spread the word! were talking about spreading improvement ideas
TRANSCRIPT
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