IGNITE! Building Blocks of Quality Improvement part 2

A Virtual Ward

• Common purpose• Common route/referral pathway• Communication ‘hard wired’• Co-location• Cross cover of roles• Coordination of roles

QI

Leaders

Improvement Advisors

“Coaches”

All Staff

“Dosing Formula”

WTE dedicated Improvement

0.05% > 50% WTE

0.5% 10-50% WTE

5% 5-10% WTE

50% 1-5% WTE

Level Training

Strategic/ Expert

+1 year

Advanced Months -Year

Intermediate Weeks -Month

Basic Hours -Days

CAPACITY CAPABILITYIn

stitute

/ QIS

Fro

nt

line

“Stop THINKING outside the box, start GOING outside the box…”

Without this we won’t have the right values to continually improve

Learning System

Essentials

Person & Family

Centered Care

Learning System Essentials

Cultural & Infrastructure

Essentials


Comprehensive ‘capture’ process: Issues, events & feedback

System diagnostics across the continuum

Model for Improvement active at the

frontline

Real time transparent

measurement & understanding of

variability

Learning System

Essentials

Person & Family

Centered Care

Learning System Essentials


Essentials

Organisation

Division

Ward



What is actually

going on in your

system?


Current“5 why’s”

Future


Aim

Measures

Change Concepts


From “Trial and error” to “Trial and learn”



Chile School Register

Ward Outcomes

Children receiving bedtime story


URGENT CARE TEAM DASHBOARD

15

20

25

30

35

Apr-

13

Jun-1

3A

ug-1

3O

ct-13

Dec-

13F

eb-1

4A

pr-

14

Jun-1

4A

ug-1

4O

ct-14

Dec-

14F

eb-1

5A

pr-

15

Jun-1

5A

ug-1

5O

ct-15

Dec-

15F

eb-1

6A

pr-

16

Jun-1

6A

ug-1

6Unplanned Admissions / 1000 population

(>64y) (O#1)

Num

ber/

month

Month

Num

ber/

month

25

27

29

31

33

35

37

39

41

43

45

Apr-

13

Jun-1

3A

ug-1

3O

ct-13

Dec-

13F

eb-1

4A

pr-

14

Jun-1

4A

ug-1

4O

ct-14

Dec-

14F

eb-1

5A

pr-

15

Jun-1

5A

ug-1

5O

ct-15

Dec-

15F

eb-1

6A

pr-

16

Jun-1

6A

ug-1

6

Type 1 A&E attendances / 1000 population (>64y) (O#2)

Month

0

20

40

60

80

100

120

140

Apr-

14

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

Oct-16

Dec-

16

NWAS cat green conveyances from care homes (O#3)

Conveyances p

er m

onth

Month

5

6

6

7

7

8

8

9

9

10

10

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

Patient & Family Experience Score (O#4)

Score

out of 10

Month

0

10

20

30

40

50

60

70

80

90

100

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

Mean response time (mins) (P#2)

Min

ute

s

Month

0

2

4

6

8

10

12

14

16

18

20

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

Number conversions to acute trust - % on graph (P#3)

Month

%

0

20

40

60

80

100

120

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

Average LOS under UCT team (P#4)

Month

Hours

0

20

40

60

80

100

120

140

160

180

200

Jul-14

Sep-1

4

Nov-

14

Jan-1

5

Mar-

15

May-

15

Jul-15

Sep-1

5

Nov-

15

Jan-1

6

Mar-

16

May-

16

Jul-16

CICT new referrals (B#1)

Num

ber/

month

Month

Num

ber/

month

0

10

20

30

40

50

60

70

80

90

100

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

CICT 95% Centile LOS (B#2)

Days

Month

0

5

10

15

20

25

30

35

40

45

50

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

Referral Source (P#6)

Month

Num

ber

per

0

20

40

60

80

100

120

140

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

New patients seen (activity) (P#1)

Month

New

patie

nts

seen

0

2

4

6

8

10

12

14

16

18

20

Jun-1

4

Aug-1

4

Oct-14

Dec-

14

Feb

-15

Apr-

15

Jun-1

5

Aug-1

5

Oct-15

Dec-

15

Feb

-16

Apr-

16

Jun-1

6

Aug-1

6

Potential & Actual Safety Events [DATIX] (P#5)

Month

Num

ber

per m

onth




frontline



variability

Learning System Actions

DEMOSTRATE

DELIVER

DO

DEVELOP

DIAGNOSE

DISCOVER

Cycle time




frontline



variability

Learning System Effectiveness

Proximity to the frontline

Alignment to strategic objectives


Family as a unit of care

Partnership in personalizedcare

From “what’s the matter?” to “what matters to me”

System co-designRepresentationCollective Voice

Valued workforce & psychological safety

Compassionate leadership with relentless focus

who connect with the ‘front

line’

Functional ‘Team’ ethos incl. clinical &

informatics integration

Increasing staff capacity

& capability in QI & innovation




frontline



variability


Essentials

Learning System

Essentials

Person & Family

Centered Care

© Dr Peter Chamberlain









line’








frontline



variability


Essentials

Learning System

Essentials

Person & Family

Centered Care


Deming’s “System of Profound Knowledge”

S

K P

V









line’






Essentials

Learning System

Essentials

Person & Family

Centered Care


Without this we won’t have the mechanisms to sustain continuous improvement







Essentials

Learning System

Essentials

Person & Family

Centered Care



Without this we won’t have the foundationsto support continuous improvement


Essentials

Learning System

Essentials

Person & Family

Centered Care



Without this we won’t have the foundationsto support continuous improvement

Without this we won’t have the principlesto direct continuous improvement

“Going under the bonnet”

Where do we go from here?

QI Building blocks Framework

1 2 3 4 5Is coded data collected and collated automatically in real time ie. within one time unit of specified analysis (shorter time unit the better, maximum time unit 1 month)

Does data on projects/ work streams consistently cover a family of meaningful measures including outcome, process and balancing measures?

Is there a suite of system measures actively in place aligned to strategic objectives? Are these measures reported on time on a monthly basis?Is there evidence of the identification of improvement gaps and QI projects as a result?

Are projects and system measures data consistently presented in time series and routinely analysed using ratified statistical process control?

Are data summaries of live and current improvement work are made available throughout the organisation within publically facing areas either physically or electronically?

0-3 0-3 0-3 0-3 0-3

/60

/60

/60

-----180

0 Organisation has not started/ no progress1 Organisation has started / early progress2 Organisation has embedded / steady progress3 Organisation has fully met criteria across whole organisation

QI Building blocks Framework

Aims of QI Building Blocks Framework

DIALOGIC (jigsaw)

Help individuals and teams understand & assimilate key factors required for continuous quality improvement

DIAGNOSTIC (180 point framework)

Provide pragmatic guidance for organisations in operationalising their

quality strategy and achieving high performing organisational status

Inputs ActivitiesOutputs –

Knowledge & Strategy

Outputs –Operational Effectiveness

Outcomes — ImpactShort Term Medium Term Long Term

(1years) (2+years) (3+years)

• QIBBF dialogic & diagnostic

• AQuA commitment to QIBB concept

• Resources to support QIBB program

• Networking, coordination & promotion

• Academicexpertise

• Senior leadership involvement in learning and deployment

• Organizational & respect & interest to learn and apply

• Interest with people of influence

• Accessible and effective communication mechanisms

• Engagement with stakeholderorganisations online and workshops

• Testing & adaptation

• Supported learning platform including active peer involvement

• Accessible framework, guide and expert support

• Connection of framework to OD strategies

• Promotion of QIBB at different levels on different programs

• Formative evaluation

• Academicratification

• New knowledge applied to current thinking

• Individuals understanding key linkages between philosophy, foundations & mechanisms

• Reframing of organisational quality narrative & values

• Re-alignment of organisational development plans and priorities

• Prioritisation of staff skills and areas of focus

• Leader and staff training at respective levels

• Healthy and key Vision & Values embedded in ‘functional ‘DNA’’

• Redefined and new transformationprograms

• Changes to organisational procedures

• Capacity & capability embedded systematically

• Staff enthusiasm and motivation

• Revised measurement, quality and performance systems

• Improved intra and inter organisational relationships

• Assimilation of core QI methods, innovation, integration & leadership

• Alignment of organisational goals and frontline improvement

• Continuous improvement of systems and processes

• Improvement in staff satisfaction,joy at work & psychological safety

• Internal culture thriving and healthy

• Shift from organisational to system focus

• Evidence of change from patient feedback

• Partnership between public, patient and organisation

• Improvedefficiency of use of resource

• Improvement in mortality & safety metrics

• Reduced waiting times for services

• Equitable service

• Development of innovative treatment, pathways and services

• Demonstrable continuous improvement in care outcomes

• Improved staff retention & skill

• Improved financial balance

• Adoption of newest advances

• Improvement in patient reported experience measures

ORGANISATIONAL

Excellence in quality

High performing organisation recognition

Clear upward trajectory in resilience, responsiveness & reputation

Assumptions

Value of quality improvement methodology

Executive support & organisational commitment

Senior leadership capacity to implement

Resources for deployment

Mechanisms for improvement & deployment

External Factors

Activity vs quality agenda / contractual basis

Financial austerity

Political re-organisation

Change in senior leadership

Competing organisational priorities

QUALITY IMPROVEMENT BUILDING BLOCKS FRAMEWORK LOGIC MODEL v01









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frontline



variability


Essentials

Learning System

Essentials

Person & Family

Centered Care










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frontline



variability


Essentials

Learning System

Essentials

Person & Family

Centered Care


/


One year organisational coaching program and action learning sets

IGNITE! Building Blocks of Quality Improvement part 2

Healthcare