care experience improvement model (ceim): making meaningful … · care experience improvement...
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Care Experience Improvement Model (CEIM): Making meaningful person-led improvements from feedback
Learning session 2
#CEIM2
Improvement Hub
Enabling health and social care improvement
Welcome - event hosts
Claire CurtisDiane GrahamSusan Siegel Ann McLinton
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Housekeeping
Fire exits
Toilets Mobiles
Lets get tweeting
#CEIM2Photography
Fire alarms
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And…
Event support team
Questions throughout
the day
Who’s represented
Auchtermuchty District Nursing Team – NHS Fife
Balcurvie Ward – NHS Fife
B11 Surgical Ward – NHS Forth Valley
CHAS (Children’s Hospices Across Scotland)
Early Pregnancy – NHS Fife
Ellon Virtual Community Ward – NHS Grampian
First Contact Physiotherapy – NHS Highland
Geriatrics, ARI – NHS Grampian
Who’s represented
Kincardine Community Hospital Multidisciplinary Team – Aberdeenshire Health and Social Care Partnership
Major Trauma Centre and Rehab – NHS Grampian
Mayfield – NHS Fife
Mental Health and Substance Misuse Team – NHS Grampian
Moray Mental Health – NHS Grampian
North East Care Management – Aberdeenshire Council
Palliative and End of Life Care Working Group – Angus Health and Social Care Partnership
How you said you were feeling about where you are so far
11 words (18%)49 words (82%)
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What we will cover today
Hear and learn from each other on progress
Introduction to quality improvement approaches
Thinking about what's next
But first!
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Aim of the learning session
To share progress and learn from others about how the care experience improvement model (CEIM) has been implemented so far and to start planning for the improvement stage.
Quick recap on the Care Experience Improvement
Model (CEIM)
Care Experience Improvement Model
Care experience Conversations
Review and prepare
feedback
Reflective improvement
meetings
Prioritise improvement opportunities
Test and evaluate improvements
Implementation and spread
1. Hold a care experience conversation with a minimum of 6 patients per month (Etchells E et al., 2017)
2. Record the words of the person and try not to summarise or interpret
Conversations
Use a conversational approach to gather narrative feedback from at least 6 patients per month
Review and prepare feedback
Prepare feedback to share with your improvement team
1. Analyse and look at what the feedback is telling you.
2. Prepare feedback for presentation to reflective improvement group
Reflective improvement
meetings
Prioritise regular monthly multidisciplinary reflective improvement meetings
1. Present the direct quotes/feedback to the improvement group using an improvement focused facilitation approach.
2. Discuss together and identify opportunities for improvement or where you can make good practice as consistent or systematic as possible.
3. Prioritise what you will work on next and allocate improvement projects to members of the multidisciplinary team
Use improvement methodology to test and implement improvements
improve
1. Involve all levels of staff within the team and
generate ownership
2. Prototype idea and iteratively test
3. Monitor and measure success
4. Embed improvements into every day practice
Where are you now?• What you’ve done?• What went well?• What were the challenges?• What next?
Breakout room running orderJoan Knight Studio Theatre:
1. Palliative and End of Life Care Working Group
2. Auchtermuchty District Nursing Team
3. Early Pregnancy
BREAK FOR REFRESHMENTS4. Ellon Virtual Community Ward5. Balcurvie Ward6. First Contact Physiotherapy7. Mayfield
The Space:
1. Geriatrics, ARI2. Moray Mental Health3. Kincardine Community
Hospital MDT4. Mental Health and Substance
Misuse Team
BREAK FOR REFRESHMENTS5. B11 Surgical Ward6. Major Trauma Centre and
Rehab7. CHAS
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Appreciative feedback
Feedback structure
• What I noticed or wondered
• What I am interested to know more about
• It may have been even better if….
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Lunch
Remember to tweet!#CEIM2
Aim to speak to 2 people you haven’t met before
during 30 min lunch
Reflections and feedback
How do you feel nowabout what you have
done since the last learning session?
Put in fishbowl
Quick temperature check
One
‘emotion’
word
per post-it
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Introduction to Quality Improvement
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Fundamental Principles of Improvement
Truly knowing why you need to improve
Using your data in real-time so you know what changes make things better
Developing effective changes that suit your context
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Fundamental Principles of Improvement
Testing changes at a small scale instead of doing everything straight away
Only making a change permanent once you are sure it will work
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The Model for Improvement
Aim
Measure
change
Rapid cycle improvement
Associates in Process Improvement (API)
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https://m.youtube.com/watch?v=cICymTKYQxI&feature=youtu.be#dialog
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What are we trying to accomplish?
‘Aims create systems’ (Deming)
Provides a clear sense of what we are trying to accomplish
Measurable – how much by when?
Specific – who, where?
An Improvement
Aim…
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Constructing an aim statement: How good and by when?
Specific
Timebound
Aligned
Numeric
By March 2019, 95% of
endoscopy patients at
the Queen Mary
Hospital have a bedside
handover.
Our theory of change
Driver Diagrams
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Why use a driver diagram?
Visually present a theory of change.
To articulate what parts of a system that
need to change.
To clearly show the causal relationships between the drivers
and the aim.
To help teams work collaboratively
together and focus on changes that will
impact most.
To identify outcome and process measures
for improvement.
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Driver Diagrams
Aim
Primary driver
Secondary driver
Secondary driver
Primary driver
Secondary driver
Secondary driver
Primary driver
Secondary driver
Secondary driver
Achievement statement
To achieve the aim we need…
To make this happen we need …
To make this happen we will…
Change idea
Change idea
Change idea
Change idea
Change idea
Change idea
Turas module: https://learn.nes.nhs.scot/2278/quality-improvement-zone/qi-tools/driver-diagram
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Example aim statement
By October 2020, I will have lost 2
stones in weight and have a
regular weight loss programme in
place
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Aim: lose 2st in 6 months
Primary drivers:
Reduce calories in
Increase calories out
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Aim: lose 2st in 6 months
Reduce calories in
Increase calories out
Secondary drivers:
Eat less
Drink less alcohol
Substitute low-cal foods
Be more active
Take up sport
Primary drivers:
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Break
Remember to tweet!#CEIM2
chat to people during the break
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CEIM aim statement
By March 2021 our team will
be systematically making
improvements and
improving care experience
each month based on
service user feedback.
Specific
Timebound
Aligned
Numeric
#CEIM2
Creating a driver diagram...
1. Gather together the relevant stakeholders who have knowledge and different perspectives of the system you are working in.
2. Start with your aim/goal – make sure it is clearly defined and measurable.
3. In your teams brainstorm what we need to achieve the aim. Use the post-it notes to write down your ideas. For example people, culture, environment.
4. Theme and cluster the ideas to see if common themes emerge as primary drivers.
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Creating a driver diagram...
5. In your teams brainstorm what you need to do to achieve your primary driver
6. Identify change ideas for each secondary driver.
7. Prioritise the change ideas according to which is likely to have the highest and/or quickest impact.
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Construct a driver diagram
Activity: 20 mins
At your table use the CEIM aim statement to develop your driver diagram.
Use post-it notes to build up each section
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CEIM aim statement
By March 2021 our team will
be systematically making
improvements and
improving care experience
each month based on
service user feedback.
Specific
Timebound
Aligned
Numeric
#CEIM2
Feedback
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What changes can we make that result in improvement?
Change ideas – These are the specific ideas that teams can test to see if they make a difference and result in improvement.
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Then use small scale testing: PDSA – Plan Do Study Act
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Cycles of PDSA Tests Build Knowledge and Confidence
Proposals, theories, hunches, intuition
Changes that will result in improvement
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How it works
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PDSA – Key Points
Cannot be too small
One PDSA will almost always
lead to another
Help you to be thorough and
systematic
Help you learn from your work
Can produce rapid results
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Without data, you are just another person with an opinion –
Andreas Schleicher
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How do you know that change is an improvement?
1. We gather regularly – daily, weekly or monthly
2. We use for learning, not judgement
3. Helps us see if we are doing what we think we are doing
4. Helps us understand and share our story
5. We display visually
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What we can measure
• Information in your service that you can count (Quantitative)
• Peoples feelings and opinions (Qualitative)
• Observing what’s happening in front of you everyday
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Visualising our change impact
Example: losing weight Example: increasing exercise
1. The national team will continue to be available to provide advice or coaching when you need it.
2. We will share with you the presentations and resources from today on the online network page.
For us!For you!
1. Continue to work on implementing CEIM
2. Think about what help you need and where you will find it
3. Complete your driver diagram and measurement plan with your whole team
4. Think about your feedback for Learning session 3 - we will send you a template
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Evaluation
