Model for Improvement

By the end of this session you should

be able to…

• understand why Community Planning Aberdeen is using the Model for Improvement

• use the Model for Improvement

• apply core tools and techniques to your improvement projects

• access further reference materials and training

• get started on an improvement project!

Context for today

The thinking

part…

Model for Improvement

The doing

part…

The Model for Improvement:

the thinking part

If you don’t answer the 3 thinking questions before you start your improvement project – be prepared to fail!

The doing part: testing

Plan: How will we ‘test’

doing something differently?

Do: Let’s try!

Study: Did it work?

Act: What’s next?

All improvement requires change, but not all change is an improvement.

DESIGN DESIGN DESIGN DESIGN APPROVE

The Typical Approach

IMPLEMENT

In the real

world

Around

the table

DESIGN

TEST & MODIFY

TEST & MODIFY

APPROVEIF NECESSARY

TEST & MODIFY

Quality Improvement Approach

START TO IMPLEMENT

Around

the table

In the real

world

• Project charter

• Driver diagram

• Run charts

Quality Improvement Tools

Getting started

Why are you improving?

• Rationale for change

• Involving your stakeholders

• Understanding your system

Insanity is doing the same thing over and over again and expecting different results –Albert Einstein

Improvement Project Team

• Sponsor

• Project Manager

• Subject Matter

Expert

• Improvement

Advisor/Coach

• Data Manager

• Practitioner

• Customer/ client

(Not necessarily

different people)

The Model for Improvement

What are you trying to achieve?

Aim statement

• What?

• How much?

• By when?

• Target group

Our improvement project

We work together in a community within

Aberdeen City.

We have recently engaged with the

community to develop the local outcome

improvement plan.

One of the priorities identified was

increasing physical activity for all age groups

in the community.

We completed a survey and only 20% of

respondents said they were doing the

recommended physical activity of 30

minutes, five times a week.

Write an aim statement

• What?

• How much?

• By when?

• Target group

Example:

What are you trying to accomplish?

Aim statement

Support and inspire

people in communities to

participate in physical

activity by providing the

right opportunities and

recognising their efforts

Aim statement

Increase by 50% the

number of people who

report undertaking 30

mins of exercise, five

times a week in Tillydrone

by October 2019

What are you trying to achieve?

Aim statement

• What?

• How much?

• By when?

• Target group

The Model for Improvement

OutcomeAssociated with the project aim

(how best the project can be

measured)

Number of people who report

undertaking 30 mins of exercise,

five times a week in Tillydrone

ProcessTo assess the key processes which

have to be happening reliably to

achieve your aim

Number of people attending the

sports centre every day

BalancingMakes sure that changes to

improve one part of the system are

not causing problems in other parts

of the system – are there any

unanticipated consequences?

Number of mental health referrals

Family of measures

Qualitative data is also valuable

e.g.

‘We really enjoy the Family Fun

activities at the sports centre

and we now exercise together

as a family every week’

Things to consider when collecting

data for your measures

Who will be responsible for

data collection?

What is the data source /

how will the data be

collected?

Frequency of data

collection and when it will be

collected

Do you need any

equipment to measure?

How can data collection be

integrated with work?

What factors might

influence the measure?

Measurement plan

Don’t get caught out with a list of measures that are never collected…

The Model for Improvement

‘Change’ can mean different things

Selecting Changes

• Fixing something or innovative change?

• Where are changes sourced from: literature, evidence, experience of others, hunches and theories

• Steal shamelessly and learn from others

• Use best practice

• Choose the changes you think will have the biggest impact

• Avoid low impact changes

Selecting changes

Example:

Aim: Increase by 50% the number of people who report undertaking 30 mins of exercise, five times a week in TillydroneOctober 2019

Change ideas?

• Better links with organisations

• Meet with partners

• Complete a survey

• Develop a communications strategy

• Study data from our survey

A Practical Need Often Drives

Creativity!

Your Project Charter

• Focus on aim

• Link to strategic priorities

• Rationale for improvement

• Measures (Baseline?)

• Change ideas

• Barriers

• Team

Driver diagrams(improvement tool)

Supports the team to explore all factors that will help achieve the aim

Helps identify measures

Provides an improvement route map or theory of change

Communication tool

Why a driver diagram?

Alignment with purpose

Individual decisions

A tool to help organise our theories and ideas during an improvement effort Langley et al. 2009, p.429

To Lose

3 stone

by end of

June

2019

Calories

In

Calories

Out

Reduce daily

calorie intake

Increase

consumption of

low calorie Foods

Alcohol reduction

Increase weekly

exercise

Track Calories Via

A Food Diary

Plan Meal Menu

For The week

Only Drink Water

For Two Weeks

Walk Dog 5 Days A

Week

Bike To Work

Attend Weekly

Weight Loss Class

Access education

& support

Secondary DriversPrimary DriversAIM Proposed Changes

The 4 Key Components of a Driver DiagramIn order to

achieve

this aim…

We need to

ensure…

Which requires… Change ideas to

ensure this happens.

Increase by

50% the

number of

people who

report

undertaking

30 mins of

exercise,

five times a

week in

Tillydrone

by October

2019

Effective

communication

approaches

Community

Engagement

Share messages about

benefits of physical activity

at all ages

Increase range and uptake

of activities available for all

ages

Weekly Family Fun activity

sessions at the community

centre

Termly ‘clean up day’ at the

park

Walking group for new

Mums

S6 pupils run weekly

exercise sessions in the

park

Include stories about new

activities and the impact for

individuals in the

community newsletter

Develop a shared approach

between school; health

centre & community centre

Secondary DriversPrimary DriversAIM Proposed Changes

Driver Diagram

High quality

facilities and

opportunities

Partnership

Working

Improve communication

about exercise activities

Improve equipment at the

play space

Involve community

members in development of

activities

Improve volunteering

opportunities around sports

and exercise

Outcome Measure:

% of people

reporting 30 mins

of exercise, 5 times

per week

Use ‘My fitness pal’ app to

record fitness levels

Process Measure:

# of people

attending activities

each week

Your Project Charter

• Focus on aim

• Link to strategic priorities

• Rationale for improvement

• Measures (Baseline?)

• Change ideas

• Barriers

• Team

What we’ve covered so far…

• understand why Community Planning Aberdeen is using the Model for Improvement

• use the Model for Improvement

• apply core tools and techniques to your improvement projects

• access further reference materials and training

• get started on an improvement project!

The thinking

part…

Model for Improvement

The doing

part…

36

Testing a change using PDSA

• A structured approach for making small incremental changes to systems

• A full cycle for planning, implementing, testing and identifying further changes

• A common sense, easy to understand tool for bringing about change

• A tool which can reduce anxiety to change

The doing part: testing!

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

P

DS

A

Change:

New Mums’

Walking Group

Change:

Family Fun

Activities

Change:

Stories in the

Newsletter

Iteration

1

2

3

4

PDSA RampsAIM: Increase by 50% the number of people by who report undertaking 30 mins of exercise, five

times a week in Tillydrone by October

The Paper Aeroplane

Challenge

Aim: To create a paper aeroplane that flies

the length of the room by pm.

The Paper Aeroplane Challenge

PLAN DO STUDY ACT

Cycle Aim of test Theory/ plan Predict

length

of flight

Actual

length

of flight

Observations What we will do next

time

Cycle1

EXAMPLE

Discover how

far a short

winged aircraft

can fly

Short wings will ensure

a straight flight path

4

strides

Cycle 2

Cycle 3

Paper Aeroplane: PDSA Recording

Recording: Outcome data

• Consistency of purpose

• Prediction, Planning & Documentation enables learning… and reliable implementation if your test is a success.

• Learning from Failure – one test (PDSA) leads to another until you learn how to succeed or abandon the idea!

• Sharing and Stealing from others can help

The Paper Aeroplane Challenge – key

learning points

Scaling up and

spread

Testing ideas on a small scale

Collecting and using

data to understand

impact

Recording your data

What's wrong with this picture?

Moving forward without data or the information we need is like driving with your eyes closed

Without data, you're just another person with an opinion. – W. Edwards Deming

• With data we can measure the impact of what we are doing

• With data we know if our changes are leading to improvement

• With data we can decide whether to adopt, adapt or abandon

The dangers of going in blind?

• Traditional performance management often focuses on measures gathered at specific points in time.

• This can limit our ability to understand our changes while we are making them.

• One of the most useful benefits of measuring data for improvement is that we gather data and use it in real-time.

• A run chart is one of the best tools to determine if what we are doing is having the impact we want.

How do we analyse data variation for

quality improvement?

Run charts – an improvement tool

Number of Families attending Family Fun Activity Class

School holiday

Horizontal Axis

Ver

tica

l Axi

s

Median

0

2

4

6

8

10

12

14

16Number of Serious Assaults

Improvement?

April 2014 April 2015

Nu

mb

er

of

se

rio

us

as

sa

ult

s r

ep

ort

ed

Number of serious assaults reported

Run charts – an improvement tool

APRIL 2014

↑

‘When you have two data

points, it is

very likely that one will

be different from

the other.’ Deming

↑ APRIL 2015

• Run chart rules help us identify changes that are beyond just the normal variation we would expect as part of a process or system.

• When we use run charts we are looking for changes or trends – we call this a “special cause.”

• Applying Run Chart Rules helps us to interpret the variation in our data and the impact of changes.

• By applying these rules we can carry out analysis and answer the question:

“How will we know if a change is an improvement”

Interpreting Our Data: Understanding

Variation

Interpreting the Data: Three Rules for

Run ChartsA shift: 6 or more

points above or

below the centre

line

A trend: 5 or

more points up

or down

An astronomical

data point

• These rules help us to identify trends and understand variation in our data.

Annotations – telling your story:

• Adding annotations highlights key events, tests or changes carried out.

• Annotations add more information and tell us when key actions carried out or changes were made.

Creating a Run Chart: No. people attending the walking group each month

Plotting Your Chart:

1. Label Vertical scale – Number of people

2. Label Horizontal scale – Month

3. Plot the data points

MonthNumber of people Annotation

Jan 16 75 Start of Annual Programme Feb 16 77Mar 16 87 Free fruit offered

Apr 16 87

May 16 89

Jun 16 95Jul 16 88Aug 16 8 Storm Sally hit Aberdeen Sep 16 83Oct 16 84

Nov 16 80Attended parents evening to publicise programme

Dec 16 83Jan 17 79Feb 17 90 Springwatch guided walkMar 17 94Apr 17 97May 17 98

Plotting Your Chart:

4. Now calculate and place a median or middle line.

The median is the middle number. ... To find the median number: Put all the numbers in numerical order smallest to largest. If there is an odd number of results, the median is the middle number. If there is an even number of results, the median will be the average of the two central numbers.

An example with our walking group attendance data:

8 75 77 79 80 83 83 84 87 87 88 89 90 94 95 97 98

Median

Your finished chart:

NUMBER OF PEOPLE ATTENDING WALKING GROUP

0

10

20

30

40

50

60

70

80

90

100

Number of people

Start of

Annual

Programme

Free fruit

offered

Storm

Sally hits

Aberdeen

Attended

parents

evening to

advertise

programme

Springwatch

guided walk

Month

Interpreting your chart: Rules for Run

ChartsA shift: 6 or more

points above or

below the centre

line

A Trend: 5 or

more points up

or down

An astronomical

data point

• Take a few minutes on your tables to look for any variation in the graph you have created.

• The rules help us identify changes which are beyond just normal variation.

Interpreting Run Charts: Trend

0

10

20

30

40

50

60

70

80

90

100

Number of people

0

10

20

30

40

50

60

70

80

90

100Number of people

Interpreting Run Charts: Astronomical Data Point

Astronomical point – An unusually small or large number in the data –Significantly different to the other values and should be discussed by the team.

Remember: Every data set will have a high and a low - this does not mean the high or low are necessarily astronomical

Start of Annual

Programme

Free fruit

offered

Storm Sally

hits Aberdeen

Attended parents

evening to

advertise

programme

Springwatch

guided walk

0

10

20

30

40

50

60

70

80

90

100

Number of people

Interpreting Run Charts: Shift

Shift – 6 or more consecutive points either all above or all below the median line. Exclude values on the median line.

In this example you may not identify a shift as the project team would probably decide to ignore the storm/astronomical data point.

Start of Annual

Programme

Free fruit

offered

Storm Sally

hits Aberdeen

Attended parents

evening to

advertise

programme

Springwatch

guided walk

• Run charts are a very useful tool for tracking improvement over the course of a project - you now have practical experience.

• Using Run Charts helps you understand the variation in your data and the impact of changes.

• One of the most useful benefits of measuring data for improvement is that we gather data in real-time and react to it.

• Collecting data is crucial - without data we are “driving blind.” We need data to inform decision making and to evidence that what we are doing is worthwhile or showing improvement.

Collecting and using data summary

Reporting for improvement

Improvement Tracking

Further resources

http://communityplanningaberdeen.org.uk/

communityplanning@aberdeencity.gov.uk

Other learning opportunities:

Monthly Project Surgery

Quality Improvement Practitioner

Programme

https://khub.net/group/community-planning-

aberdeen-improvement-practitioners-

network

What we’ve covered today

• understand why Community Planning Aberdeen is using the Model for Improvement

• use the Model for Improvement

• apply core tools and techniques to your improvement projects

• access further reference materials and training

• get started on an improvement project!