Welcome to Q
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Bringing together members of the Q community from across the West of England to connect, network and start collaborating to shape the way in which we can work together to accelerate improvement in the NHS
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Welcome to Q
- 2. @weahsn @theQCommunity @NHSImprovement @HealthFdn #WelcomeToQWest Penny Pereira Deputy Director of Improvement The Health Foundation Programme Director of the Q initiative
- 3. Our vision for Q Penny Pereira 29 March 2017
- 4. Congratulations! 29.03.2017 Welcome to Q in the West of England
- 5. Your Q community • A connected community working together to improve health and care quality across the UK • Supports people in their existing improvement work: making it easier to share ideas, enhance skills and make changes that benefit patients 29.03.2017 Welcome to Q in the West of England
- 6. 29.03.2017 Welcome to Q in the West of England
- 7. Designed by you, for you • Designed with 231 founding members – diverse cross section of improvers from across the UK • Members continue to help shape the community 29.03.2017 Welcome to Q in the West of England
- 8. Collaborating Thriving Q Connecting Learning 29.03.2017 Welcome to Q in the West of England
- 9. Choose how you are involved 29.03.2017 Welcome to Q in the West of England
- 10. 29.03.2017 Welcome to Q in the West of England
- 11. To connect? 5min 30min s +hour 29.03.2017 Welcome to Q in the West of England
- 12. To learn? 5min 30min s +hour QI Connect Webinars 29.03.2017 Welcome to Q in the West of England
- 13. To exchange? 5min 30min s +hour 29.03.2017 Welcome to Q in the West of England
- 14. To collaborate? 5min 30min ss +hour 29.03.2017 Welcome to Q in the West of England
- 15. What’s next for you? 29.03.2017 Welcome to Q in the West of England
- 16. Opportunities to help lead Convener Apply to help shape how Q develops locally; facilitating local networks and feeding in centrally Connectors Volunteer to help members make connections online and face to face 29.03.2017 Welcome to Q in the West of England
- 17. What might the future look like? 29.03.2017 Welcome to Q in the West of England
- 19. Thank you Visit us online: http://q.health.org.uk Email us: QMembers@health.org.uk Follow us on Twitter: @theQCommunity #Qcommunity
- 20. @weahsn @theQCommunity @NHSImprovement @HealthFdn #WelcomeToQWest Anna Burhouse Director of Quality West of England AHSN
- 21. Our • A chance to meet and collaborate with other like-minded improvers • Share best practices for improving your local healthcare services • All teach and all learn philosophy • A place to grow and shape to meet our local needs
- 22. Your Journey • A chance to apply for an improvement coaching course that will enable you to, guide, motivate and support colleagues involved in improvement work • Co-produce 5 specially designed CPD learning events • Access to our online QI toolkit • Apply to join a ‘Commons Stewardship Group’ which will lead and facilitate initiatives across the West of England
- 23. Q National Commons Stewardship group Made up of 15 national convenors West of England Commons Stewardship Group 1 convenor with 5 additional members Gloucestershire STP Chapter BNSSG STP Chapter BSW STP Chapter Expressions of interest to Dave Evans
- 24. @weahsn @theQCommunity @NHSImprovement @HealthFdn #WelcomeToQWest Julian Simcox Patient Leader Public Contributor West of England AHSN PPG Chair CCG Patient Rep Why being part of the Q Community to me as a Patient/ Carer is such a valuable opportunity
- 27. Patient’s rights… but how can we know?
- 28. Joint & Equal, and how? Co-production = "professionals supporting change, not delivering it“ “Co-production is an equal relationship between people who use services and the people responsible for services. They work together, from design to delivery, sharing strategic decision-making about policies as well as decisions about the best way to deliver services.” Think Local Act Personal 2016
- 29. September 2015 Patient Volunteers have many skills, some of them in short supply for the NHS. Personally I have for 25 yrs worked in the field of Quality, and how to design systems that deliver it.
- 30. 3 x Measurement Paradigms A RI Accountability Improvement Research Who? Audience (Customers) Purchasers Payers Patients/members Medical groups Medical group Quality Improvement team Providers and staff Administrators Science community General public Users (clinicians) Why? Purpose Comparison Basis for choice Reassurance Spur for change Understanding of (a) Process (b) Customers Motivation and focus Baseline Evaluation of changes New knowledge without regard for its applicability
- 31. Sunnyside PPG (Patient Participation Group) The PPG is a Partnership of patients, doctors, healthcare professionals, and surgery staff. Our mission is to: 1. Help patients to take more responsibility for their health. 2. Contribute to the continual improvement of services and quality of care. 3. Provide practical support for the practice and help implement change. 4. Foster improved communication between the practice and its patients. Clevedon Sunnyside
- 32. Sunnyside GP practice already applies Improvement Science (IS) in a number of ways, for example .. 1. Reducing DNA Rates over time – an initiative that now impacts 1/3 of practices in North Somerset. 2. Working with patients who want to learn to Self-Manage using their own data, as well as the data collected (over time) on their behalf by clinicians 3. FFT over time patient-by-patient/ signal-from-noise 4. Establishing a “systems approach” to our STP – specifically via Sign Posting & Social Prescribing 5. Establishing a “systems approach” to Involuntary Loneliness e.g. Leg Club But some HCPs don’t get the paradigm that Quality ≡ IS ≡ over time Systemics
- 33. Viewing Variation – Over Time 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Financial Year -200 -150 -100 -50 0 50 100 150 200 250 300 350 400 excess mortality observed minus expected deaths BaseLine 1.00.017 26/04/2011 06/05/2011 16/05/2011 26/05/2011 29/05/2011 10/06/2011 20/06/2011 02/07/2011 12/07/2011 22/07/2011 01/08/2011 15/08/2011 19/09/2011 17/10/2011 10/11/2011 02/12/2011 24/12/2011 20/01/2012 18/02/2012 15/03/2012 09/04/2012 07/05/2012 08/06/2012 10/07/2012 16/08/2012 13/09/2012 12/10/2012 24/11/2012 30/12/2012 15/03/2013 20/04/2013 26/05/2013 29/06/2013 02/08/2013 06/09/2013 2 o3 times per week 0 25 50 75 100 125 150 175 200 BP SYSTOLIC BaseLine 1.00.017
- 36. @weahsn @theQCommunity @NHSImprovement @HealthFdn #WelcomeToQWest Mark Juniper Consultant in Respiratory and Intensive Care Medicine Quality Lead GWH Swindon Taking my place in the Q…
- 37. What is Q? “A connected community working together to improve health and care quality across the UK”
- 38. My QI journey…
- 39. Habits of an improver
- 40. Q Resources Health foundation – Publications – Website -Patient safety links -QI methodology -Person-centred care Network of colleagues – directory
- 41. 3 universities 1 ambulance trust 5 community health service providers 2 mental health trusts Connecting through Q
- 43. Effective networks for improvement: ‘The 5C wheel’
- 44. Shaping our approach: what can we do? 100 people 1000 ideas? ……where is there variation? ……what can we improve together?
- 45. Shaping our approach: what can we do? We have a history of delivery! NHS South West Quality and Patient Safety Improvement Programme 2009 WEAHSN – NEWS and sepsis – ED safety checklist – mortality reviews
- 46. GWH approach: - Structured sustainable projects: – SU2S – ELC – PQUIP – Point of Care (cardiology) – HIPQIP Scaling Up – ‘Saving Babies Lives’ care bundle • Delirium (Scotland) • Sepsis (Wales) Shaping our approach: what can we do?
- 47. “A connected community working together to improve health and care quality across the UK”
- 49. @weahsn @theQCommunity @NHSImprovement @HealthFdn #WelcomeToQWest Suzie Bailey Director of Leadership and Quality Improvement at NHS Improvement …..Mission Possible?
- 50. 50
- 51. 51 Culture and leadership are fundamental to safe, effective and patient-centred care
- 52. Cultures are… “the way we do things around here” “There needs to be a more consistent approach across the NHS, and a coordinated drive to create the right culture” Freedom to Speak Up Report, February 2015 52
- 53. Clear evidence base 53 “Every interaction by every leader at every level shapes the emerging culture of an organisation” (West et al, 2014)
- 54. 54 – Specification and planning – Infrastructure design – Measurement and oversight – Self-study
- 55. Lessons from high performers? 55 – Leverage operational excellence – Swarm problems in real time – Discipline of knowledge share – Create opportunities for learning – But…the hard part is the leadership model Leaders should: – Find ignorance – Convert to knowledge – Teach others to do the same
- 56. What is the typical approach to change in the NHS? Deficit based • what is wrong? • solve problems • identify what we need to improve • fill gaps and deficiencies Strength based • what is strong? • work with our existing assets and resources • amplify what works • “positive deviants” 56
- 57. Importance of co-production and ownership across the system 57
- 58. 58
- 59. An adaptive framework – local, regional and national 59 Create and sustain the necessary conditions for continuous improvement 13 initial actions Develop capability
- 60. 60
- 62. 62
- 63. A framework for action 63
- 64. Our commitment to change – 3 pledges 16 • We will model in all our dealings with people and in our own organisations the inclusive, compassionate leadership and attention to people development that establish continuous improvement cultures. • We will support local decision-makers through collectively reshaping the regulatory and oversight environment. In particular, we owe local organisations and systems time and space to establish continuous improvement cultures • We will use the framework as a guide when we do anything at a national level concerning leadership, improvement and talent management so we engage across the sector with one voice.
- 65. It’s all about the people… 65
- 66. 66
- 67. 67
- 68. 15 years……? 68
- 69. 69
- 70. How do we avoid the echo chamber? 22 Enthusiasts Visionaries Pragmatists Conservatives Laggards The typical effect sizes of spread activities are perhaps 10-20% at best (Grimshaw) Source: Geoffrey Moore, building on the work of Everett Rodgers
- 73. ‘Shaping our approach’ • Healthcare Q’mmunity connects and activates improvement • Q network helps to save lives • Q network welcomes 1000th member • In control of my health through Q • Q fever hots up healthcare • Using Q to end the queues
Editor's Notes
- Putting Quality First is a strategy that many other industries pursued decades ago. It has for example turned the UK Car Industry from a basket case into a world beater – and they are by no means alone in this. From the late 80s engineers the world over started to network to share their discoveries and to evolve their expertise – assisted of course by a burgeoning communications technology. Don Berwick’s IHI has attempted to mirror this – but (I would say) with less of an impact. Prioritising Quality is an evolved and new way of thinking – a paradigm shift is needed because most people just don’t get it – and actually (25 years after I had my first shift, I now know that) a series of paradigm shifts is needed. Don Berwick now admits that he didn’t get it – he walked out half way through Deming’s 4 day seminar! I don’t yet know if Network Q will become the grand facilitator of the needed shifts – of something which leads to a paradigm shift for the NHS – but by being part of it I’m personally committed to finding out.
- There are two main ways of folding your hands – neither is better than the other – but sometime in childhood each of us chooses just one of these ways and then sticks to it. Doing it the other way is, metaphorically at least, a new way of thinking – a different paradigm, mind set, a new world view even. First you have to change your theory, and then test it to see what happens. Then you can study the outcomes and decide whether it’s worth making the new way a standard part of every day life. Most of you are probably thinking – I didn’t even know there is a second way, but now I do know and I’ve tried it, the pain is not worth the gain? Incidentally, this is how the NHS Model for Improvement is meant to work. Deciding whether something new we are trying is actually beneficial requires data and evidence – over time.
- This is the new paradigm of Quality – and it changed the world – and still does. The notion is that if you always Put Quality First, everything else eventually comes right – but to achieve this there has to be strong Managerial Leadership and Constancy of Purpose, and everything has to be subsumed to the system – its design and its maintenance, then its continual improvement – and even (if there’s no other option) its transformation.
- The NHS Constitution says that as Patients we can expect a Quality Environment, and a System that delivers Quality Outcomes. Deming would have asked “how can we know if a promise is being kept?” and “by what method?” He died in 1993, but if here today he would ask why there is so much costly inspection, and why so many arbitrary targets which attempt to motivate people and hold them to account, but which sadly do the opposite – actually causing poorer Quality! A new paradigm is needed – and that is what he prescribed – and was emulated in the Berwick Report (2013). If you want a concise introduction to Deming just read this report.
- Co-production video- https://www.youtube.com/watch?v=vugLEaEcBR0&app=desktop http:// www.thinklocalactpersonal.org.uk/_assets/Resources/Coproduction/LadderOfParticipation.pdf I am a “co-producing” patient – a self-empowered one. I’m not the only one in this room, and there is a growing number of us. We are trying to work to a different paradigm. Actually being intrinsically motivated and self-empowered is the only kind of empowerment that works. This is another new paradigm. Here is a model which seeks to explain this – taken from a forthcoming paper seeking to define what good health for an individual looks like.
- Here is another new Paradigm. It’s been around in the NHS for many years, yet if Deming were still here he would have said it is far from being core to the culture. Here are some of the reasons: http://www.improvementscience.net/jois/jois_view_abstract.php?volume=33 Don Berwick’s Report in 2013 advocated that this model should become core to a new Quality-based learning culture https://www.gov.uk/government/publications/berwick-review-into-patient-safety Incidentally here are some of things to bear in mind when using the Improvement Model: Visiting and continually re-visiting the Purpose brings clarity for everyone involved Establishing assumptions and then hypotheses -- so that they can be tested -- connects everyone to the reality of what is actually happening – you only have to read the Nobel-prize winning Daniel Kahneman to realise just how easy it is to separate ourselves from what’s really happening https://en.wikipedia.org/wiki/Thinking,_Fast_and_Slow Achieving maximal Learning at minimal Cost requires some smart experimental design Avoiding the scaling-up of an intervention too quickly – better to go slow to go fast, whilst en route drawing-out wider and deeper learning Monitoring data over time, and in real time, enables the creation of systemic knowledge: BaseLine® http://www.saasoft.com/baseline/baseline.php Prioritising Outcome data before Activity data – connects everyone to the purpose Redesigning systems to avoid wasted resources is a skillset not commonly available in Healthcare – but I can be learned Being continuously aware of what Deming called “Tampering” – how common sense destroys quality https://en.wikipedia.org/wiki/Tampering_(quality_control)
- Here are three more important paradigms. Understanding the difference will help you understand how to successfully work both with the existing culture AND the newly emerging one that’s properly rooted in improvement science, innovation and learning. The A-I-R Measurement Model really can help sort out your measurement dilemmas. http://www.improvementscience.net/blog/?p=4178 This paper also describes the 7 philosophical foundations of Improvement Science. The way that numbers get used in the NHS is driven by the Accountability paradigm – sometimes professional researchers are brought-in, often a long time after an intervention – using Research methods that are often quite alien and impractical to the everyday life of the NHS, and these methods are usually used in a way that is oblivious to the (very practical) possibilities that stem from Improvement.
- The main reason I wanted, as a patient/carer, to join Network Q was that to me it demonstrates that I am taking my role as Patient Leader seriously. One of my formal roles for example is as PPG Chair in the surgery where I’m a patient: Sunnyside in Clevedon. Our mission statement (on the slide) is very similar to the one recommended by NAPP (the National Association of Patient Participation) so is not peculiar to our practice. It however does not occur to most PPG members that in order to assist the achievement of this mission they should learn some new skills, nor do I think this ought to be a requirement for volunteering, but to an as yet small (but growing number) we believe it ought in time to be such a requirement. Being able to say we’re part of the Network Q Community I predict will also be a distinct help when validating our work: with other practices – and with our CCG – for whom Improvement Science is still tends to be seen as a “nice to have” rather than as an essential core activity.
- In the past year we have also set-up a patient-led group that from July will precis the BNSSG performance reports so that patients can understand them and see how the system is currently running – via PPGs. Very happily (!) the person who has the job of representing the 3 CCGs and interfacing with us (Marie Davies) is also now also a Network Q member, so she immediately gets that we’re on the same page and level – and can work jointly with us.
- To Deming, being able to view variation (change) over time is a vital first step to being able to maintain stability – which can then be a solid platform for the testing of improvement ideas. This can also be the key to real engagement
- Julian Simcox: Patient Leader: for most of my adult life I’ve been a Professional 1st/ Patient 2nd like I guess most people here. Nowadays I have a switched paradigm – it’s Patient 1st and carer 1st too – but does this mean leaving everything to the professionals to sort out? My answer to this is NOT On YOUR LIFE and so this is why as a patient I have become a Network Q member? It’s a no brainer because Co-producing decisions means being able to share a common language. Speaking of paradigms – a paradigm is a way of seeing things, a way of thinking – it’s a way of helping you make sense of (and adapt to) – your environment. And if a particular paradigm seems to work alright it quickly becomes a HABIT – though not necessarily the BEST WAY of seeing: (Stand-up : Praying hands metaphor). To change your habit/ behaviour, first you have to change your paradigm. This rarely comes naturally; in 1986 Don Berwick attended W. Edwards Deming’s 4 day seminar and flew home after 2 days believing it to be a waste of time! Then he woke up and went back for the other 2 days – without this paradigm shift the IHI would not now exist. In 1950 W. Edwards Deming taught Japanese industrialists a new paradigm – one that over the next 30 years changed the world: Subordinate everything to Quality and design your organisational systems to consistently deliver it. Up until then everyone thought to only way to get quality was to pay for it. More resources = more quality. Deming’s new paradigm not only changed the world, it led to us being here today – but TO GET IT, FIRST you have to SEE it. What you see is what you do is what you get is what you see. He called the Q paradigm a Chain Reaction, but it starts with paradigm-shift because FIRST you have to be able to see it. Here are a number of (as I see things, NEEDED) paradigms: the NHS Constitution says Patients have rights, but how would we (and i) know they’re being delivered upon? I’m not the only patient leader in this room – we’re largely unseen. We’re waiting to be Co-producers, but as yet we are not usually “designed-in-to” the NHS system. Network Q membership should help this? The NHS Model for Improvement is Deming’s way of making science and learning something that’s methodically sustaining in the life of an organisation – it is elegantly simple to do – but only if FIRST you get it/ see it. Then it culturally impacts everything. Knowing, and hence Measurement, is vital for understanding and improving your system – but there are 3 distinct paradigms and the one we need most (improvement) gets squeezed out – yet it could be a bridge (if enough individuals can just see it, do it, get it). + (6) (7) Here is what a group of patients is leading for themselves in N. Somerset. If you want to know more come talk to me later? To finish: (Stand-up: Folded Arms metaphor)
- Numerous national reports have made recommendations for change in culture and style of leadership. Berwick report said: the most important single change in the NHS in response to this report would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.”
- What do I mean by culture?
- There is a very strong evidence base for why should focus on developing enabling cultures – you all play such a critical role as senior leaders to ‘oxygenate’ your organisation and work with partners across your local system to do the same
- Following Smith review, national board formed specifically to oversee developing capability in improvement and leadership development. Board reports into the 5YFV CEO group
- The framework is deliberately designed to be adaptive – we want to work with people across the system to test and learn what works, this is a long journey over the next 15-20 years
- Model, support and be guided by the framework
- Ed wanted to finish with ‘it’s all about the people………..’