a method to our madness: our theory of how improvement happens ninon lewis and david williams
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Early Years Collaborative: Learning Session 4. A Method to our madness: Our theory of how improvement happens Ninon Lewis and David Williams Institute for Healthcare Improvement. Components of a learning system. System level measures Explicit theory or rationale for system changes - PowerPoint PPT PresentationTRANSCRIPT
A METHOD TO OUR MADNESS: OUR THEORY OF HOW
IMPROVEMENT HAPPENSNinon Lewis and David Williams
Institute for Healthcare Improvement
Early Years Collaborative: Learning Session 4
COMPONENTS OF A LEARNING SYSTEM
1. System level measures2. Explicit theory or rationale for system changes3. Segmentation of the population4. Learn by testing changes sequentially5. Use informative cases: “Act for the individual learn for the
population” 6. Learning during scale-up and spread with a production plan
to go to scale7. Periodic review8. People to manage and oversee the learning system
Source: Tom Nolan PhD, Associates in Process in Improvement
SESSION OBJECTIVES• Explore Stephen Covey’s “Big Rocks Theory” as a
guide to understanding how we can prioritize our work
• Connect the Big Rocks theory to the seven Early Years Collaborative key change areas
• Explore a four-part execution strategy for EYC improvement efforts within key changes
Place the big rocks first…
Video Credit: The Seven Big Rocks Productivity System
Early Years Aim
Early Intervention in Maternity
ServicesAttachment and Child
Development Beyond
Maternity Services
Continuity of Care in
Transitions Between Services
27 - 30 Month Child Health
Review
Developing Parents'
Skills
Family Engagement to Support
Early Learning
Income Maximisation
KEY CHANGES
A FRAMEWORK FOR EXECUTION
CPP EXECUTION STRATEGY• Setting Breakthrough Performance Goals• Developing a Portfolio of Projects to Support the
Goals• Deploying Resources to the Projects That Are
Appropriate for the Aim• Establishing an Oversight and Learning System to
Increase the Chance of Producing the Intended Results
Setting Breakthrough Performance Goals
Early Intervention in Maternity Services
• Breakthrough Performance Goal #1• Breakthrough Performance Goal #2
Attachment and Child Development beyond maternity services• Breakthrough Performance Goal #1• Breakthrough Performance Goal #2• Breakthrough Performance Goal #3
Continuity of Care in Transitions Between Services
• Breakthrough Performance Goal #1
27 - 30 Month Child Health Review
• Breakthrough Performance Goal #1
Developing Parents' Skills
• Breakthrough Performance Goal #1• Breakthrough Performance Goal #2
Family Engagement to Support Early Learning
• Breakthrough Performance Goal #1
Income Maximisation
• Breakthrough Performance Goal #1
Breakthrough Performance Goal #3
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PORTFOLIO OF MEASURES
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DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS
• A portfolio is a collection of projects that will together move our stretch aims.
• Your portfolio will be informed by a broad view of what you and other partners can do.
• There’s a lot in your portfolio already.
DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS
Early Years Aim
Early Intervention in Maternity Services Project
Attachment and Child Development Beyond
Maternity services
Project
Project
Income Maximisation
Project
Project
Project
27 - 30 Month Child Health Review Project
Developing Parents' Skills
Project
Project
DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS
Big Aim
Early Years Aim
Early Intervention in Maternity Services Project
Attachment and Child Development Beyond
Maternity services
Project
Project
Income Maximisation
Project
Project
Project
27 - 30 Month Child Health Review Project
Developing Parents' Skills
Project
Project
DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS
Early Years Aim
Early Intervention in Maternity Services Project
Attachment and Child Development Beyond
Maternity services
Project
Project
Income Maximisation
Project
Project
Project
27 - 30 Month Child Health Review Project
Developing Parents' Skills
Project
Project
Big Rocks
DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS
Early Years Aim
Early Intervention in Maternity Services Project
Attachment and Child Development Beyond
Maternity services
Project
Project
Income Maximisation
Project
Project
Project
27 - 30 Month Child Health Review Project
Developing Parents' Skills
Project
Project
CPP Portfolio of Projects
Children have all the developmental skills and abilities expected of a 27-30 month old
Societal Issues
Child’s physical & mental health and emotional development
Carer’s physical & mental health and skills
Level of education Improved sharing of information
Improved joint working
Improved early identification
Detailed Aim:85% of all children within each CPP have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review by end-2016
Misuse of alcohol & drugs
Health
Improved child’s dental health
Improving child nutrition
Poverty
Quality Of Home Environment
Domestic Abuse & Violence
NutritionDisabilities & Mental health
Attachment
Improved stability / permanence for LAC
Improved money management
Improved management, planning and quality of services
Improved family centred response
Improved leadership, culture and planning
Improved teamwork, communication, skills and collaboration
Improving brain development and physical play
Parenting skills & knowledge
WORKSTREAM 2 (1 year to 30 months)
Identification & reasons for current resilience
Aim 1⁰ 2⁰
Theory of what drives developmental milestonesTheory of what actions will
ensure developmental milestones are reached
Workforce Issues
Transport, Community Capacity & Cultures
Early Learning & Play
Access To Services
Employment
Additional Support
Version: 06/03/2013
R
Where project ideas come from!
DEVELOPING A PORTFOLIO OF PROJECTS TO SUPPORT THE GOALS
• A portfolio is a collection of projects that will together move our stretch aims.
• Your portfolio will be informed by a broad view of what you and other partners can do.
• There’s a lot in your portfolio already.• Use a driver diagram or logic model to show how the
portfolio hangs together• You can annotate with system and project measures
Aim Statement: Improve what? By how much? By When
AP D
S
AP
D S
APD
S
A P
DS
Change Ideas
Every project wants a charter
Measure(s)
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SAMPLE PROJECT CHARTER (LOCATED ON EYC EXTRANET)
• What’s in your CPP’s Portfolio of Projects?
• What key changes do they belong to?
• Are there any key changes without project activity?
AT YOUR TABLES…
CPP STAFFING• Deploying Resources to the Projects That
Are Appropriate for the Aim
• Establishing an Oversight and Learning System to Increase the Chance of Producing the Intended Results
SAMPLE CPP STAFFING MODEL
SAMPLE CPP STAFFING MODEL
SAMPLE CPP STAFFING MODEL
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SAMPLE CPP STAFFING MODEL
SAMPLE CPP STAFFING MODEL
Considering this model…• How are your
resources deployed?• What are the gaps?• What does your CPP
need to develop going forward?
AT YOUR TABLES…
REPEATED USE OF THE PDSA CYCLE
Hunches Theories
Ideas
Changes That Result in Improvement
A PS D
APS
D
A PS D
D SP ADATA
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
1) What are we trying to accomplish?2) How will we know that a change is an improvement?3) What change can we make that will result in improvement?
Sequential building of knowledge under a wide
range of conditions
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A PS D
A PS D
A P
S D
D SP A
A PS D
A PS D
A P
S D
D SP A
A PS D
A PS D
A P
S D
D SP A
A PS D
A PS D
A P
S D
D SP A
Early Intervention in Maternity Services Project(s)
Attachment and Child Development beyond maternity services Project(s)
Developing parents' skills Project(s)
Continuity of care in transitions between services Project(s)
A PS D
A PS D
A P
S D
D SP A
27 - 30 month Child Health review Project(s)
AIM: BIG DOT EARLY YEARS
Change Concepts, Theories, Ideas
Attachment and Child Development beyond maternity services
27 - 30 month Child Health review
Early Intervention in Maternity Services
Continuity of care in transitions between services
MULTIPLE KEY CHANGES FOR A SINGLE AIM
Thank You!