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Our coaching faculty
Katherine Brittin,
Associate Director of QI
Auzwell Chitewe,
Associate Director of QI
Francisco Frasquilho,
Senior Improvement AdvisorDr Amar Shah,
Chief Quality Officer
Marco Aurelio,
Senior Improvement Advisor
With support from other QI team members…
Susan Alfred,
Improvement Advisor Sher Kayani,
Improvement Advisor
ELFT QI support & data team
Shuhayb Ramjany,
Training & Programme
Support Officer
Forid Alom,
Strategic Lead for Information
Analytics
Katie Angus,
Communications & Events
Officer
Tim Gill,
Programme Manager
Improvement Coaching Programme
Day Overview of Content
Day 1 - 22/09/20 Orientation to ICP , building a team, Life QI
Day 2 - 23/09/20Deep dive into ‘Model for Improvement’ and 'Sequence of
Improvement’, Psychology of change
Day 3 - 06/10/20 Developing a change strategy, systems thinking
Day 4 - 20/10/20 Understanding variation using run charts, testing and PDSA
Day 5 - 05/09/20 Understanding variation using control charts, Triple Aim
Day 6 - 26/09/20 Advanced control charts, using qualitative data and storytelling
Day 7 - 28/01/21 Implementation and scale up
Day 8 - 29/01/21 What's next for QI coaches and celebration
Day 2 Content
AM
Morning reflection
History of QI
Quality Management
Lens of profound
knowledge
The ELFT sequence of
improvement
(Parts 1 and 2)
Lunch
PM
Action Learning Sets
(on MS Teams)
Using root cause
analyses tools
Psychology of change
framework
Morning Reflection
• Breakout "Impromptu Networking"
• What was one thing that you came away with from yesterday:
1. That you found powerful or useful – new learning, surprising.
...And why
• 2 Mins in each pair
Quiz
Take 10 minutes to work through the 5 questions on this quiz
Feel free to use the internet to help you find the answers
https://bit.ly/3jLpSwZ
https://forms.office.com/Pages/ResponsePage.aspx?id=slTDN7CF9UeyIge0jXdO4zSx_FDRefxPkxB6TQPE7oBUQlpORFA5OVB
BUzAyNlNEOU5EQ0NXNUZLTC4u
Bill Smith (1986)
Motorola
Six SigmaMikel Harry (1988)
Motorola- MAIC
Forrest Breyfogle 111
(1992)- Integration
Michael George
(1991)- Integration
F.Taylor-The Principles of
Scientific Management
(1911)
Toyoda Family
Kiichiro Toyoda
Sakichi Tooda
Taiichi Ohno 1950-1980
Toyota Production System
Reference: Wortman 2001
Womack & Jones
Scoville & Little
Comparing Lean and
Quality Improvement
(2014)
Joseph Juran
1904-2008
W. Edwards Deming
1900-1993
Walter Shewhart
1891-1967
Improving
Quality
Quality
Improvement=
Managing Quality
http://bmj.com/cgi/content/full/bmj.m2319?ijkey=kYlOhc5cg7CKBDl&keytype=ref
https://bit.ly/3bldJMh
IMPROVEMENT
UCL
LCL
CONTROL CONTROL
Original Zone of Quality Control
WEEKMONTH MONTH
New Zone of Quality Control
QUALITY PLANNING
Quality Improvement
DS
A P
DoStudy
PlanAct
LESSONS LEARNT
PERFORMANCE SHIFT
DESIGN
qi.elft.nhs.uk
@ELFT_QI
Improvement Coaching Programme
The science of improvement and profound knowledge
“Some problems are so complex that
you have to be highly intelligent and
well informed just to be undecided
about them.”
- Laurence J. Peter
A good reference on this topic is “Wicked Problems and Social Complexity “
by Jeff Conklin, Ph.D., Chapter 1 in Dialogue Mapping: Defragmenting
Projects through Shared Understanding. For more information see the
CogNexus Institute website at http://cognexus.org, 2004.
Wicked Problems!
Knowledge for Improvement
Science of
Improvement
Knowledge
Subject Matter
Knowledge
Improvement: Learn to combine subject matter knowledge and Science of Improvement knowledge in
creative ways to develop effective changes for improvement.
Improvement
“Dr. Edwards Deming made an
important contribution to the
science of improvement by
recognizing the elements of
knowledge that underpin
improvements over a wide
spectrum of applications.
He gave this body of knowledge
the foreboding name “a System
of Profound Knowledge.”
“System” denotes the emphasis
on the interaction of the
components rather than on the
components themselves.”
“Profound” denotes the deep
insight that this knowledge
provided into how to make
changes that will result in
improvement in a variety of
settings.
The Improvement Guide, page xxiv.
The Lens of Profound KnowledgeAppreciation
of a system
Understanding Variation
Theoryof
Knowledge
Human
BehaviorQI
“The system of profound
knowledge provides a
lens. It provides a new
map of theory by which to
understand and optimise
our organizations.” (Deming, Out of the Crisis)
It provides an opportunity
for dialogue and learning!
The timeline for the development of Profound Knowledge1900s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s
Va
ria
tio
n
Shewhart Control Chart
1924
Design of Experiments
Sir Ronald Fisher, 1925
Shewhart’s 1931 and 1939
Books on Quality Control*
Sampling methods
Developed, H. F. Dodge
Lectures at The USDA,
1938, organized By Deming*
Use of
statistical
methods to
support the
war
effort 1941 -
1945
Enumerative vs
Analytic
Studies in Statistics,
Deming
Sys
tem
s
F. Taylor,
Frank &
Lillian
Gilbreth,
Scientific
Management
General
Systems
Theory
Lugwig von
Bertalanffy,
1949
Principles of Systems
Jay Forrester, 1968
The
Goal
1984
Theory of
Constraints
E. Goldratt,
1990
Ps
yc
ho
log
y
B - f(p,e) Kurt Lewin 1920
Participatory
Management Mary
Parker Follett, 1925
Hawthorne Experiments
Plant, Elton Mayo, 1927
Anthropology
Experts
apply theory
to business
Tavistock
institute 1951
Eric Trist
Soclotechnical
System
Organization
Development
D. McGregor
Human Side of
Enterprise D.
McGregor, 1960
Maslow – Hierarchy of
Needs1962
Motivation Theory
Herzberg, 1968
Open
Systems
Fred Emery
Motivation
Theory
Kohn
1993
Motivation
Theory
Herzberg,
2003
Kn
ow
led
ge John Dewey
Realism of
Pragmatism,
1905
Mind & The World
Order, C.I. Lewis
1929
How We Think
Dewey, 1933
Double Loop
Learning in
Organizations
Chris Argyris,
1977
Appreciation for a System
• Interdependence, dynamism of the parts
• The world is not deterministic
• Direct, indirect and interactive variables
• The system must have an aim
• The whole is greater than sum of the parts
Understanding Variation
• Variation is to be expected!
• Common or special causes of variation
• Data for judgment or improvement?
• Ranking, tampering & performance management
• Potential sampling errors
Theory of Knowledge
• What theories drive the
system?• Can we predict?
• Learning from theory and
experience
• Operational definitions (what
does a concept mean?)
• PDSAs for learning and
improvement
Human Behavior
• Interaction between people
• Intrinsic versus extrinsic
motivation
• Beliefs, values & assumptions
• What is the Will to change?
What insights might be obtained by looking through the Lens of Profound Knowledge?
UV
HB
TK
ST
You will be placed in one of 8 breakout rooms:
1) Systems Thinking (Theory)
2) Systems Thinking (Example)
3) Understanding Variation (Theory)
4) Understanding Variation (Example)
5) Theory of Knowledge (Theory)
6) Theory of Knowledge (Example)
7) Human Behaviour (Theory)
8) Human Behaviour (Example)
Refer to the Improvement Guide for details on each component of
Profound Knowledge (Chapter Four pages 75-88)
Theory – Use Miro to list key components of your section.(15
minutes)
Example – Use Miro to produce an example related to the wearing of
face masks by the general public. (15 minutes)
Assign a presenter. When we come back, you’ll present back to the
whole class. (2 minutes each).
Exercise: Explain Profound Knowledge
Interaction of the Components of Profound Knowledge
• Although the four components of profound knowledge have been described separately here, their importance in improvement is derived mainly from their interaction.
• Focusing on appreciation for a system without considering the impact that variation is having on the system will not produce effective ideas for improvement.
• Similarly, the interplay of the human side of change and the building of knowledge, as seen in areas of study such as cognitive psychology, is critical for growing people’s knowledge about making changes that result in improvement.
AppendicesAppreciation
of a system
Understanding Variation
Theoryof
Knowledge
Human
BehaviorQI
Key Principles to Guide Improvement work
• We can think of all work as a process
• A system is an interdependent group of items, people, and processes with a common aim
• Every system is perfectly designed to achieve the results it achieves
• People are a key part of systems in organizations – they want to do a good job and take pride in their work
• Improvement requires change, but not every change is an improvement
• Variation in data can be due to common and special causes
• Improvement in quality can occur with reduction in costs (the Chain Reaction and Business Case for Quality)
Applying the science
Elements of a process
5. Suppliers 6. Customers
2. Thing being passed along
3. Inputs 4. Outputs
1. Sequence of steps
“QUALITY”Attributes of the
outputs that meet
the needs and
aspirations of the
customers
What can go wrong in a process?
1. Problems in
execution within
steps
2
1
2. Problems in hand-offs
between steps
3
3. Process was not
designed to meet
the needs
System principles
• A system is an interdependent group of items, people, or processes working together toward a common purpose
• Every system is perfectly designed to achieve the results it achieves
• If each part of a system, considered separately, is made to operate as efficiently as possible, then the system as a whole will not operate as effectively as possible [Ackoff, 1981].
• Two basic types of change in a system are:
• First-order Change: A change that occurs within a given system. The system remains the same.
• Second-order Change: A change whose occurrence changes the system (change of change, discontinuity, logical jump, etc).
• Complexity in a system - detail and dynamic
4-13
Changing the old
Making the future attractive
WillIdeas
Execution
Establish the Foundation
Setting Direction: Mission, Vision and Strategy
PULL
PUSH
Leadership for improvement
IHI, 2012
Psychology is Useful in Building Will
Using the lens of psychology to lead improvement
• Leaders appreciate differences in people and the importance of the fundamental attribution error.
• They understand the value of interdisciplinary teams.
• They use reward and recognition systems that rely more on intrinsic motivation rather than extrinsic motivation.
• They appreciate the challenge that change brings to the human system.
• They plan for the social impact of technical change and make people part of the solution.
Key Concepts in Theory of Knowledge
• There is no substitute for knowledge
• Management is prediction, any plan is a prediction.
• Prediction is based on theory
• No true value - effect of the method of measurement.
• Operational definitions - put communicable meaning to a concept.
• Analytic vs. Enumerative Studies
PlanAct
DoStudy
- Objective- Questions and predictions (Why?)- Plan to carry out the cycle(who, what, where, when)- Plan for Data collection
- Carry out the plan- Document problems and unexpected observations- Begin analysis of the data
- Complete the analysis of the data - Compare data to predictions - Summarize what was learned
- What changes are to be made?
- Next cycle?
Building knowledge (theory of knowledge)
Deductive and inductive learning are built into the Plan-Do-Study-Act (PDSA) Cycles
• From Plan to Do is the deductive approach
• A theory is tested with the aid of a prediction
• In the Do phase, observations are made and departures from the prediction are noted
• From Do to Study the inductive learning process takes place
• Gaps (anomalies) to the prediction are studied and the theory is updated accordingly
• Action is then taken on the new learning
Understanding Variation
Shewhart’s Theory of Variation:
Common Causes — those causes inherent in the process over
time, affect everyone working in the process, and affect all outcomes of the
process
Special Causes — those causes not part of the process all the time or do not
affect everyone, but arise because of specific circumstances
Shewhart’s theory of variation
Tools to learn from variation in data
Distribution of Wait Times
0
10
20
30
40
50
60
5 15 25 35 45 55 65 75 85 95 105
Wait time (days) for Visit
nu
mb
er
of
vis
its
Clinic Wait Times > 30 days
0
2
4
6
8
10
12
14
16
C F G D A J H K B I L E
Clinic ID
# o
f w
ait
s >
30 d
ays
Relationship Between Long
Waits and Capacity
0
5
10
15
20
75 95Capacity Used
# w
ait
tim
es >
30 d
ays
Run Chart Shewhart Chart
Frequency Plot Pareto Chart Scatterplot
IH p. 8-34
Examples of variation in hospital mortality
20.216.6
0
10
20
30
40
50
Jan-0
9
Ma
r-0
9
Ma
y-0
9
Jul-0
9
Sep-0
9
No
v-0
9
Jan-1
0
Ma
r-1
0
Ma
y-1
0
Jul-1
0
Sep-1
0
No
v-1
0
Jan-1
1
Ma
r-1
1
Ma
y-1
1
Jul-1
1
Sep-1
1
No
v-1
1
Jan-1
2
Ma
r-1
2
Ma
y-1
2
Jul-1
2
RATE OF STILLBIRTHS PER 1000 SKILLED DELIVERIES - UER
Subgroup Center UCL LCL
Wave 2 started
30.0
0
10
20
30
40
50
60
70
80
Jan-0
9
Ma
r-0
9
Ma
y-0
9
Jul-0
9
Sep-0
9
No
v-0
9
Jan-1
0
Ma
r-1
0
Ma
y-1
0
Jul-1
0
Sep-1
0
No
v-1
0
Jan-1
1
Ma
r-1
1
Ma
y-1
1
Jul-1
1
Sep-1
1
No
v-1
1
Jan-1
2
Ma
r-1
2
Ma
y-1
2
RATE OF INSTITUTIONAL U5 DEATHS PER 1000 ADMISSIONS - NR
Subgroup Center UCL LCL
Wave 2 started
Interaction of the components of profound knowledge
• Although the four components of profound knowledge have been described separately here, their importance in improvement is derived mainly from their interaction.
• Focusing on appreciation for a system without considering the impact that variation is having on the system will not produce effective ideas for improvement.
• Similarly, the interplay of the human side of change and the building of knowledge, as seen in areas of study such as cognitive psychology, is critical for growing people’s knowledge about making changes that result in improvement.
References
Conklin, J. (2004 ) Wicked Problems and Social ComplexityDialogue Mapping: Defragmenting Projects through Shared Understanding. Chapter 1.For more information see the CogNexus Institute website at http://cognexus.org, 2004
Deming, W.E. (1986) Out of the crisis. MIT press 3rd edition, 2018
Lens of Profound Knowledge: Langley, J., Moen, R., Nolan, K., Nolan, T.W., Norman, C., Provost, L.P. (2009). The Improvement Guide. Jossey Bass, 2nd edition. Page 76 – 84
Quality Improvement Department
East London NHS Foundation Trust
4th Floor 9 Alie Street
London
E1 8DE
020 7655 4200
@ELFT_QI
Thank you
qi.elft.nhs.uk
@ELFT_QI
Improvement Coaching Programme
Identifying the Quality Issue
The sequence of improvement
Identifying the quality
issue
Understand the problem
Developing a strategy and change ideas
Testing Implement &
sustaining the gains
• Deciding what to
improve
• When to use QI
• Forming a team
• Understanding the
context (MUSIQ)
• Gathering info
• Pareto
• Flow Chart
• Fishbone
• Scatter plot
• 3-part data review
• Divergent/
convergent
thinking
• Driver diagram
• Engaging the
team
• Creativity methods
• PDSA
• Time series
analysis (run
charts, control
charts)
•Policy, training,
manuals, resource
•Quality control,
•Audit and assurance
processes
•Benchmarking
Where can you find these tools to help you in practice?
• Deciding what to improve?
• When to use QI?
• Understanding the context
(MUSIQ) – This was
covered yesterday
Identification of quality issue
Identifying a Quality Issue
Please chat your ideas in the chat box
What data / intelligence would you use to help teams
understand what to improve?
Knowing what needs to improve?
Deciding what to
improve?
Local/national audits
CQC/Internal Assurance Findings
Commissioner Priorities
Incidents and Serious
Incidents
Complaints/
PALS queries
Staff View
Service User and Carer Feedback
The answer lies in the
type of problem you are
trying to tackle
So when is it most helpful to use QI?
Heifetz, R.A (1994). Leadership without easy answers, Harvard University Press
Rittel, H.W. and Webber, M.M., (1973). Dilemmas in a general theory of planning. Policy sciences, 4(2), pp.155-169.
Conklin, J., (2006). Wicked problems & social complexity, San Francisco, CA: CogNexus Institute.
Technical Challenges
Challenges for which you have the
answer for and a solution
Adaptive Challenges
Challenges for which you don’t have a
solution for, that are messy and require
learning
Technical vs Adaptive Challenges
Technical Adaptive
Problem is clear Problem requires learning
Solution is clear Solution requires learning
Knowledge, skills resident within organisation May need to learn new skills and approaches
Work often sits with authority Works sits with stakeholders
Generally linear / cause & effect Non-linear, can be unpredictable
We’ve done it before May be a new situation / scenario
Success is usually resolution or the issue or
has a clear end point
Success is often just about making progress –
may never be solved
No change in values, beliefs, loyalties or
priorities necessary
Values, beliefs, loyalties and priorities may
need to shift
Some core principles to keep in mind
What problems might you apply QI methodology to help tackle?
Please visit menti.com
and use the following
code 90 46 16 0 to
access questions
• Reducing bed occupancy and
Length of stay on older adult
inpatient wards
• Reducing inpatient violence and
aggression
• Reducing the time to hire new staff
members
• Improving Joy at Work
• Improving the quality of life of CYP
with Asthma
Complex problems we’ve used QI for
References
Heifetz, R.A (1994). Leadership without easy answers, Harvard
University Press
Rittel, H.W. and Webber, M.M., (1973). Dilemmas in a general
theory of planning. Policy sciences, 4(2), pp.155-169.
Conklin, J., (2006). Wicked problems & social complexity, San
Francisco, CA: CogNexus Institute
The sequence of improvement
Identifying the quality
issue
Understand the problem
Developing a strategy and change ideas
Testing Implement &
sustaining the gains
• Deciding what to
improve
• When to use QI
• Forming a team
• Understanding the
context (MUSIQ)
• Gathering info
• Pareto
• Flow Chart
• Fishbone
• Scatter plot
• 3-part data review
• Divergent/
convergent
thinking
• Driver diagram
• Engaging the
team
• Creativity methods
• PDSA
• Time series
analysis (run
charts, control
charts)
•Policy, training,
manuals, resource
•Quality control,
•Audit and assurance
processes
•Benchmarking
The Importance of Systems Thinking
Complex, processes,
systems and culture
Subject matter
expertise
Hearts and minds
Explore measures and
impact
The Health System
The complexity of the health system
Structures
ProcessesCulture
We work in complex
systems, involving an
interdependent network of
processes working toward a
common aim of delivering a
service to our service users.
The complexity of the health system
A system: “a group of items, people, or
processes working together toward a common purpose.”
Langley, et al. The Improvement Guide,Jossey-Bass Publishers, 2009: pages 77 -79.
Structures
ProcessesCulture
“Every system is perfectly designed to get the results it achieves” – Paul Bataldan
Understanding the problem“Every system is perfectly
designed to achieve the results
it is designed to get”
- Paul Batadan
Who can help to evaluate current state?
Root cause analyses – what's in our toolbox?
Let's try to generate a five
why to answer the
question -"Why are people
not attending therapy
appointments?"
5 "Whys"
People Environment Materials
Methods Equipment Technology
Cause and Effect Diagram –a 'fishbone'
Cause and Effect Diagram real example
Notenboom, Kim & Beers, Erna & van Riet-Nales, Diana & Egberts, Toine & Leufkens, Hubert & Jansen, Paul & Bouvy, Marcel. (2014). Practical Problems with Medication Use that Older People Experience: A Qualitative Study. Journal of the American Geriatrics Society. 62. 10.1111/jgs.13126.
Has anyone used flow
chart/process mapping
before?
Process Mapping/flow charts
What is a process map?
• A process map is a visual representation of a process, created by the people who operate and interact with the process.
Process Mapping/flow charts
Types of Process Mapping:
• High Level Block / Top Down Diagram
• Detailed Flow Chart
• Swim Lane chart
• Work/Activity diagram
• Value adding/Non-Value adding chart
Helps understand the current state reality of
any process (warts and all) from beginning to
end
Can provide measurable baseline information
on “where are we now”
Identifies problems, delays, waste, areas
for errors, confusion, bottlenecks and
constraints AND opportunities
Brings the team together, helps create joint
ownership and understanding g
Images downloaded from https://www.freeimages.com/
Triage
Assessment
or therapy
booking
Referrals
meeting
Referral
received
• Admin log
referral
• Clarify if
enough informa
tion
• Opened
to service
• Allocated
for triage
• Passed to
triage clinician
• Referral checked
for required
details
• Follow up if
needed
• Sent to referrals
co-ordinator to
collate
• Referrals
discussed
• Clarify suitability
for groups, 1:1 or
needing further
assessment
• Assessment
request passed
to admin
• Assessment slot
allocated
• Patient
contacted/booked in
High Level Block / Top Down Diagram
High Level Block / Top Down Diagram
Shows the activities of the process.
Represents the stage in the process where
a question is asked or a decision is
required.
Shows the start of a process and the inputs
required. Also used to mark the end of the
process with the results or outputs.
Shows the direction or flow of the process.
Detailed Flow Charting/ Process Mapping Symbols
Box
Diamond
Oval
Arrow
Detailed Flowchart
Close referral
No
Yes
No
No
Examples
Vilfredo Pareto,
Economist and political
scientist, 1848 -1923
Pareto Chart
80% of results will come from
focusing on around 20% of the
elements contributing to a
problem
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
0
10
20
30
40
50
60
70
80
90
100
Community Health Service: Pareto Chart of Patient Complaint themes
Vital Few
80% of results will come from focusing on around 20% of the elements contributing to a problem
Frequency
of
occurrence
Cumulative
percentage
References
Cause and effect : Kim & Beers, Erna & van Riet-Nales, Diana & Egberts, Toine & Leufkens, Hubert & Jansen, Paul & Bouvy, Marcel. (2014). Practical Problems with Medication Use that Older People
Experience: A Qualitative Study. Journal of the American Geriatrics Society. 62. 10.1111/jgs.13126.
Cause and effect: Langley, J., Moen, R., Nolan, K., Nolan, T.W., Norman, C., Provost,
L.P. (2009). The Improvement Guide. Jossey Bass, 2nd edition. Page 429.
Flow charts: Langley, J., Moen, R., Nolan, K., Nolan, T.W., Norman, C., Provost, L.P. (2009). The Improvement Guide. Jossey Bass, 2nd edition. Page 414.
The sequence of improvement
Identification of quality
issue
Understanding the problem
Developing a strategy and change ideas
Testing Implement &
sustaining the gains
• Deciding what to
improve
• When to use QI
• Forming a team
• Understanding the
context (MUSIQ)
• 3-part data review
• Gathering info
• Pareto
• Flow Chart
• Fishbone
• Scatter plot
• Divergent/
convergent
thinking
• Driver diagram
• Engaging the
team
• Creativity methods
Needs – Areas in a population that
need addressing.
Assets – Collective resources that
communities and individuals have
at their disposal to promote
wellbeing.
1. Reviewing data on inequalities, service utilisation
to identify patterns.
2. Engaging with care givers to understand their
perspective on the populations needs and assets
3. Engaging with service users and citizens to
understand their perspective
So what is a three-part data review?
Kretzmann, John and McKnight, John P. Asset-based Community Development. National Civic Review. Volume 85, Issue 4. Winter
1996.
What does this look like in practice?
What data do we have at ELFT
around service usage?
What does public health data
tell us?
Who isn’t thriving?
What does a good day look
like?
What helps and what doesn’t
help
What people/services are most
important?
What strengths and assets does
this group have?
What is preventing the group
thriving?
What changes do we need to
make?
What do Care Providers say? What do Service Users and
Carers say?
What does our data say?
Let's hear from a team…..
The Learning Disabilities Service in Luton and Bedford were one of the first at ELFT
to undertake and complete a three part data review in 2018.
They did this as part of a project looking at improving quality of life for people with
learning disabilities
Some top tips for conducting a three-part data review
Don't spend too long doing it
Break up the task by asking team
members to take a small chunk each
Use accessible data or opportunities to collect in existing
process
Be creative with your mediums to
gather information
How is it helpful?
Requires you to
explore the
situation from
multiple
perspectives
Requires you to
engage with service
users and carers to
understand what
they need
Helps begin to
identify areas that
need
strengthening or
amplifying
Begins to help the
team develop
change
ideas/strategy for
change
Our action learning set faculty
Katherine Brittin,
Associate Director of QI
Auzwell Chitewe,
Associate Director of QI
Francisco Frasquilho,
Senior Improvement Advisor
Marco Aurelio,
Senior Improvement Advisor
Sher Kayani,
Improvement Advisor
Susan Alfred,
Improvement Advisor
The Perfect Team - Google's “Project Aristotle”
After looking at 180 groups for more than a year to find the anatomy of the perfect team, Google’s researchers found:
• Source: What Google Learned From Its Quest to Build the Perfect Team , New York Times Magazine February. 25, 2016, as presented by Phyllis M. Virgil
Success was NOT related to
“personality type, skills, talent, or
background, etc. The “who did not
matter...
Understanding and
influencing group norms
were the keys to team
success. Be Heard
Be Understood
Be Known
Be Safe
Purpose of Action Learning Sets
• Support your learning in a smaller group
• Develop and practice skills
• Have a safe place to bring queries, issues, reflections around QI projects you coach
Be Heard / Be Understood / Be Known / Be Safe
Time to get together into our Action Sets on MS Teams
Which root cause analysis tool is the most appropriate?
1. The improvement team at Mile End hospital have got together and based on recent data they want to improve the waiting time at the Older Adults clinic but need to find what is happening at the clinic – firstly who needs to be in the discussion and what tool would they use?
2. The improvement team at City and Hackney psychology services have noticed an increase in their DNA rate – they are curious as to what may be the reasons for this. Who needs to be in the discussion and what tool would they use?
Break time
IHI Psychology of Change Framework
Lens of profound knowledge
The “Know-Do” Gap
So…why is change so hard?
Roger’s Adopter Categories
Why is change so hard?
Resistant to change?
- Behaviours
Resistant to change?
- Reasons
Psychology of change – what do we need?
Unleashing Intrinsic motivation
• Let's use menti to collate our answers;
• What can we do as leaders to 'unleash intrinsic motivation'
• ALL MENTI AVAILABLE FOR ALS FACILITATOR HERE
• https://www.mentimeter.com/app/596101
Unleash Intrinsic Motivation
Unleashing Intrinsic motivation
• Now let's move into 2 group to prepare a teach back
• Group 1 – How do you co-design people driven change & co-produce in an authentic relationship
• Group 2 – How to you distribute power and how do you adapt in action
Co-design people-driven change
People centred aim statement
Initial aim statement:
We will decrease the LOS for acute inpatients by 50% within 9 months
People driven aim statement:
We, Katherine Brittin, Amar Shah and Auz Chitewe are co-designing with service users, families and staff to decrease LOS by 50% within 9 months by convening proactive meetings with service user families and/or consultations in order to improve the quality of care and reduce costs.
Co-produce in authentic relationship
Distribute Power
Adapt in Action
Why is change so hard?
Resistant to change? -Behaviours
Resistant to change? -
Reasons
Not overcome… ..but uncover
References
Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; 2018. (Available at ihi.org)
Project Aristotle: New York Times magazine, 2016. “What Google Learned From Its Quest to
Build the Perfect Team” , New York Times Magazine February. 25, 2016,
Break time
Next steps
• Research Driver Diagrams on QI microsite
• Conduct root cause analyses with your team
• Try using some change idea tools with your team
• Develop Driver diagram with your project team using ‘LIfeQI’
Checklist – Have you completed?
• Pre test skills assessment
• Named your team
• Completed the evaluation
Evaluation
https://tinyurl.com/ICPDay2eval
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