Weston Park Collaborative Tuesday 15 November 2016 9:00 to ... · 15/11/2016 · Weston Park Collaborative – Session 2 Tuesday 15 November 2016 – 9:00 to 12:15 Room 2, R Floor,

Weston Park Collaborative – Session 2

Tuesday 15 November 2016 – 9:00 to 12:15

Room 2, R Floor, RHH

09.00 – 09.05

Jim

Welcome and Agenda

Agenda

Time Topic Who

9.00 Welcome & Agenda Jim

9.05 Progress update from Outpatients Outpatients

9.15 Progress update from Inpatients Inpatients

9.25 Themes, Global aims, Specific aims and Fishbone Nick

10.25 Break

10.40 Progress update from Pharmacy Pharmacy

10.50 Progress update from Daycase Daycase

11.00 Progress update from Radiotherapy Radiotherapy

11.10 Creativity session / brainstorming Steve / Rosie

12.00 Next steps and timeline Jim

09.05 – 09.15

Progress Update from Outpatients Team

Progress Report - WPH OPD

What progress have you made since the last session?

• Completed process map for injection patient pathway – helped to

confirm thinking and measurability

• Defined Global Aim – “To improve the pathway for patients who

have injections in OPD”

• Started measuring – waiting times/journey tracker sheet –

template amended following initial usage

• To collect data for 1 month

• Survey monkey -35/70 responses

• Gathered data +++

• Datix analysis to identify themes

• Reviewed system for green referrals

What’s going well?

• Waiting times already improved

• Better understanding already of where the blocks are

• More focussed aim

• Improving timings collection tool

• Started to “auto-think” in an improvement mindset

• Microsystems information board

• Sharepoint

• Green referrals – quick win

What are your challenges?

• Involving everyone and ensuring good

communication

• Time for staff to complete actions in

between meetings

What are your plans and next steps?

• To develop a newsletter ‘a la’ pharmacy

• Translate data into something meaningful – i.e. timings,

survey results etc and use it to improve service!

• Look at “patient talks”

• E-check-in

• Quick wins

• Simplify some processes in the dept e.g. allocation,

environment, communication

OPD – Injections in OPD

Write a Theme for Improvement: _________________________________________

Global Aim Statement Create an aim statement that will help keep your focus clear and your work productive:

We aim to improve: _________________________________________________________________ (Name the process)

In: _______________________________________________________________________________ (Clinical location in which process is embedded)

The process begins with: _____________________________________________________________ (Name where the process begins)

The process ends with: _______________________________________________________________ (Name the ending point of the process)

By working on the process, we expect: __________________________________________________ (List benefits)

It is important to work on this now because: ______________________________________________ (List imperatives)

Create Flowchart

The pathway for patients that have injections in OPD WPH

Preparing the notes when the patient attends

Patient reporting back to reception

See next slide

See next slide

Category – patient experience

Improve patient experience and reduce

waiting times

Improve efficiency

More timely – better care for patients

Streamline the patient’s journey

A smoother patients experience

A quicker more structured journey for the

patient.

Patient receives their injection

Consistency of a patient’s journey

Communication

Correct follow up given to the patient

Patient informed of when to go to

pharmacy

Correctly assessed in correct clinic by

clinician

Minimize errors to improve the patient

experience

Improve the staffs role / experience increase

job satisfaction

Reduce inconsistency in the patient journey

We want to improve our service

To keep within the times of patient

appointments

Important to identify small changes that may

positively impact on the patient experience.

Reduce variation in care

Maximize clinic slot utilization

Identify correct use of environment

Need to be more efficient

By working on this process we expect It is important now because

09:15 – 09:25

Progress Update from Inpatients Team

Progress Report - Inpatient Microsystem WD2,3 and TCU

What progress have you made since

the last session?

• Weekly meetings have commenced

• 5Ps completed

• First global aim completed

• Specific aim completed - whiteboard

• Themes identified include; electronic whiteboard usage,

admissions and TTO’s.


• Staff engagement

• Good MDT representation

• Using effective meeting skills

• Actions are always followed up between meetings

• All staff are being updated on the progress of the group by

a newsletter attached to the handover sheet and put up in

the staff rooms.


• Consistent attendees , different staff members attend each

week .

• The need for medical representation

• Work pressures

• Ongoing work on wards


• Create a cause and effect diagram

• Start thinking about change idea

• To keep working up the improvement ladder so that we will be at

a stage where we can implement a PDSA cycle based around

effective electronic whiteboard use

• Look at admissions process

• Ask for input / representation from pharmacy and medical staff

Use of whiteboard - inpatients









Create Flowchart

Ward 3, TCU and Ward 2

The effective use of the whiteboard

Patient admission

Discharge of the patient

More joined up working and communication

An improved discharge process

It’s a trust requirement and it helps with the discharge process

9.25 – 10.25

Nick Miller

Specific Aims and Fishbone Diagrams

Cause & Effect

The Microsystem

Improvement Ramp

Effective Meeting Skills

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Dartmouth Microsystem Improvement Curriculum

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

Flowchart or Process Map

Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Cause & Effect


Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

PDSA

Remember that the aim of the 5Ps is.......

To understand the system well

enough to generate your first

themes for improvement

Global Aim Statement

• Clarifies and connects the improvement theme to

your work

• The starting point

• Sets the scope

• Increasing clarity of focus

• Specific aims

• Fishbone diagrams / cause & effect

Aim of this section

• Clarify what a specific aim is

• What is a Fishbone Diagram?

• Why we use them

• How we do them

• Have a go at a specific aim & fishbone

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


5Ps Assessment

Theme

Global Aim

Specific Aim

PDSA

Narrow the focus

What is a specific aim?

• At its simplest its what you want to achieve & by

when

• Allows you to make a start on comparing now

with a future improved state

• Gives you a detailed & clear focus for planning

changes

• Its measurable

Specific Aim Statement

• Want you want to achieve

• By how much?

• By when?

Principles of an Effective Specific Aim

1. State clearly & precisely

2. Use numerical goals

3. Set a specific target date

4. Avoid drift…..keep it focused

5. Something you don’t need permission for

6. Something you can work on now

Global/Specific Aim Worksheet



We aim to improve: ____________________________________________________ _____________ (Name the process)






Create Flowchart

Specific Aim Statement We will: _ improve _ increase _ decrease

The: _ quality of _ number/amount of _ percentage of ________________________ (describe what will b e measurably different)

By: ___________________________________________________________________ (percentage)

OR

From: _________________________________________________________________ (baseline state/number/amount/percentage)

To/By: ____ _____________________________________________________________ (describe the change in quality or state the number/amount/percentage)

By: ____________________________________________________________ (date)

Example: We will decrease the amount that my dog weighs from 55 pounds to 50 pounds by August 31, 2007.

Or simply

How much?

By When?

Examples

“We aim to reduce to the number of central line

infections in the intensive care ward from 12 per

year to zero by 1st July 2013.”

Measure: The number of central line infections

recorded on the intensive care ward

IHI Collaborative Specific Aims re:

Reducing Adverse Drug Events.

Examples

“We aim to decrease the length of waiting time

from referral to first appointment

from a current maximum of 17 weeks wait

to a wait of 9 weeks or less

by December 2015”

Measure: The number of weeks wait from patient

referral to attending first appointment

.

From “Global” to “Specific” Aim

- Antenatal Clinic

“We aim to improve patient flow in the midwifery booking clinic.

The process begins when the woman books in at reception.

The process ends when the woman books out at reception.

By working on this we expect to improve patient experience,

reduce clinic waiting times, organise our resources effectively

and make the department look less chaotic.

It is important to work on this now because women are

dissatisfied with the time they spend here, they become lost in

the department and we are frustrated and embarrassed about

this”

From “Global” to “Specific” Aim

- Antenatal Clinic

“We aim to improve patient flow in the midwifery booking clinic.

The process begins when the woman books in at reception.

The process ends when the woman books out at reception.

By working on this we expect to improve patient experience,

reduce clinic waiting times, organise our resources effectively

and make the department look less chaotic.

It is important to work on this now because women are

dissatisfied with the time they spend here, they become lost in

the department and we are frustrated and embarrassed about

this”

Antenatal Clinic

“We aim to decrease patient waiting in the

midwifery booking clinic by 50% by 1st August 2015”

Measure: The time in minutes that patients wait in

the waiting room

Have a go

• 10 minutes

• In microsystem groups

• Work on a specific aim based on your global aim

• Remember measures

• How much by when

5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


Fishbone / Cause and Effect Diagram

Result

/effect

People

Materials Process

Equipment

What is a Fishbone / Cause & Effect Diagram

• A tool that depicts the possible causes that

contribute to a single effect

• Outcomes always have many causes and rarely

result from a single cause

• An acorn does not produce an oak tree on its own

Web of Causation – Delayed Diagnosis

Heathcare is complex

Delayed

Diagnosis

and

Treatment

Samples

batched

in lab

Prescription

needs to be

authorised

– Doctor

has left the

ward

Why do a Fishbone?

• To identify the various causes of an effect or

outcome

• To build a picture about potential causes and

effects to guide improvement work

• Start to group potential causes under the headings

• We give more thought to the problem

• Most importantly, it helps the team answer the

question of where to begin with the process of

improvement – Its fun!

Lengthy

Appointments

People Equipment

Materials Process

Clinical staff inconsistent Support staff not

trained

No one responsible for patient flow Patients arrive with more

needs than originally

stated

Providers are lateSupport staff unprepared

for patient visits

Equipment

broken

Not enough computers

Equipment missing

Inventory low

Missing exam

room supplies

Charts are missing

Information, e.g. test

results missing

No standard

registration processMA does paper flow and patient flow

Variation in rooming process

Check out

process delays

Poor communication between all

staff on patient status

Fishbone (Cause and Effect) of Lengthy Appointments

37

Your 25 min challenge:

• Confirm SPECIFIC AIM

• To create a CAUSE AND EFFECT DIAGRAM for this specific aim

‘the problem’

primary cause

secondary

causes

What?

How much?

By when?

10.25 – 10.40

Break

10.40 – 10.50

Progress Update from Pharmacy

Progress Report – Pharmacy Microsystem


the last session?

• Inpatients are on-board.

• Newsletter – good general communication

• Data collected

• Quick fix of bloods reporting (DCSU)

• Mapped the patient journey

• Purpose statement

• Love and nuts for Pharmacy, DCSU, Inpatients


• Meeting regularly

• Enthusiasm

• Effective meeting skills being used

• Good representation from Pharmacy, DCSU, Inpatients


• Attendance due to workload deciding what to focus on first

• Medical representation

• Feels it is too big to solve – all interlinked

• IT in general


• Coin drop for patients

• Love and nuts for patients

• Find a theme

• Patient survey

• Banner

10.50 – 11.00

Progress Update from Daycase

Progress Report – Day Case Microsystem


the last session?

• 2 tests of change with new patient counselling

• 2 weekly meetings continue


• Staff engagement on the unit

• We have progressed our tests of change


• Representation at meetings from a wider range of staff

• Medical staff representation / input

• Staying on track, questioning meeting every 2 weeks

• Keeping momentum after a long time in the process

• Basic IT issues


• To study what happened at our 2 tests

• To take the learning from these and re-evaluate

• Plan further tests based on our learning

11.00 – 11.10

Progress Report Update from Radiotherapy

Progress Report - R/T and R/T Physics Microsystem


the last session?

• Weekly meetings have continued

• Decision to split into R/T and R/T physics to allow focus on

global aims for each area simultaneously.

• 5Ps completed

• First global aim completed

• Lots of themes for improvement identified


• Staff engagement

• Lots of ideas generated for change

• Good representation

• ‘Core group’ very committed – continuity between meetings

is good.

• Team accessing Sharepoint

• Lots of patient input so far


• Deciding at what point to start communicating to wider team

– there is a feeling that we ‘need something to show’ before

we can get full engagement.

• The need for medical representation

• Work pressures often mean difficulty in picking up actions

between meetings.


• Map out process maps for themes identified for tests of

change

• Start thinking about the first change idea we are going to

explore

• Create Specific Aim for each group and continue to work up

the improvement ramp.

Breast patient pathway - Radiotherapy









Create Flowchart

the treatment pathway and experience for breast patients in

Radiotherapy.

The receipt of the referral form for radiotherapy.

the follow up telephone call after radiotherapy has finished.

See next slide

See next slide

• To identify and additional

requirements in the information and

support needs of this group of

patients.

• To identify any stages in the

treatment process that have little or

no added value.

• To evaluate the adequacy of

appointment slots.

• DIBH has recently been introduced into

the department.

• The National Cancer Patient Experience

Survey indicates there may be some

unmet needs regarding support after RT

and information about long term effects.

• The Support4All project is about to get

underway.

• Staff indicate it may be useful to store

electron cut-outs centrally.

• The positioning of larger ladies has been

raised.

• The use of hospital gowns has been

raised as a possible area of

improvement.

By working on this process we expect It is important now because

11.10 – 12.00

Change ideas brainstorming and multivoting

Creative Thinking Agenda 11.10 – 12.00

Time Topic Leader

11.10 Creative thinking – the theory Steve

11.20 Creative thinking warm ups Rosie

11.30 Brainstorming activity Steve

11.45 Multi - voting Rosie

11.55 Summary Rosie

Steve

Creative Thinking – the theory

52

Attention…..Escape……Movement

Movement Play imaginatively with this suggestion and generate ideas from

it without judgement or criticism. Encouraging mental

movement.

“Let’s try to generate at least 10 ideas for ways to manage

patients arrivals in outpatients without a receptionist or a desk”

Attention Looking closely, observing with fresh perspective and really

noticing current rules and assumptions.

“patients who come to outpatients must first come to reception”

Escape Challenge or block an existing rule is encouraging escape from

the current mental valley.

“the Trust has made it illegal to have a receptionist and a desk in

outpatients”

Rosie

Creative thinking Warm Ups

WARM UP 1

You have 1 minute to fill in the circles with as

drawn ideas as possible (the sheet is 2 sided)

Ready Steady….

0 9 0 0 0 1 8 7 6 5 4 3 2 1 5 0 0 0 4 9 8 7 6 5 4 3 2 1 0 3 9 8 7 6 5 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0 2 1 9 8 7 6 5 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0 0 Hours Minutes Seconds

Circles

HOW MANY?

Did anyone do 40?

WARM UP 2

You have 2 minutes to think of as many

alternative uses of the household object on your

table

Ready Steady….


Alternative Uses


Alternative Uses

DEBRIEF • Fluency – how many uses you can come up with

• Originality – how uncommon those uses are (e.g.

“sim card tool” is more uncommon than “holding

papers together”)

• Flexibility – how many areas your answers cover (e.g.

cufflinks and earrings are both accessories, aka one

area)

• Elaboration – level of detail in responses; “keeping

headphones from getting tangled up” would be worth

more than “bookmark”

WARM UP 3

You have 4 minutes to turn the shapes you have

been given into a picture. Uncommon subject

matter, implied stories, humour, and original

perspective all earn high marks.

Ready Steady….


Incomplete Figure


Incomplete Figure


Incomplete Figure


Incomplete Figure

DEBRIEF

• Uncommon subject matter

• Implied stories

• Humour

• Original perspective

Steve

Brainstorming

BRAINSTORMING………. “Generate a wide variety of ideas from ALL participants

WITHOUT criticism or judgment.”

Brainstorming

Successful

brainstorming:

•Encourage creativity

• Involve everyone

•Generate excitement

and energy

•Levels out hierarchy

Brainstorming Steps

1. Review the topic, clarify as needed

2. Take a minute or two of SILENT thinking

3. Go around the table for each person to give

an idea.

4. After the first round, members can pass.

5. Once one member passes, let all members of

the group shout out ideas.

When ideas start to flow…let them come!

Brainstorming cont.

-Go for Quantity….NO DISCUSSION at this

stage.

-NO CRITICISM of ideas…not even a groan or a

grimace….or even ‘that’s a great idea’!

-Build on each others ideas

-Encourage wild ideas.

-One conversation at a time.

-Write ALL ideas on flipchart for all to see

Brainstorming - Practice.

In your group.

- allocate a facilitator.

- 10 minutes

Generate at least 30 different ways to

communicate the amazing improvement work

taking place at Weston Park Hospital

Rosie

Multivoting

Affinity Grouping and Multivoting

• Affinity grouping is a brainstorming method in

which participants organise their ideas and identify

common themes. In the brainstorming all ideas

need to be recorded on Post ITs and posted up

onto the flip chart.

• Multi-voting is a structured series of votes by a

team, in order to narrow down a broad set of

options to a few.

1. Clarify and remove duplicates.

2. Start by choosing two ideas.

3. Agree with the group whether they are related.

If they are related put them together.

4. At the end of the exercise there should be less

than 10 groups of post it notes.

5. Give a short descriptive header to each group.

Affinity Grouping

Multi-voting Steps

-Number each idea.

-Each person can have 1/3rd of the ideas to vote on.

eg if 21 ideas were generated, each person gets 7 votes. They can not

vote on one idea more than once.

-Tally votes.

-Eliminate ideas with few votes.

- If this identifies 3 -4 ideas to work with stop here.

Otherwise repeat with the remaining items.

Selection Criteria

Add some criteria to help the voters

Suggestions might be depending on the change -

Ideas that can be started fast

The change is reasonably low cost

The effort is small compared to the impact

The idea can be tested without getting ‘permission’

from others

Is the most creative!

Multi-voting Steps

Voting methods:

-Colored sticky dots

- Individually write choices on piece of paper

-Go to the list and indicate your choice w/marker

-A show of hands as each number is called out.

-Remember selection criteria

Have a go – multi-voting

• Remove duplicates

• Descriptive header to groups left (no more than

10)

• Number each idea and vote on 1/3rd (tick/dot)

82

Summary

• Creativity involves breaking established patterns

• Warm up exercises can help

• Brainstorming – broad idea generation

• Multi voting – narrowing down options

• Team creativity – joint problem solving helps with

team building and learning

12.00 – 12.10 Jim

Next steps and timeline

WP Collaborative Overview

Action

Meeting 1

Action

Meeting 2

Action

Meeting 3

July 2016 Sept 2016 Nov 2016 Jan 2017 Mar 2017 May 2017 July 2017

16th January 9-12:15

Cause & Effect

The Microsystem

Improvement Ramp


Global Aim

1

2

3

5 P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures

SDSA

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2


5P Assessment

Theme

Global Aim

Change Ideas

Specific Aim

Measures


Global Aim

1

2

3

SDS

A

P

DS

A

P

DS

A

P

DS

A

PDSA

1

3

2

Next Steps Before learning session 3

16 January 2017

1. Coaches keep coaching

2. Teams keep meeting - 5P’s, meeting skills,

refine your specific aims and fishbones

3. Change ideas

4. Think about patient involvement

5. Tell 1 other person about the collaborative

Progress Reports Progress Update Team__________________________ Date___________

What progress have you made since the last session?




Dates for the diary

• Please complete post it note evaluation – what went

well – what could be improved

• MCA Connect – 1 December 2016

• Outpatient Collaborative final session 28 November

2016 – MEC, NGH, 9-12.30

• Ward Collaborative update event, NGH, MEC - 2

December 2016

Thank you

Well done!

Documents

Weston Park Collaborative Tuesday 15 November 2016 9:00 to ... · 15/11/2016 · Weston Park Collaborative – Session 2 Tuesday 15 November 2016 – 9:00 to 12:15 Room 2, R Floor,