www.hqip.org.uk

Clearing the barriers to improvementMandy Smith & Liz SmithQuality Improvement Facilitators

Taking Action to Improve QualityBirmingham25th March 2014

Achieving successful change requires . .

VISION SKILLS INCENTIVES RESOURCES ACTION PLAN CHANGE

SKILLS INCENTIVES RESOURCES ACTION PLAN CONFUSION

VISION INCENTIVES RESOURCES ACTION PLAN ANXIETY

VISION SKILLS RESOURCES ACTION PLAN

NO CHANGE

VISION SKILLS INCENTIVES ACTION PLAN FRUSTRATION

VISION SKILLS INCENTIVES RESOURCES FALSE STARTS

Promoting the vision

• The vision is care which complies with standards, because this delivers the best outcomes

• Do all the clinical team and stakeholders agree?

• Is the audit focussed on clinical priorities?

• Will the audit design provide convincing evidence for change?

• Does it aim at quality improvement?

Aims and objectives

• Setting the correct AIM and OBJECTIVES is key.

• WEAK aims:• Audit compliance with guidelines• Evaluate care of .......

• STRONG aims:• Improve compliance with guidelines by . . .• Increase patient safety by . . .

• Practical exercise

Developing skills

• Do front line staff lack skills in clinical audit and managing change?

• Access to audit facilitators and practical support

• Do audit facilitators understand their role?

• The importance of clinician leads

• Support from senior management

• Good audit governance – not bureaucracy

Developing skills

• Do front line staff have the skills to implement new working practices?

• Identify the needs for training and support

• Don’t train people to do what they already know how to do but can’t do for reasons other than lack of knowledge – i.e. lack of resources, faulty systems and processes.

• Identify and address the underlying causes for lack of compliance.

Identify your strengths

• Are these skills already available in your organisation?

• Identify who else in your organisation has change management skills & experience.

• Where can skills be shared or transferred?

• Who has the power and influence to lead change?

• How do the clinical audits you are working on relate to other QI activities?

Maximising incentives

• Incentives fall into two main categories:

• Incentives for organisations

• Incentives for healthcare professionals

Maximising incentives

For organisations:

• reputation and publicity

• high –level assurance

• evidence for commissioners

• service improvement and development

Maximising incentives

For healthcare professionals:

• professional pride and reputation

• personal development, revalidation

• reduction in complaints

• improved services

Finding the resources

• Resources may include time, money, people and equipment

• Remember - clinically effective services are more cost effective

• Engage budget holders

• Engagement with commissioners

Finding the resources

• Audit data can provide powerful evidence for a business case

• Developing a business case:

• A proposal seeking authorisation for the allocation of resources

• Required whenever expenditure has to be justified

• Follow the prescribed format used in your organisation

Contents of a business case• Executive summary

• Background including current position & proposed development

• Quantifiable benefits so impact can be assessed

• Project management arrangements including timelines, procurement strategy etc.

• Financial analysis – consult your finance colleagues

• Risk analysis

• Summary of proposals

Planning for action

• Poor or inadequate action planning is worse than none at all

• Do you understand the fundamental reasons for the shortfalls identified by the audit?

• Are the actions SMART? • Specific, Measurable, Assignable, Realistic and

Time-related

• Using the ‘AIMS’ tool

Three types of Measure

• Outcome measures: Voice of the patient. How is the system performing? What is the result?

• Process measures: Voice of the workings of the system. Are the parts/steps in the system performing as planned?

• Balancing measures: Looking at a system from a different angle. What happened to the system as we improved the outcome and process measures? e.g. unanticipated consequences, other factors influencing outcomes – a holistic view.

Balancing Measures

Reduce length of stay

Decrease post op ventilation time

Increase VTE treatment

4 hour A&E waiting time

readmission rate

re-intubation rates

bleeding / HIT

.....................!

Planning for action

• Do the front line staff who will be implementing the actions actually believe they will be effective?

• Using the CAST system to prioritise actions

WEAK ACTIONS STRONG ACTIONS

Raise staff awareness Remove barriers to doing the work effectively

Remind staff Redesign the work

Provide training Supervise, monitor and feed back

Write a new policy Use IT or technological solutions

Acting on the plan

• Taking action is a process and the action plan documents and supports the process

• Monitor consequences and address barriers

• Go with the willing to build the evidence base for change

• Celebrate achievements and build on success

• Report, review and learn from failures

In summary

• Share the vision with all the key stakeholders

• Support staff in developing new skills

• Provide incentives that matter to your colleagues

• Work with stakeholders to identify the resources

• Plan for action and follow the plan through to successful change

VISION

SKILLS

INCENTIVES

RESOURCES

ACTION

PLAN

CHANGE