Spreading and sustaining improvement: myths models and magic

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Myths, models and magic

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Rosanna HuntHorizonsNHS England

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It took over a century for handwashing to become mainstream practice and it is still not universal.

We are now beginning to understand the challenge of spread and scale-up in complex systems.

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A study of healthcare

interventions from the 1960s

to the 1990s found it took an

average of 17 years until

they became standard care.

Balas, E.A. and Boren, S.A. (2000) ‘Managing clinical knowledge for health care improvement.’ In Bemmel, J. and McCray, A.T. (Eds.) (2000) ’Yearbook of Medical Informatics 2000: Patient-Centered Systems.

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David AlburyInnovation Unit

A leading thinker in the field of spread and scaling-up innovation

5 myths of spread

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Myth 1: Scaling-up is about spreading information

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Myth 2: Spreading means transferring from one context to another

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Myth 3: Innovation and spread are separate and sequential processes

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Myth 4: The more innovations we come up with the more spread we will get

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Myth 5: The key agents of spread are professionals

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Talk about the five myths:

Do we do any of these?

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@rosielhunt

Talk about the five myths:

Do we do any of them?Myth 1: Scaling-up is about spreading informationMyth 2: Spreading means transferring from one context to another Myth 3: Innovation and spread are separate and sequential processesMyth 4: The more innovations we come up with the more spread we will getMyth 5: The key agents of spread are professionals

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@rosielhunt #improvefalls

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NHS Spread and sustainability Model

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Productive Ward spread rapidly across the NHS and further afield and is widely cited as an example of large-scale change

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The Kaiser Permanente spread model

Collaboratives

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@rosielhunt16

What are we spreading?

How Does It Work?

Simplicity

Cultural Fit

Business Case

Tools

Implementation Support

Demonstrated Sustainability

Demonstrated Transfer

Adaptability

Unintended Consequences

Does It Work?Will It Work Elsewhere?

Comparative Performance

Outcome vs. Process

Improvement Attributable to

Practice

Strength of Evidence

Logic Model

Key Components

Specific Processes

OrganizationalEnablers

Barriers and Risks

Will It Spread?

© Kaiser Permanente 2016 reproduce by permission only

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Assessing the context

OrganizationalEffectiveness

Staff Skills and Capacity

Space and Equipment

Technology

Champion

Project Management

Training

Measurement and Monitoring

Alignment and Sponsorship

Implementation Infrastructure

Strategic Alignment with

Goals and Priorities

Sponsorship & Leadership

Oversight Structure

Operational Effectiveness

Relationships among Units

Readiness for Change

Practice Resources

© Kaiser Permanente 2016 reproduce by permission only

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The EAST model

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What is the best way to spread new knowledge?

Source of data: Nick Milton http://www.nickmilton.com/2014/10/why-

knowledge-transfer-through.html

Social connection/discussion is

14 times more effective

than

written word/best practice

databases/toolkits etc.

Source of image: www.happiness-one-quote-time.blogspot.com

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“Stages of change” Transtheoretical model of behaviour change

Prochaska, DiClemente & Norcross (1992)

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@rosielhunt

I am not aware my smoking is a

problem – I have no intention to quit

I know my smoking is a problem – I

want to stop but no plans yet

I am making plans & changing things

I do in preparation.

I have stopped smoking!

I am continuing to not smoke.

I sometimes miss it – but I am still not

smoking

“Stages of change”

Smoking

Prochaska, DiClemente & Norcross (1992)

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The reality of our change situation

Our tools are often not effective at the stage of change that most people we work with are at

It’s hard to engage people in change

It’s hard to get people to make the changes we want them to make

People get irritated, defensive, irrational

We feel powerless in our ability to lead or facilitate the change

90% of the tools available for health and care change agents are designed for the “action” stage

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Talk about what you are

spreading/scaling-up.

What’s going to work for you?

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@rosielhunt

Finding the magic:

Building energy for

change

Psychological

Physical

Spiritual

Social Intellectual

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Building spiritual energy

Where are the projects that align with our purpose?Could they use us? Lets give them a boost!

Finding

vehicles for

change

Resistance to change is personal

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Building psychological energy

• A culture of improvement starts with personal and individual growth

• What is your personal limitation?

• Build trust by sharing it with colleagues and getting them to help you grow

Kegan et al (2016) An Everyone Culture: Becoming

a Deliberately Developmental Organization

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Building social energy

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People who are highly connected have twice as much power to influence

change as people with hierarchical power

Leandro Herrero

http://t.co/Du6zCbrDBC

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“The QI community’s role is in creating the learning environments for studying, adapting, trying out, sometimes failing but always refining”.

Don Berwick IHI, 2017

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Building energy for change through the creation of learning environments

http://www.patientvoices.org.uk/flv/0032pv384.htm

Myths, models

and magic

#improvefalls@rosielhunt

Psychological

Physical

Spiritual

Social Intellectual