spread the word! were talking about spreading improvement ideas

Spread the Word! We’re Talking About

Spreading Improvement Ideas

Ben Ridout

Outline

• Context

• 7 “Spreadly Sins”

• Theory and Framework

• Practical Tips and Tool

Context

“Islands of improvement”

Limited resources and time

Rediscovering the same ideas?

Spread

“when best practice is disseminated consistently and reliably across a whole system, and involves

the implementation of proven interventions”

* Jeffcott, S. The spread and sustainability of quality improvement in healthcare. NHSScotlandQuality Improvement Hub.

Technical Aspects Social Aspects

Disseminate Information

Overcome Barriers

Change

7 Deadly…“Spreadly Sins”

7 “Spreadly Sins”

1. Don’t bother testing – just do a large pilot

2. Give one person the responsibility to do it all

3. Rely solely on vigilance and hard work

4. Spread the success unchanged; don’t bother adapting

5. Require the person and team responsible for initial improvements to lead spread

6. Check progress/data just once every quarter

7. Expect huge improvements quickly then spread right away

Table Discussion

1. What’s your experience been with the “Spreadly Sins”?

2. How can we avoid committing the “SpreadlySins” in our work?

Some Theory

Diffusion of Innovation

Psychology of Change

Complexity Theory

Diffusion of Innovation

1. Advantageous

2. Compatible

3. Simple

4. Testable

5. Observable

Stages of Change

1. Precontemplation

2. Contemplation

3. Action

4. Maintenance

Complexity Theory

Spread of change somewhat messy process

• Degree of exploration and experimentation

Nolan K, Schall M, Erb F, Nolan T.; Using a framework for spread: The case of patient access in the Veterans Health Administration. Joint Commission Journal on Quality and Patient Safety.2005Jun;31(6):339-347.

* The Improvement Guide 2nd Edition – p. 196

Leadership

Strong leadership essential to success

– Support innovation as key strategic initiative

– Spread process needs to be managed

• Day-to-day leadership

Better Ideas

1. Clear advantage

2. Compatibility

3. Simplicity of change

4. Ease of testing

5. Observability

Setup for Spread

Develop spread plan early

Initial plan for spread

– Identify ways to attract early adopters

– Changes packaged for easy comprehension and testing

Find successful site(s) to promote

Social System

Communication at the heart of spread

• Over-communicate by factor of 10

Communication twofold

– Raising awareness – attract adopters

– Sharing technical content

Feedback Loops

1. Measurement

– Demonstrate extent of spread

– Demonstrate outcome of changes implemented

2. Knowledge Management

– Capture and share knowledge generated during spread process

Nolan K, Schall M, Erb F, Nolan T.; Using a framework for spread: The case of patient access in the Veterans Health Administration. Joint Commission Journal on Quality and Patient Safety.2005Jun;31(6):339-347.

* The Improvement Guide 2nd Edition – p. 196

Experience in Practice

No simple answer

Different approaches for different contexts

Training alone unlikely to be successful

Best strategies incorporate variety of approaches

Experience in Practice

Extent of spread affected by factors in 3 domains:

1. Intentional activities to introduce spread

2. Attitudes and capabilities of clinical staff

3. Context of site/facility being targeted

Top Tips from Evidence

1. Involve range of people in implementation & dissemination

2. View people as active change agents not passive

3. Emphasize alignment with people’s priorities

4. Target messages differently to different audiences

5. Support and train people to understand and implement change

6. Plan dissemination strategies from outset

7. Dedicate time for dissemination

8. Make use of wide range of approaches

9. Evaluate success of innovations and improvements

The Health Foundation (2014). Spreading improvement ideas: Tips from empirical research

NHS Spread Tool

Questions?

Contact Information

Ben Ridout

Director, Patient & Public Engagement

T: 604.668.8211

bridout@bcpsqc.ca