An Introduction to Improvement

To develop a basic understanding of:

• Service improvement in healthcare

• Some of the tools and techniques used

To apply process thinking associated with

your own practice and patient journey.

Session Outcomes

What Is Improvement?

Definition:Continually working together to improve the experience and outcomes for patients and users; Looking for other ways to provide healthcare, that continuously improves the way it meets the needs of those who depend on it and the working lives of staff who provide it.

Key Improvement Themes

Personal and organisational development

How to recognise and value differences in

style and preferences, including yourself, and build a culture that supports

improvement

Process And Systems

ThinkingHow to understand

your work processes and systems and all the linkages within them, looking for ways to increase

capacity and reduce demand and waste

Making it a habit; initiating, sustaining

and spreadingHow to build

improvement into daily work: making it something that we

don’t think about as special but we just

get on and do it

Involving users, carers,

staff and publicHow to involve and

understand the experience and needs of your patients, their

carers and your colleagues

Why Do We Need Improvement Science?• Help us to aspire to be the best

• Give us the ability and belief to change

• ‘Bottom out’ problems not jump to

solutions

• Evidence, support and prove our ideas

If you’re still in doubt ask yourself why not! Shouldn’t we all strive to give better patient care?

Improvement is having the VISION to look at the way you work and the CREATIVITY to do things differently

“Vision is seeing the potential hidden in the

chaos of the moment”

William Van Dusen Wishard

What Does Improvement Involve?

What Does Improvement Involve?

Having the belief in yourself and others that you have the power to improve and to install an IMPROVEMENT CULTURE that welcomes change!

“When building a culture of improvement, you need to

work like a farmer, planting seeds and nourishing the ground.”

Marshall 2002

What Does Improvement Involve?

Having improvement knowledge, skills, tools and techniques – and knowing how to use them!

“Knowing is not enough; we must apply. Willing is not enough; we must do.”

J Wolfgang von Goethe

Tools and Techniques

1. Process and Patient Flow Mapping

2. Model for Improvement

3. Understanding Variation

1. Process and Patient Flow Mapping

Process mapping …

Identify opportunities to improve

Select a process

Map the process

Analyse current situation

Analyse current situation

Lots of steps

delays

bottlenecks

Reworked loops

Reworked loops

Identify opportunities to improve

With as few steps as possible

Each step must add value to the process.

1. Letter arrives at

patients home with the

admission date

2. Patient calls the

hospital to request a bed near a toilet

5. Patient arrives on

ward and is placed in a bed next to the window

6. Patient rings call bell as told

7. Nurse attends

patient and assists to

toilet

8. Patient rings call bell for help back

to bed

9. Nurse helps patient back to

bed

3. Call transferred to waiting list department – unable to help

4. Call transferred to

bed managers – message taken

(3 weeks later)

Ž

Ž

Ž

Ž

ŽDelay No value for patient handoff

Start: 1st May 2006

End: 24th May 2006

Process Map

 

Ž

2. Model for Improvement

Model for improvementWhat are we trying to

accomplish?

How will we know that a change is an improvement?

What changes can we make that will result in the

improvements that we seek ?

Act Plan

Study Do

Copyright IHI 2000

testing ideas before implementing changes

change ideas

measurements

aims

PDSA cycle for learning and improvement

Act• Did it work and what is next?• Repeat test?• Different idea?• Rollout bigger, involve more people?

Plan• Why and what do you want to do?• How will you do it?• Who will be involved?• When/ where will you do it and for how long?Study

• What did the test tell you – results, outcomes etc? (Seek help to analyse it)

Do• Test your ideas out• Small scale changes• Know what and how you are going to measure

Keep it small keep it:

Specific

Measurable

Achievable

Realistic

TTimely

Remember

Your Turn!

• Based on the scenario, take a couple of minutes to think what could have been done differently.

• Ask yourself how the patient’s experience could have been improved

• Think of an idea (keep it small and smart!)

• Have a go at a PDSA cycle!

PDSA cycle for learning and improvement

Act• Did it work and what is next?• Repeat test?• Different idea?• Rollout bigger, involve more people?

Plan• Why and what do you want to do?• How will you do it?• Who will be involved?• When/ where will you do it and for how long?Study

• What did the test tell you – results, outcomes etc? (Seek help to analyse it)

Do• Test your ideas out• Small scale changes• Know what and how you are going to measure

3. Understanding Variation

Percentage of T&O Elective Inpatients Admitted on Day of Surgery 4 Jul 05 - 20 Aug 06

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Week Ending

Perc

en

tag

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Unstable

Stable

Change

What has happened?

ActualMeanLower Control LimitUpper Control Limit

Remember – having some variation is ok providing you monitor and manage it!

RecapKey things you need are:• Vision and creative ways to do things differently• Improvement culture and willingness to change• Appropriate knowledge and skills

Useful tools and techniques include:• Process and patient journey mapping• Improvement model & PDSA Cycles• Understanding variationRemember – it might be a bumpy ride but to be a

successful leader of change you must have the right mindset…..