Solution / change in organisation A Change principle Solution / change in organisation B Slide 56 The concept of resistance to change is negative and emotionally draining We all change naturally; at our own pace with our own rationale Dont speak of us and them consider the Whats in it for me factor Spread can be better understood through attractors How can I make my change more naturally attractive to others? Slide 57 Innovators Early Adopters Early Majority Late Majority Laggards Rogers E (2003) Diffusion of Innovations 5 th ed New York: Free Press 2.5%13.5%34% 16% Rogers adopter categories are based on studies of when an individual adopted a specific innovation Nearly everyone is a laggard at some time; with a very rational reason! Slide 58 Think quietly by your self for a few minutes Then find two others and share Slide 59 Slide 60 Ask yourself What are the problems that cause the bigger problem? What are you trying to achieve? (aim for each driver) How will you know a change is an improvement ? (outcome measures for each driver ) Drivers Which in turn contribute directly to the bigger aim Aim The big dots Ask yourself What is the big (possibly strategic) problem you are addressing? What are you trying to achieve? (aim) How will you know a change is an improvement ? (outcome measures) Ask yourself What changes can you make that will result in the improvement you seek? What are the change ideas / interventions/ solutions to test with PDSA cycles before implementing? How will you know a change is an improvement? (process measures for each intervention) Intervention 1 Intervention 2 Intervention 3 Intervention 1 Intervention 2 Intervention 3 Intervention 1 Intervention 2 Intervention 3 Interventions The small frontline dots Contribute directly to the drivers Slide 61 What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo Understanding the problem. Knowing what youre trying to do - clear and desirable aims and objectives Measuring processes and outcomes What have others done? What hunches do we have? What can we learn as we go along? Langley G, Moen R, Nolan K, Nolan T, Norman C, Provost L, (2009), The improvement guide: a practical approach to enhancing organisational performance 2 nd ed, Jossey Bass Publishers, San Francisco Slide 62 62 Knowledge of Systems Theory of knowledge Knowledge about Variation Knowledge of Psychology W Edwards Deming (1994) The New Economics Slide 63 Value the differences! Slide 64