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Q Community Masterclass:

Coaching, Mentoring and

Positively Supporting Others with

Improvement

13 July 2017

Welcome to Your Day

SW AHSN

• The SW AHSN mission is to improve the health and patient experience of people in the South West by supporting and accelerating innovation and quality improvement.

• The SW AHSN holds a unique position in the South West, bringing together likeminded people from academia, industry, life sciences, local government and the voluntary sector to work with the NHS in pursuit of a common goal – to improve people’s health and patient experience.

SW AHSN & Q

Warm Up Exercise

FINISHED FILES ARE THE RESULT OF

YEARS OF SCIENTIFIC STUDY COMBINED

WITH THE EXPERIENCE OF YEARS

www.q.health.org.uk

The Q Community

What is Q?

A Community of People…….

………Committed to improving Health & Care

Where a wide range of knowledge and experience is welcomed and shared……….

……..And, where there are no limits on innovative ways of working.

‘Q at its heart is cross-boundary and multidisciplinary, and will involve patients and people seeking to influence or working with the health and care system at every level’ (The Health Foundation)

What Q Expects of You

Engage in Q with Integrity

Committed to and actively participate in multi disciplinary working

Share your Knowledge and Experience with Others

Listen to and Respect the views of others, even if different to your own

Provide Constructive Feedback and Value the contribution of others

Share and Spread your Learning within and beyond Q

What does being a Q Member mean?

• A ‘home’ for improvers

• Raising the profile of improvement

• Knowing more about ‘who is doing what work’

Having

• Spread and share learning beyond Q

• Building and strengthening networks and contacts

Doing• Polite, respectful

• Challenge constructively

• Giving Feedback

• Contributing to building Q

Being

Engage. Connect. Commit.

Pledge – What can you/will you do next to contribute to Q and to other members and support Q to grow?

Members Update

Connect

• Find two other Q Members in the room

• Introduce yourselves

• Identify any shared points of interest and experiences

Engage

• What brings you to this session today?

• What is your experience of coaching and mentoring?

• What do you want to get out of today?

Commit

• What were your pledge commitments? How have you progressed with these?

• Any other Q activities you have been involved with/have plans for

Key Learnings from Today

Engage

29 September 2017

Systems thinking: Q visit to Department of Engineering, Cambridge

University

11 October 2017

South West Q Masterclass, Woodlands Castle, Taunton

30 October 2017

Leaders in Healthcare conference, Liverpool

23 November 2017

National Q event, Liverpool

28 February 2018

South West Q Masterclass, St Mellion International Resort, Saltash

10/3/2017

Connect

Visit online:

http://www.swahsn.com/

http://q.health.org.uk

Follow on Twitter:

@sw_ahsn

@theQCommunity

#Qcommunity

Make Connections

Build Your Network

Strengthen Your Connections

http://www.swahsn.com/

http://q.health.org.uk/

https://twitter.com/sw_ahsn

https://twitter.com/theQCommunity

https://twitter.com/search?f=tweets&vertical=default&q=#Qcommunity&src=tyah

Commit

• Q is Growing - Wave 4 Recruitment is about to start! Anticipated that

there will be 2000+ Q members by end of the year

• Piloting the Strategic Leadership for Q - Based on the ideas of

shared resources and a ‘commons’ based approach

Health Foundation

SW AHSN Individuals

One Final Thought For You as Q Members

‘ You are a treasure in the making…….Badly needed’

Don Berwick, Q Community Event,London 20 October 2016

Coaching Skills For Improvement

Dee Wilkinson

GP/Executive Coach, Coach Supervisor, Mediator

Absent Friend & Facilitator : Sue Mellor – MA Research Coaching & Mentoring, Coach Supervisor

SMMCC

The mind is like a parachute

Best used when open: So, lets get curious

Welcome

Engage

Connect

Commit

SMMCC

SMMCC

Our session

• Bring to awareness the skills we are using on a daily basis

• To review the differences between coaching & mentoring

• Use the GROW model in a real conversation (no role play)

• Practice Session

”Never forget the importance and brilliance of simplicity”

SMMCC

Reaching your own potential

On a scale of 1 - 10 How much of your own potential are you using?

What do you require in order to improve?

SMMCC

SGW: The Differences Between Coaching & Mentoring?

Coaching is the very opposite of telling someone what to do

Gilbert & Whittleworth

SMMCC

Why a Coaching Approach?

"Good management of NHS staff leads to higher quality ofcare, more satisfied patients and lower patient mortality. Goodstaff management offers significant financial savings for theNHS, as its leaders respond to the challenge of sustainability inthe face of increasing costs and demands"

NHS Staff Management and Health Service Quality

Michael West (Aston Business School / Dept of Health) 31 August 2011

In other words, staff engagement and effective team leadership ultimately save lives.

SMMCC

Adapted from www.performancecoachtraining.com Carol Wilson 2012

Principles of Coaching

SMMCC

http://www.performancecoachtraining.com/

Coaching is…..

….“a process which enables people to work out what it is they want to achieve and then to act on the solutions identified. …. This is accomplished through a style of dialogue between coach and coachee which assists the coachee to gain new insight and clarity of thought and then to move forward with energy and purpose.” Carol Wilson, The Performance Coach, 2012

….“the art of facilitating the development, learning and performance of another.” Myles Downey, Effective Coaching, 2003

“I cannot teach anybody anything. I can only make them think.” Socrates

21,700,000

SMMCC

Coach as a detective

Noticing with awareness:

• Language, words, phrases

• Changes in voice, behaviors, body language

• Congruence

• Excitement

• Energy

• Values

• Focus

• Assumptions

SMMCC

Nancy Kline describes Assumptions

“Assumptions are not dry. They sound it, but in the actual, they are glittering, terrifying, velvety, teeth baring, rock-a-bye, grave, generous, power-hungry things. The presence of assumptions at the very core of our lives is actually an electrifying concept. And searching for them competes hands down with the best forensic thriller you couldn't put down”.

SMMCC

Foundation Skills for Coaching Conversations

• Building rapport

• Listening

• Asking impactful questions

SMMCC

Listening

•Level 1 – Peripheral

•Level 2 – Apparent

•Level 3 - Global

SMMCC

SMMCC

Quick Listening Exercise

• Find a partner

• One listen first and one talk

• What are you most proud of?

• For 1 minute each – don’t start until the timer says go!

Explore Alternatives

•“The test of first rate intelligence is the ability

to hold two opposed ideas in mind at the

same time and still retain the ability to

function” F. Scott Fitzgerald (1896 -1940)

SMMCC

Coaches ask questions that:

• Challenge assumptions that limit thinking

• Focus on positives

• Make use of what is already there

• Encourage small steps

• Help gain different perspectives

SMMCC

The GROW Model

Sir John Whitmore

SMMCC

Skills Practice

• In threes Coach, Coachee, Observer. Choose a current project you are working on.

• Have a coaching conversation using the GROW model

• 15 min coaching

• 5 min quality feedback

• 1 hour total for each person to take a turn

SMMCC

GROW

15 minutes coaching

5 minutes quality feedback

SMMCC

Learning Points

•Feedback key learning points

SMMCC

Please do contact us for any further information or clarification

[email protected]

[email protected]

SMMCC

Suggested Models & Resources

➢ GROW Model – You Tube South West Coaching➢ Coaching for Performance (Grow Model) – John

Whitmore➢ Change & Transition – William Bridges➢ Quiet Leadership – David Rock

Picture use from https://creativecommons.org

mailto:[email protected]

mailto:[email protected]

FLOW

FLOW

Coaching teams to discover great care

Paul Harriman

FLOW

Aims / Objectives

• To describe how a combination of

team coaching and improvement

science creates improvement

• To describe the Flow Coaching

Academy

• To give you a taster of a Big Rm in

operation

FLOW

Great care is

discovered not

decided

Steve Speir modified by Tom Downes

FLOW

Quality: The IOM’s Six Aims

High Quality care is care that is:

• Safe – no needless deaths

• Effective – no needless pain or suffering

• Patient-Centered – no helplessness in those served or serving

• Timely – no unwanted waiting

• Efficient – no waste

• Equitable – for all

FLOW

Improvement

The combination of a change

with a method to attain a

superior outcome

FLOW

Model I: Bad Apples

The

Problem

Quality

Frequency

FLOW

The Simple, Wrong Answer

Blame

Somebody

FLOW

The Cycle of Fear

Increase

Fear

Micromanage Kill the

Messenger

Filter the

Information

FLOW

Model 2: Positive deviance

Quality

Frequency

FLOW

Model 2: Continuous Improvement

“Every Defect is a Treasure”

Quality

Fre

qu

en

cy

FLOW

“EVERY SYSTEM IS

PERFECTLY

DESIGNED TO GET

THE RESULTS IT

GETS.”

Paul B. Batalden, MDCo-Founder The Institute for Healthcare Improvement

Founding Director, Center for Leadership and Improvement,

The Dartmouth Institute for Health Policy and Clinical Practice

11

FLOW

Flow Coaching Academy aka Improving

Flow Programme• Born out of Flow, Cost, Quality and the

Sheffield Microsystems Coaching

Academy (MCA)

• It is a 5-year programme to learn how to

coach mesosystems

• Aim is to develop 10 partner local FCA’s

by 2020

• Spread via a social franchising model

FLOW

Team Coaching

Improvement

Science

Pathway

Improving Flow – The Elements

QI

Global Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Specific aim

Change

Ideas

Brainstorming

Change Concepts

Benchmarking and

visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams

Selection criteria &

Multivoting

Change

idea

Standardise

A P

S DDefine

measures

Pre-

Phase

A P

S D

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

A P

S D

FLOW

Pathway


FLOW

Clinical Microsystems

• 1992 – Quinn – ‘Intelligent Enterprise’

• Studied the ‘best of the best’

• They are organised around the frontline interface with the customer

• ‘Smallest replicable unit’

FLOW

Microsystem Improvement

• Nelson, Batalden, Godfrey 2000 – 2007

• Looked at the characteristics of high

performing clinical microsystems

• Formulated a curriculum to develop high

performing microsystems

FLOW

Cystic

Fibrosis

Service

STH,

Sheffield

Healthcare

System

FLOW

Skin Cancer Mesosystem(each microsystem has workgroups: *doctors, ^nurses, +admin clerical, #managers,

@support workers)

Start End

High Level Value Stream Map of Patient Flow

Dermatology

*^+#@

Plastics

*^+#@

Operating

Theatre

*^+#@

Pathology

*^+#@

Oncology

*^+#@

Primary

Care

*^+#@ Clinical Scientist

Pathologists

FLOW

“The principal task of the mesosystem is to

enable the work of the microsystems for the

population(s) of patients served.”

Paul Batalden

FLOW

Ownership not Buy In

‘If you want to make true and lasting

change, ask the people who do the work

how to go about it’ Daren Anderson, MD

VP/Chief Quality Officer

Community Health Center, Inc.

FLOW

Team Coaching

Improvement

Science

Pathway


QI

Global Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Specific aim

Change

Ideas

Brainstorming

Change Concepts

Benchmarking and

visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams


Multivoting

Change

idea

Standardise

A P

S DDefine

measures

Pre-

Phase

A P

S D

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

A P

S D

FLOW

Team Coaching


FLOW

Coaching

”It is not telling people what to do,

It is giving them a chance to examine what

they are doing in the light of their intentions.”

Peter Senge,

MIT and Society for Organizational Learning

FLOW

‘Improvement in health care is

20% technical and 80% human’

Marjorie Godfrey, MS, RN

The Dartmouth Institute For Health Policy and

Clinical Practice

People and Behaviours

FLOW

The Team Coaching Model

Transition PhaseReflection,

Celebration & Renew

`

Pre PhaseGetting Ready

Action PhaseArt & Science of

Coaching

Godfrey, MM (2012) In Press

FLOW

Getting Started - The Team Coaching Model

Pre-PhaseGetting Ready

“Meeting them where they are”

Action PhaseArt & Science of Coaching

Transition Phase Reflection, Celebration & Renew

*Context

-Review of past

improvement efforts and

lessons learned-tools used

-Preliminary system

review-Micro/Meso/Macro

*Site Visit

*Resources(data)

*Logistics (time)

*Expectations

-Clarity of aim

-Leadership & Team

discussions about roles

and logistics

*Relationships

-Helping

-Keep on track

*Communication

-Virtual

-Face-to-Face

-Available & accessible

-Timely

*Encouragement

*Clarifying

-Improvement

Knowledge

-Expectations

*Feedback

*Reframing

-Different perspectives

-Possibility

-Group dynamics-new skills

*Improvement Technical Skills

-Teaching

*Reflection

on improvement journey

-What to keep doing or

not do again

-Review measured

results and gains

-Assess team capability

and coaching needs &

create coaching

transition plan

*Celebration!

*Renew and re-energize

for next improvement

focus

*Evaluate coaching

Godfrey, MM (2013)

FLOW

Action Phase

TransitionPhase

Pre-Phase

Pre-Phase

Action Phase

TransitionPhase

Pre-Phase

Action Phase

TransitionPhase

Pre-Phase

Action Phase

TransitionPhase

Pre-

Phase

Action

Phase

Transition

Phase

Pre-

Phase

Action

PhaseTransition

Phase

The Team Coaching Model Over Time

28Godfrey, MM

FLOW

Coaching skills

Helping Active Listening

COM-B Reframing

Ladder of Inference

Resistance

& Reflection

Solution Focused

ARTS & PEARLS

Giving & Receiving Feedback

Time Management

Coaching Roadblocks

Troika Consulting

FLOW

Coaching in practice

• Co-coaching

• Weekly meetings

• Effective meetings

Habit formation, helping teams to do the

right thing

FLOW

Coaching in practice

Clinical Coach

Flow Coach

FLOW

Our approach

The Big Room

(Oobeya)

FLOW

A place to meet

Physiotherapist gives an

account of the test of change

to get a patient home on the day they

were discharged by the GSM

consultant

Senior

registrar

General

Manager

GSM

Matron

Service

Improvement

Social

Services

Manager

Community

Services

managerPhysiotherapist

Secretary

Discharge

Liaison

FLOW

Weekly meetings

• Rhythm– Regularity

– Consistent

– Discovery & action orientated

• Pace– Conducted effectively

– Flattened hierarchy

– Communications

– Ground rules

– Reaching agreements

FLOW

Ground Rules

• Coaches likely to do this early on

• Agree how you will work with each other

• Put them up in the room you meet in

1. If you oppose you must propose

2. No side conversations

3. Start on time, finish on time

4. Use effective meeting roles

5. No question is a stupid question

6. No individual blame

7. Stick to the agenda

8. Car park off-track discussions

FLOW

Making decisions together

• Consensus

• Seeing the whole picture

• Deciding where to focus

• Voting

FLOW

Communication Strategy• How will you communicate in a way that invites

“everyone to get in the game?”

• Determine process and stick to it!

• Creative options– Newsletter

– Emails

– Intranet

– All Staff monthly town hall meetings

– Buddy system

– Screen Savers

FLOW

Team Coaching

Improvement

Science

Pathway


QI

Global Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Specific aim

Change

Ideas

Brainstorming

Change Concepts

Benchmarking and

visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams


Multivoting

Change

idea

Standardise

A P

S DDefine

measures

Pre-

Phase

A P

S D

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

A P

S D

FLOW

Improvement

Science


Global Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Specific aim

Change

Ideas

Brainstorming

Change Concepts

Benchmarking and

visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams


Multivoting

Change

idea

Standardise

A P

S DDefine

measures

Pre-

Phase

A P

S D

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

A P

S D

FLOW

People vs. System

“80% of the problem

is the system not the

people”

W. Edwards DemingProfessor of statistics at New York University

(1946–1993)

Author, lecturer, and consultantPhoto © 2014 The W. Edwards Deming Institute Blog

FLOW

FLOW

improvement - The

structure

Diagnosis -

Change

Ideas

Treatment

- PDSA

SDSA

‘Standardise’

Value

inVolve

Vision

Values

Visualisation

Assessment

FLOW

Global

Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Specific aim

Change

Ideas

Brainstorming

Change Concepts

Benchmarking

and visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams


Multivoting

Change

idea

Standardise

A P

S DDefine

measures

Pre-

Phase

A P

S D

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

A P

S D

FLOW

Build a Big

Room

Pre-

Phase

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

FLOW

Assessment Assessment

5Vs - Measurement to understand the system

Value stream map

with data

Lead times

Cycle times

Patient survey data

Staff survey data

Activity data

Benchmarking to

find best-practice

Relational

Co-ordination

Financial Data

Spaghetti diagrams

Outcome dataPatient stories

Supply time

Work in progress

Incident data

Stakeholder

mapping

FLOW

Themes

‘Post-it

Frenzy’

Build a Big

Room

Pre-

Phase

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

Themes for Improvement –

Broad topics for

improvement

FLOW

Global

Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Pre-

Phase

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

Global Aim – Defines the

scope of the process to be

improved, the possible

benefits (measures) and why

its important to do this

FLOW

Global

Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Change

Ideas

Brainstorming

Change Concepts

Benchmarking

and visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams


Multivoting

Pre-

Phase

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

Change Ideas –

techniques to

more deeply

understand and

generate

possible change

ideas to improve

the process

defined by the

global aim

FLOW

Global

Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Change

Ideas

Brainstorming

Change Concepts

Benchmarking

and visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams


Multivoting

Pre-

Phase

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

Driver diagram –

organising

multiple aims and

change ideas

linked to a

specific aim

FLOW

Global

Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Specific aim

Change

Ideas

Brainstorming

Change Concepts

Benchmarking

and visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams


Multivoting

Change

idea

Define

measures

Pre-

Phase

A P

S D

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

‘The model for

improvement’

FLOW

The Model for Improvement

A P

S D

Specific Aim

Change Idea

Measurement over time –

Measurement Plan

FLOW

Global

Aim

Themes

‘Post-it

Frenzy’

Build a Big

Room

Specific aim

Change

Ideas

Brainstorming

Change Concepts

Benchmarking

and visits

Process/Value

Stream Map

Fishbone

Spaghetti

Diagrams


Multivoting

Change

idea

Standardise

Define

measures

Pre-

Phase

A P

S D

A P

S D

Coached weekly

meetings

Patient

stories

System

data

Reflective

learning

A P

S D

FLOW

FLOW

improvement - The

structure

Diagnosis -

Change

Ideas

Treatment

- PDSA

SDSA

‘Standardise’

Value

inVolve

Vision

Values

Visualisation

Assessment

FLOW

The Five Vs

“To do things differently, we must see things

differently. When we see things we haven’t

noticed before, we can ask questions we

didn't know to ask before.”

John Kelsch, Xerox

FLOW

Flow

Flow is not about the what

of clinical care decisions,

but about the how, where,

when and who of care

provision.