Striking the balance: approaches to accountability and quality improvement to achieve results
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Slides from session A9 at the International Forum on Safety and Quality in Healthcare, 13th April 2016
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Striking the balance: approaches to accountability and quality improvement to achieve results
- 1. Striking the Balance: Approaches to Accountability and Quality Improvement to Achieve Results Helen Bevan Chief Transformation Officer Horizons, NHS England Christina Krause Executive Director BC Patient Safety & Quality Council @helenbevan @ck4q #qfA9 #quality2016
- 2. Speed Networking “When do you feel most engaged and energized at work?” @helenbevan @ck4q #qfA9 #quality2016
- 3. Three ways to enhance quality Quality planning Quality improvement Quality control Source: Juran quality trilogy All three are necessary for quality outcomes All three need to be aligned QP QCQI @helenbevan @ck4q #qfA9 #quality2016
- 4. Three ways to enhance quality Source of model: Juran quality trilogy Identify the needs of population, create aims & metrics for outcomes & set out a series of steps for meeting our aims Ensuring high quality care through monitoring, inspecting, accrediting, regulating & include corrective responses Achieve better outcomes through a systematic change approach with strong leadership, adaptive culture and people who are skilled in QI methods. QP QCQI @helenbevan @ck4q #qfA9 #quality2016
- 5. TRIZ: Theory of Inventive Problem solving Stopping counter-productive activities and behaviours “Every act of creation is first an act of destruction” Pablo Picasso @helenbevan @ck4q #qfA9 #quality2016
- 7. Our TRIZ topic… How can we deliberately create a health care system that favours quality assurance over quality improvement as a strategy for improving care? TRIZ @helenbevan @ck4q #qfA9 #quality2016
- 8. Step 1 As a table group make a list of “to-dos” on the first paper sheet in response to this task: How can we deliberately create a health care system that favours quality assurance over quality improvement as a strategy for improving care? • Go wild! • 5 minutes TRIZ@helenbevan @ck4q #qfA9 #quality2016
- 9. Step 2 As a table group, go down your first list and ask: – Is there anything that we are currently doing that in any way, shape or form resembles any of the items on list one? – Is there an element of truth in here? • Cross out anything that you do not currently do, circle those that do – Be unforgiving about these items and talk about their impact • 5 minutes TRIZ@helenbevan @ck4q #qfA9 #quality2016
- 10. Step 3 As a table group, for each one you circled ask: “what are the first steps that will help us stop getting undesirable results?” • Make a list of actions on a new sheet • Be prepared to share some of your content from lists 2 and 3 with the wider group • 5 minutes TRIZ@helenbevan @ck4q #qfA9 #quality2016
- 11. Intrinsic motivators build energy and creativity @helenbevan @ck4q #qfA9 #quality2016
- 12. Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity @helenbevan @ck4q #qfA9 #quality2016
- 13. Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity create focus & momentum for delivery Drivers of extrinsic motivation @helenbevan @ck4q #qfA9 #quality2016
- 14. Drivers of extrinsic motivation create focus & momentum for delivery Intrinsic motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity •System drivers & incentives •Payment by results •Performance management •Measurement for accountability @helenbevan @ck4q #qfA9 #quality2016
- 15. Internal motivators •connecting to shared purpose •engaging, mobilising and calling to action •motivational leadership build energy and creativity Drivers of extrinsic motivation •System drivers & incentives •Performance management •Measurement for accountability create & focus momentum for delivery @helenbevan @ck4q #qfA9 #quality2016
- 16. The power of extrinsic drivers @helenbevan @ck4q #qfA9 #quality2016
- 17. Three types of levers for large scale change ‘Prod mechanisms’ targets performance management price & payment incentives regulation competition ‘Proactive support’ relies on building ‘intrinsic motivation’ in staff to make the right changes to improve ‘People focused’ education and training national contracts professional regulation clinical quality standards Type one: Type two: Type three: Source: Health Foundation Constructive comfort: accelerating change in the NHS 2015 @helenbevan @ck4q #qfA9 #quality2016
- 18. Three types of levers for large scale change ‘Prod mechanisms’ targets performance management price & payment incentives regulation competition ‘Proactive support’ relies on building ‘intrinsic motivation’ in staff to make the right changes to improve ‘People focused’ education and training national contracts professional regulation clinical quality standards Type one: Type two: Type three: Source: Health Foundation Constructive comfort: accelerating change in the NHS 2015 Less than 10% of the potential for improvement at system level can be delivered through type one change @helenbevan @ck4q #qfA9 #quality2016
- 19. “I have some Key Performance Indicators for you” or “I have a dream” Source: @RobertVarnam @helenbevan @ck4q #qfA9 #quality2016
- 20. @helenbevan @ck4q #qfA9 #quality2016
- 21. https://www.youtube.com/watch?v=DKK-yFn7e_0 @helenbevan @ck4q #qfA9 #quality2016
- 22. https://www.youtube.com/watch?v=DKK-yFn7e_0 @helenbevan @ck4q #qfA9 #quality2016
- 23. @helenbevan @ck4q #qfA9 #quality2016
- 24. @helenbevan @ck4q #qfA9 #quality2016
- 34. What Is the Balance in Your System? @helenbevan @ck4q #qfA9 #quality2016
- 35. Adapted from the Danish national quality strategy @helenbevan @ck4q #qfA9 #quality2016
- 36. @helenbevan @ck4q #qfA9 #quality2016
- 37. What Is the Balance in Your System? Table Discussion @helenbevan @ck4q #qfA9 #quality2016
- 38. @helenbevan @ck4q #qfA9 #quality2016
- 39. Examples of Polarities to Manage Old power AND Transactional AND Micro AND Collaborative learner AND Customizing AND Wholeness AND Complex AND New power Transformational Macro Expert advisor Standardizing Linear Simple @helenbevan @ck4q #qfA9 #quality2016
- 41. #qfA9
- 42. Positive results of focus on this left pole Negative results of over-focus on the left pole to the neglect of the right pole Negative results of over-focus on the right pole to the neglect of the left pole Deeper Fear from lack of balance Greater Purpose Statement - why balance this polarity? * and Adapted from the Polarity Management map, Polarity Associates PolarityMapAction steps How will we gain or maintain the positive results from focusing on this left pole? What? Who? By When? Measures? Action Steps How will we gain or maintain the positive results from focusing on this right pole? What? Who? By When? Measures? Early Warnings Measurable indicators (things you can count) that will let you know that you are getting into the downside of this left pole. Early Warnings Measurable indicators (things you can count) that will let you know that you are getting into the downside of this right pole. Positive results of focus on this right pole
- 43. At Your Tables … An opportunity to dive deeper on quality assurance and quality improvement through polarity mapping. Using the worksheet on your table – explore the concepts of: Accountability AND Improvement @helenbevan @ck4q #qfA9 #quality2016
- 44. Jeremy Heimens TED talk “What new power looks like” https://www.youtube.com/watch?v=j-S03JfgHEA old power new power Currency Held by a few Pushed down Commanded Closed Transaction Current Made by many Pulled in Shared Open Relationship @helenbevan @ck4q #qfA9 #quality2016
- 45. So what does this mean for us in the room today? • Striking the balance … both/and, not either/or • Understanding and applying within our own contexts • Turn to your neighbour … What does it mean for you back home? @helenbevan @ck4q #qfA9 #quality2016
- 46. Thank you! Helen Bevan @helenbevan Helen.Bevan@NHSIQ.nhs.uk Christina Krause @ck4q ckrause@bcpsqc.ca @helenbevan @ck4q #qfA9 #quality2016
Notes de l'éditeur
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- Link below http://www.bbc.co.uk/news/magazine-23790147 http://www.bbc.co.uk/learningzone/clips/martin-luther-king-i-have-a-dream-pt-1-2/1293.html With the brooding statue of Abraham Lincoln peering down at him, King began by telling protesters that their presence in the symbolic shadow of the "great emancipator" offered proof of the marvellous new militancy sweeping the country. For too long, he complained, black Americans had been exiles in their own land, "crippled by the manacles of segregation and the chains of discrimination". The whirlwinds of revolt would continue to shake the very foundations of the country: "And those who hope that the Negro needed to blow off steam and will now be content will have a rude awakening if the nation returns to business as normal," King said. It would be fatal for the nation "to overlook the urgency of the moment and to underestimate the determination of the Negro". “He's good - he's damned good” Kennedy on King Wearied by the suffocating heat, the crowd's initial response was muted. The speech was not going well. "Tell 'em about the dream, Martin," shouted Mahalia Jackson, referring to a rhetorical riff that King had used several times before, but which had not made it into his prepared speech because aides insisted he needed fresh material. But King decided to cast aside his prepared notes, and launched extemporaneously into the refrain for which he will forever be remembered. "I have a dream that one day this nation will rise up and live out the true meaning of its creed," he shouted, his out-stretched right arm reaching towards the sky. Soon he was hitting his rhythm, invigorated by the chants and cries of the crowd. "Dream on!" they shouted. "Dream on!" With his voice thundering down the Mall, King imagined a future in which his children could "live in a nation where they will not be judged by the colour of their skin but by the content of their character". Then he reached his impassioned finale. King asked the crowd to yell so it was heard the world over Watching at the White House, the president was riveted. Like so many Americans, it was the first time he had heard the 34-year-old preacher deliver a speech in its entirety - the first time he had taken its measure, listened to its cadence. "He's good," Kennedy told one of his advisors. "He's damned good." The aide was struck, however, that the president seemed impressed more by the quality of King's performance rather than the power of his message.