Patient Safety & Quality Improvement in Action Conference

Patient Safety & Quality Improvement in Action Conference

Thursday 16 April 2015

@weahsn#PSCQI

Welcome

James ScottChief Executive Royal United Hospitals Bath NHS Foundation Trust

@weahsn#PSCQI

Work Programme for Patient Safety

Anne PullyblankClinical Director for Patient SafetyWest of England AHSN

@weahsn#PSCQI

Colorectal Surgeon NBT

AHSN

A Network of Member Organisations

5 Community

Health Services

Providers

3 Universities

2 Mental Health Trusts

6 Acute Trusts

1 Ambulance

Trust

7 Clinical

Commissioning Groups

How will the AHSN add value?

• Builds on Safer Care South West• Collaborative• Across all health system• Add innovation

West of England AHSN – Patient Safety Collaborative Initial Priorities 2015/16

Hein Le RouxTasha Swinscoe

• All practices reporting adverse events• All practices responding appropriately • Reduction in priority adverse events

Incident reporting in Primary Care:To develop a system for reporting & responding to adverse

events occurring in primary care settings

Anne Pullyblank/ Emma RedfernDeborah Evans

• All organisations agree an approach• All organisations using single EWS• Reduced emergency/cardiac arrest calls

Single Early Warning Score (EWS):To agree and implement a unified approach to scoring

observations that indicate severity of acute illness, deterioration and need for escalation of treatment

Steve BrownDeborah Evans

• All organisations participating in the network• Reduced medication related problems in

priority areas

Medicines:To develop a medicines network and associated improvement

programme across the West of England

Tricia WoodheadLindsay Scott

• All organisations using sepsis six care bundle or other agreed evidence informed practice

• Reduced sepsis-related mortality

Sepsis:To implement evidence informed practice for the identification

and treatment of patients with sepsis

Anne PullyblankCarol Peden

• Six standards in Emergency Laparotomy• Using national audit tool

Emergency Laparotomy:To implement evidence informed practice

Karen GleaveJane Hadfield

• All eligible staff trained• Reduced adverse events at handover

Human Factors for Bands 1-4 & supervisors:To improve practice at interfaces of care by taking account of

human involvement in processes

Priorities and objectives: Measures : Leads:

Shaun CleeCorinne Thomas

• Reducing self-harmMental Health Collaborative:

Providing Support To:

Engagement

ENABLERS

Capacity & Capability Measurement & Evaluation

Leadership

• Single Early Warning Score (EWS):• To agree and implement a unified approach to scoring observations that

indicate severity of acute illness, deterioration and need for escalation of treatment

NEWS

Across the system

A Common Language

Human Factors for Bands 1-4 & supervisors:To improve practice at interfaces of care by taking account of human involvement in

processes

• Incident reporting in Primary Care:• To develop a system for reporting & responding to adverse events occurring in

primary care settings

Patient Harm-The Evidence

• 10.8% of patients experience an adverse event during a hospital admission1

• 1/3 of adverse events lead to severe disability or death

• 50 % avoidable

1. Adverse events in British hospitals: Vincent et.al: BMJ 2001;322: 517-9

2. Patient safety incidents in an NHS hospital: Ali Baba-Akbari et.al. BMJ 2007;334:79.

We Normalise Harm

• Recognised complications

• ‘Surgery is a risky business’

• HCAI

How do we know a hospital is safe?

• Incident reporting• Audit• Complaints• HSMR• Staff sickness• Staff survey• Structured Mortality

Reviews

Incident Reporting

Type of Incidents

0500

10001500200025003000

Falls

Med

icatio

n

Equipm

ent

Staffin

g

Docum

enta

tion

Comm

unicat

ion fa

ilure

Press

ure

ulce

rs

Delay

ed tr

eatm

ent/.

..

Breac

h of

Poli

cy

Infe

ctio

n Con

trol

Blood

Tra

nsfu

sion

Oth

er

2008/09 2007/08

Incidents reported• Between 1st October 2010 – 31st March 2011 - Degree of Harm

NoneNone LowLow ModerateModerate SevereSevere DeathDeath

1,2651,265 283283 1717 1212 33

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

NBT

Large acute trustcluster

NBT 80.1% 17.9% 1.1% 0.8% 0.2%

Large acute trustcluster

71.7% 21.9% 5.5% 0.7% 0.2%

No harm

Low harm

Moderate

Severe harm

Death

What does better look like?


Emergency Admissions:A journey in the right direction?

Emergency Laparotomy Quality Improvement Care Bundle

•All emergency admissions to surgical assessment area have a (M)EWS completed. Outreach to review all patients with (M)EWS of 4 or more.•Broad spectrum antibiotics to be given to all patients with suspicion of peritoneal soiling or with septic shock.•Once decision is made to carry out laparotomy patient takes next available slot on emergency list (or within 6 hours of decision made).•Start resuscitation using goal directed techniques as soon as possible or within 6 hours of admission.•Admit all patients after emergency laparotomy to ICU.

25% reduction

p = 0.0830% reduction

Medicines:To develop a medicines network and associated improvement programme

across the West of England

Providing Support to:

Mental Health Collaborative:

Providing Support to:

Sepsis:To implement evidence informed practice for the identification and treatment of

patients with sepsis

West of England AHSN – Patient Safety Collaborative Initial Priorities 2015/16

Hein Le RouxTasha Swinscoe

• All practices reporting adverse events• All practices responding appropriately • Reduction in priority adverse events

Incident reporting in Primary Care:To develop a system for reporting & responding to adverse

events occurring in primary care settings

Anne Pullyblank/ Emma RedfernDeborah Evans

• All organisations agree an approach• All organisations using single EWS• Reduced emergency/cardiac arrest calls

Single Early Warning Score (EWS):To agree and implement a unified approach to scoring

observations that indicate severity of acute illness, deterioration and need for escalation of treatment

Steve BrownDeborah Evans

• All organisations participating in the network• Reduced medication related problems in

priority areas

Medicines:To develop a medicines network and associated improvement

programme across the West of England

Tricia WoodheadLindsay Scott

• All organisations using sepsis six care bundle or other agreed evidence informed practice

• Reduced sepsis-related mortality

Sepsis:To implement evidence informed practice for the identification

and treatment of patients with sepsis

Anne PullyblankCarol Peden

• Six standards in Emergency Laparotomy• Using national audit tool


Karen GleaveJane Hadfield

• All eligible staff trained• Reduced adverse events at handover

Human Factors for Bands 1-4 & supervisors:To improve practice at interfaces of care by taking account of

human involvement in processes

Priorities and objectives: Measures : Leads:

Shaun CleeCorinne Thomas

• Reducing self-harmMental Health Collaborative:

Providing Support To:

Engagement

ENABLERS

Capacity & Capability Measurement & Evaluation

Leadership

West of England AHSN Patient Safety Team

Quality Improvement and the Academy approach

Anna BurhouseQuality Improvement FellowDirector of QualityWest of England AHSN

#PSCQI

@weahsn

Why is Quality Improvement Important?

‘At present, the evidence is clear that healthcare is not always safe and can lead to poor patient experience and outcomes. At the same time, the economic downturn means an end to year-on-year financial increases. Healthcare services are being challenged to respond to this not through indiscriminate cuts, but by improving efficiency, driving up quality and reducing levels of harm.’

The Health Foundation 2014

PopulationHealth

Experienceof Care

Per CapitaCost

The Triple Aim

Don Berwick 2015

PopulationHealth

Experienceof Care

Per CapitaCost

Five Year Forward View and Triple Aim

• Chronic Disease Coordination

• Sepsis• Kidney Damage• Mental Health Care• A&E

• “Radical Upgrade in Prevention and Public Health”

• Diabetes Prevention• NHS Staff Well-Being

• Demand• Efficiency• Revenue

Don Berwick 2015

Reducing Variation

The Journey so Far……

NHS Scotland

Action for Sustainability

Improvement Requires

1. A reason to do it2. An aim3. A toolkit of methods4. Staff, patients and public

who have knowledge about Quality Improvement Science and the confidence to apply it in real life settings

5. A willingness to change6. A ‘Just Culture’

Our Triple Aim

Establish an Innovation and Improvement Academy to:

Increase the number of staff across the patch who are knowledgeable and confident in their use of quality improvement science, innovation and know how to work with industry.

Provide a range of learning options to meet the needs of a wide variety of staff – from those just learning about quality improvement through to highly experienced practitioners and leaders, via a 3 step methodology.

Develop quality improvement approaches to the involvement of patients, carers and people with lived experience in our communities, to help improve local services. 41





WEAHSN QI Pareto Effect

We would need to have at least 9000 confident staff to achieve the QI Pareto effect for our West of England health community

43

The Knowledge Base for Continual Improvement

44

Subject andDiscipline Knowledge

Knowledge for Improvement Systems Variation Psychology Improvement techniques

+

Continual Improvement

Adapted from Don Berwick 2015

Capacity and Capability – DriversCapacity and Capability – Drivers

Create Capacity and opportunities to implement Improvement

Create Capacity and opportunities to implement Improvement

Build a critical mass of people with QI expertise including patients

Build a critical mass of people with QI expertise including patients

Design and establish a QI infrastructure and measure linked to strategy

Design and establish a QI infrastructure and measure linked to strategy

Create a culture of learning with senior advocates

Create a culture of learning with senior advocates

Increase capacity and capability for QI to further improve patient safety and care

Increase capacity and capability for QI to further improve patient safety and care

46

3 Step Model for Quality Improvement

What Improvement Skills are Needed for Each Role?

Experts

OperationalLeaders

(Executives)

ChangeAgents

(Middle Managers, project leads)

Everyone

(Staff, Supervisors)

• Setting goals and measures

• Identifying problems

• Mapping process• Testing change• Simple waste

reduction• Simple

standardization• Team behaviors

• Setting goals and measures• Identifying problems• Mapping process• Sequencing tests of change• Simple understanding variation• Implementation and spread• Simple waste reduction• Simple standardization

• Setting direction and big goals

• Results leadership• Portfolio selection and

management • Managing oversight of

improvement• Being a champion and

sponsor• Understanding variation to

lead• Managing implementation

and spread

• Analysis, prioritization of portfolios

• Deep statistical process control

• Deep improvement methods

• Leadership team advisory re portfolio selection, process

• Effective plans for implementation and spread

IHI 2015

People support what they help to create

Action for Spread

Pre CePT an exampleQuality Improvement in Action

Clinical Lead Dr Karen Luyt

Consultant Senior Lecturer

Neonatal Neuroscience University of Bristol

Chief Executive Sponsor Robert Woolley University Hospitals Bristol NHS Foundation Trust

Magnesium Sulphate for Preterm birth as neuroprotection for the baby

• Preterm birth is a major risk factor for CP (motor disability).

• 10% of very low birth weight babies develop CP (650-1300 cases per year).

• Until recently no intervention available to prevent CP in preterm babies.

Preterm Birth and Cerebral Palsy

54

Benchmarking: Magnesium Sulphate

25% of UK tertiary units don’t have a guideline in place

Working initially with 5 local Trusts

University Hospitals Bristol NHS Foundation Trust North Bristol NHS Trust Gloucestershire Hospitals NHS Foundation Trust Royal United Hospital Bath NHS Trust Great Western Hospitals NHS Foundation Trust Swindon

Supported by the South West Obstetrics Network

PReCePTEvidence into Practice Example

The Pathway and Pack

Clinical Guidelines

Proforma for patient notes

Patient information leaflet designed in

conjunction with Bliss and local parents

Poster to raise awareness

Training PDSA Cycle

Bespoke adaptations for

each Trust

Lead by Research

Midwives and

Obstetricians

Various training tools are

available

The Results

Aimed to train 584 core staff, 664 people trained since September

An overall compliance rate of 85+% Putting the 5 maternity units in amongst the best known performers in

the world.

61

63





Why?

The most important single change in the NHS ….. 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……….

Don Berwick

[email protected]

@annaburhouse@QualityImprovement

Transforming the Quality, Reliability & Experience of End of Life Care

Tricia WoodheadQuality Improvement FellowAssociate Clinical Director for Patient Safety West of England AHSN

#PSCQI

@weahsn

The Improvement of Complex Systems

2

What Matters to You?

‘How people die remains in the

memory of those who l ive on’

Dame Cicely Saunders Founder of the Modern Hospice

Movement

Are we afraid of asking how good we could be?

First national VOICES survey of bereaved people:

https://www.gov.uk/.../first-national-voices-survey-of-bereaved-people-k...

3 Jul 2012

The VOICES questionnaire, was first developed in the 1990s-

The National Picture- 2014- average

Source – Quality watch

How Good Could We Be ?

2

Probability of on-time successful completion at each step

Steps 90.00% 99.00% 99.90% 99.99% 99.999%

1 90.00% 99.00% 99.90% 99.99% 99.999%

2 81.00% 98.01% 99.80% 99.98% 99.998%

4 65.61% 96.06% 99.60% 99.96% 99.996%

8 43.05% 92.27% 99.20% 99.92% 99.992%

16 18.53% 85.15% 98.41% 99.84% 99.984%

32 3.43% 72.50% 96.85% 99.68% 99.968%

64 0.12% 52.56% 93.80% 99.36% 99.936%

128 0.00% 27.63% 87.98% 98.73% 99.872%

Quality and timeliness, compasion and action

If the reliability of each step is 90% then the overall reliability for the 4 steps

together is only 65.61% (.90^4=.6561)

Aim: “90% compliance with Overall Policy and Compassionate care ” (4

step process)

Complexity and Reliability

“Never believe that a few caring people can't change the world. For indeed that's all who ever have”. Margaret Meade

Systematic Approach – across SW

• Medical Director training sessions x 2 (10/14 & 12/14)

• EOL leads project planning and training sessions x 2 (03/15 &05/15 plus follow up half day 09/15)

• Strategic Clinical Network Sponsorship

1. Models for Improvement 2. Plan do study approach to

testing front line ideas and build reliability

3. Measurement to check improvement- on going

4. Peer connections to support and share

5. Management and Leadership engagement

6. Recognition and Celebration of work done

Address the complexity in astructured way

The lens through which an Improver looks at a problem

Driver diagrams structure complexity

PRIMARY DRIVERProvision of information relevant to parties present

PRIMARY DRIVERProvision of information relevant to parties present

SECONDARY DRIVERS•Good quality Crosscare record with Active Problems, Agreed Plan•Information from overnight changes•Exclusion of irrelevant information•Prioritisation

SECONDARY DRIVERS•Good quality Crosscare record with Active Problems, Agreed Plan•Information from overnight changes•Exclusion of irrelevant information•Prioritisation

PRIMARY DRIVERFeedback given on quality of handover and ways to improve

PRIMARY DRIVERFeedback given on quality of handover and ways to improve

SECONDARY DRIVERS•Open culture•Mechanism for feedback•Evidence of action on feedback

SECONDARY DRIVERS•Open culture•Mechanism for feedback•Evidence of action on feedback

PRIMARY OUTCOME

Improve quality and timeliness of

handovers

PRIMARY DRIVERTimely and concise transfer of information

PRIMARY DRIVERTimely and concise transfer of information

SECONDARY DRIVERS•SBAR – concise, structured information•Awareness of time limits•Sensitivity to the needs of those present

SECONDARY DRIVERS•SBAR – concise, structured information•Awareness of time limits•Sensitivity to the needs of those present

Primary drivers are system components which will contribute to moving the primary outcome

Secondary drivers are elements of the associated primary driver. They can be used to create projects or change packages that will affect the primary driver

PDSA Testing builds new approach advanced care planning

Cycle 1A: 11/02/14 Identification patients by respiratory FY1 by putting a Q beside their name on ward board and handover sheets

Cycle 1B: 3/03/14 Teaching the other side of the ward- gastro FY1’s

Cycle 1D: 24/04/14 “re-inform & support” with Hannah & thank you cookies

Cycle 1C: 14/04/14 disseminate the Q project- targeted 5 medical wards a)sign sheet b) Cert to do one c) Cert to teach one

Cycle 1E: 7/05/14 Consultant lead to boost confidence in identifying Q patients

© 2009 R C Lloyd and IHI

Example of a Family of MeasuresTopicTopic Outcome Outcome

MeasuresMeasuresProcess Process

MeasuresMeasuresBalancing Balancing MeasuresMeasures

Improve care

at the end of life

Meet/ exceed 5 Priorities

1) Place of death as preferred

2) Symptoms control maximized (Voices ?)

3) Family consider 3) Family consider there was a good there was a good deathdeath

Percent compliance priorities 1, 2-4, 5,

1) Likely death identified

2-4) Clear and compassionate communication5a) Documented holistic plan

5b) Plan delivered completely

Staff acceptance Staff acceptance

Financial costFinancial cost

Coding / Coding / performance performance indicator indicator deterioration deterioration

Using Improvement Methods to rethink the idea and the reality

Between the idea and the reality, between the motion and the act, falls the shadow TS Eliot

Shine Project

Emma RedfernConsultant in Emergency Medicine & Associate Medical Director for Patient SafetyUniversity Hospitals Bristol NHS Foundation Trust

#PSCQI

@weahsn

Improving safety in Improving safety in overcrowded urgent overcrowded urgent

care systemscare systemsSHINE projectSHINE project

Dr Emma RedfernConsultant in Emergency Medicine

What are the problems? What are the problems? • Delays in discharge from acute trusts• Lack of available beds• Overcrowding in ED• High medical acuity• Ambulance queue• Agency staffing • Outliers

Perfect stormPerfect storm

What we have observedWhat we have observed• Higher rates of clinical incidents due to basics not

being done – timely ECG in chest pain, vital sign measurements missed

• High rates of clinical incidents for queuing patient • High rates of incidents for certain outliers

SHINE projectSHINE project• Standardise the delivery of high quality care across

the peaks and troughs in demand

2 parts2 parts• Design and implement a safety checklist – time

based list of tasks that need to be completed for EVERY majors/resus/queue patient

• IT innovation to ‘prealert’ site team if have patient who should not outlie – stroke, DKA, chest drain, tracheostomy, GI bleed, NOF

ChecklistChecklist• One off tasks• ECG performed and seen by Dr• CT ? Stroke, XR ? NOF• Start specialty proforma – sepsis/DKA

• Recurring tasks• Vital signs and EWS• Pain score and pain relief• Offer refreshments

Benefits - checklistBenefits - checklist• Can be completed by ED nurse, agency nurse,

SWAST paramedics = resilience• Standardised framework – ensures basics are done• Reduces freehand writing in notes

‘‘nudge’- bleeplessnudge’- bleepless

Benefits of nudgeBenefits of nudge• Right patient, right bed

• Accepting the fact that sometimes we can’t achieve this for everyone, nudge helps to get the highest risk patients into an appropriate bed

Results so farResults so far

Pain score and analgesiaPain score and analgesia

SepsisSepsis

Going forwardsGoing forwards• Project continues until June• Then evaluation• Checklist formally incorporated into ED notes • Spread to other ED

KEYNOTE ADDRESS

Dr Helen BevanChief Transformation OfficerNHS Improving Quality

#PSCQI

@weahsn

the change agent of the future

Helen Bevan

Chief Transformation Officer@HelenBevan

and staying in it:

“New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)

Source of image: installation by the artist Adam Katzwww.thisiscolossal.com

Via @NeilPerkin

@HelenBevan #dopconf

Starts on the fringe (at the edge)

Starts with the activistsGary Hamel

always


SEISMIC SHIFTS


DIGITALCONNECTION

SEISMIC SHIFTS


Work complexity

SEISMIC SHIFTS

DIGITALCONNECTION


DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity


DIGITALCONNECTION

SEISMIC SHIFTS

Hierarchical

power

Work complexity

Change from the edge


Leading change in a new era

Dominant approach Emerging direction


Leading change in a new era

Dominant approach Emerging direction

Most health and care transformation

efforts are driven from this side

Most health and care transformation

efforts are driven from this side


John Kotter, the most influential thought leader globally, recognises new approaches are needed

FROM


John Kotter: “Accelerate!”

• We won’t create big change through hierarchy on its own

• We need hierarchy AND network• Many change agents, not just a

few, with many acts of leadership

• At least 50% buy-in required• Changing our mindset

• From “have to” to “want to”

TO


From “have to” to “want to”

Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community

The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro

1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy

2. If you want to create small scale change, work through a cohesive network

If you want to create big change, create

bridge networks between disconnected groups

People who are highly connected have twice as much power to

influence change as people with positional power

Leandro Herrero

http://t.co/Du6zCbrDBC

“I have some Key Performance

Indicators

for you”

oror

“I have a dream”

Source: @RobertVarnam


is the new normal!

“By questioning existing ideas, by opening new fields for action, change agents actually help

organisations survive and adapt to the 21st Century.”

Céline Schillinger

Image by neilperkin.typepad.com


What happens to heretics/radicals/rebels/mavericks

in organisations?

Source of image: findingmyself.net



Ostracism is experienced in the brain as deeply as physical pain


What is a rebel?

•The principal champion of a change initiative, cause or action

•Rebels don’t wait for permission to lead, innovate, strategise

•They are responsible; they do what is right•They name things that others don’t see yet

•They point to new horizons

•Without rebels, the storyline never changes

Source : @PeterVan http://t.co/6CQtA4wUv1


We need boatrockers!

• Rock the boat but manage to stay in it• Walk the fine line between

difference and fit, inside and outside• Able to challenge the status

quo when we see that there could be a better way• Conform AND rebel• Capable of working with others

to create success NOT a destructive troublemaker Source: Debra Meyerson

Source : Lois Kelly www.rebelsatwork.com

There’s a big difference between a rebel and a troublemaker

Rebel


Reflection• What are your insights around “rebels” and

“troublemakers”?• What moves people from being “rebel” to

“troublemaker”?• How do we protect against this?

Source : Lois Kelly www.rebelsatwork.com

There’s a big difference between a rebel and a troublemaker

Rebel


1. able to join forces with others to create action2. able to achieve small wins which create a sense

of hope, possibility and confidence3. More likely to view obstacles as challenges to

overcome4. strong sense of “self-efficacy”

belief that I am personally able to create the change

Four things we know about successful boat rockers

Source: adapted from Debra E Meyerson

CHANGE

me

BEGINS WITH


Self-efficacy

“If you think you

can or think you

can't, you are right.”

Henry Ford

“The ability to act is tied to a belief that it is possible to do so”

Albert Bandura

There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change

and get good outcomes

Source of image:www.h3daily.com


Source: @NHSChangeDay


Source: @NHSChangeDay

What is the issue here?

“permission” ? (externally generated)

or

Self efficacy ? (internally generated)


Building self-efficacy: some tactics

1. Create change one small step at a time

2.Reframe your thinking:• failed attempts are learning opportunities• uncertainty becomes curiousity

3. Make change routine rather than an exceptional activity4. Get social support5. Learn from the best

Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/


@HelenBevan #dopconfSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively


Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively



Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively


Make it a personal PERFORMANCE target.



Research from the Sales industry:How many NOs should we be seeking to get?

• 2% of sales are made on the first contact• 3% of sales are made on the second contact• 5% of sales are made on the third contact• 10% of sales are made on the fourth contact• 80% of sales are made on the fifth to twelfth

contact

Source: http://www.slideshare.net/bryandaly/go-for-no


“Papers that are more likely to contend against the status quo are more likely to find an opponent in the review system—and thus be rejected —but

those papers are also more likely to have an impact on people across the system, earning them more citations when finally published”

V. Calcagno et al., “Flows of research manuscripts among scientific journals reveal hidden submission patterns,”

Science, doi:10.1126/science.1227833, 2012.

—


Avedis Donabedian

“Ultimately, the secret of quality is love.…… If you have love, you can then work backward to monitor and improve the system”.


Key tactic :Out-love everyone else

Source of image: Bradley Burgess


“Tomorrow’s management systems

will need to value diversity, dissent and

divergence as highly as conformance, consensus

and cohesion.”

Gary Hamel

Source of image: www.fastcompany.com

@HelenBevan


As you create your roadmap for the future, make sure you are part of the

steamroller, not part of the roadSaavik Wilcox-Hamilton

Source of quote: http://slidesha.re/1B6jrZw

“ “


1. Follow on Twitter

@HelenBevan

@NHSIQ

2. Subscribe to

3. Get materials from The School for Health and Care Radicals: www.theedge.nhsiq.nhs.uk/school

TheEdge.nhsiq.nhs.uk

Three ways to connect!

@School4Radicals@TheEdgeNHS


References and linksBaron A (2014) Preparing for a changing world: the power of relationships Battilano J, Casciaro T (2013) The network secrets of the great change agents Harvard Business Review, July-August Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Bevan H, Fairman S (2014) The new era of thinking and practice in change and transformation, NHS Improving Quality Change Agents Worldwide (2013) Moving forward with social collaboration SlideShareDiaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontierFuda P (2012) 15 qualities of a transformational change agentGrant, M (2014) Humanize: How people centric organisations succeed in a social world http://prezi.com/usju20i0nzhd/humanize-how-people-centric-organizations-succeed-in-a-social-world/ Hamel G (2014)Why bureaucracy must dieJarche, H (2013) Rebels on the edges


Jarche H (2014) Moving to the edges

Kotter J (2014) Accelerate! Harvard Business Review Press

Merchant N (2013) eleven rules for creating value in the social era

Llopis G (2014) Every leader must be a change agent or face extinction

Meyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard

Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BP

Perkins N (2014) Bats and pizzas (agility and organisational change)

Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated

School for health and Care radicals (2014) www.changeday.nhs.uk/healthcareradicalsShinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadershipWilliams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activismVerjans S (2013) How social media changes the way we work together

References and links

Q & A Panel Session

#PSCQI

@weahsn

Q&A Panel Session

Panel Job Title Organisation

James Scott Chief Executive Royal United Hospital Bath

Dr Jim Moore GP Stoke Road Surgery/ Gloucestershire CCG

Dr Helen Bevan Chief Transformation Officer NHS Improving Quality

Jane Jones Associate Director of Improvement

West of England AHSN

Ian Tulley Chief Executive Avon and Wiltshire Mental Health Partnership NHS Trust

THANK YOU

#PSCQI

@weahsn