Scottish Improvement Skills Workshop 1 Day 2

1. Scottish Improvement Skills Workshop 1 Day 2

2. Day 1 • Quality Improvement and why it matters • Improvement principles • Focussing your aim • Project charters • Developing theories for change • Leading local change

3. Day 2 • Developing change ideas using diagnostic tools • Prioritising change ideas • Introduction to measurement • Using the Plan-Do-Study-Act framework to plan a test of change

4. Developing change ideas using diagnostic tools • Process mapping • Service user feedback • Brainstorming frameworks

5. Developing change ideas using process mapping • By the end of this session you will be able to: • demonstrate how to use process mapping to generate, capture and use others’ ideas and apply them to improvement work • apply process mapping principles to identify potential ideas for change in your system.

6. System of Profound Knowledge Deming 2000

7. Lean principles • Specify value • Map the value stream • Make the value flow • Pull • Eliminate waste.

8. Waste • Transportation • Inventory • Movement • Waiting • Overproduction • Overprocessing • Defects. Staff

9. Making a cup of tea

10. High level process map: a patient journey

11. Value adding activities • Does the service user experience it? • Do they want it to happen? • Would they care if you changed it?

12. Mid-level process map

13. Detailed process map

16. Portering process • Which steps in the process do not add value? • What kind of wastes are there? • Which steps would you want to eliminate? • Which steps could you speed up? • Would a change in sequence help? • What change ideas would you try?

17. Portering change ideas ? Capacity and demand Resource management ? Increase Porter productivity (time spent on jobs despatched) to 70% by end September 2016 Porter morale ? Process Dispatch time ? Pick up time

18. Project work • What processes in your system may have steps that do not add value for your service users? • Start mapping the high level process or pathway that your service users experience. • Who do you need to work with you on this? (in your immediate team and others)

19. Process mapping: summary • 5 Lean principles • Wastes • Conventions: process steps, decision points • Value from the perspective of service users • Collaborative process: current state to future state • High level to detail

20. Developing Change Ideas using Service User Feedback • By the end of this session you will be able to: • Demonstrate how to use service-user feedback to generate, capture and use others’ ideas and apply them to improvement work • Collect and analyse service-user feedback to identify potential ideas for change in your system.

21. Service User Feedback

22. Project Work: Service User Feedback • Who would you ask? • Would you use a paper form or another method of collecting feedback? • How would you develop your questions? Who should be involved? • What kind of questions would you ask? • How would you engage service users to provide this data?

23. Service User Feedback: Summary • Why • What • How • When • Who

24. Developing change ideas using brainstorming frameworks • By the end of this session you will be able to: • demonstrate how to use a range of brainstorming frameworks to generate, capture and use others’ ideas and apply them to improvement work • apply a number of brainstorming frameworks to identify potential ideas for change in your system.

25. Brainstorming Principles Logistics Frameworks • Forcefield Analysis • Human factors • Driver Diagram

26. Brainstorming Principles of Idea Collection

27. Brainstorming Logistics

28. Forcefield analysis Present state Desired state Lewin 1943/1997

29. Human Factors and Ergonomics Aim: to optimize human well-being and overall system performance Encompasses: • Design • Engineering • Psychology • Organisational Management (including quality) • Human Sciences (anatomy, physiology, biomechanics, anthropometry)

30. System of Profound Knowledge Deming 2000

31. Applying an HFE framework Who How When Why What Where Activity People Environment

32. Aim: promote staff wellbeing Aim 1 Driver 2 Driver Change ideas ? Promote the physical, mental and emotional wellbeing of staff. By March 2017: (1) reduce staff absences from 5.2% to 4.2% (2) reduce staff related incidents from 140 to 100 per month. Environment ? A workplace that is safe for staff ? Activity ? People Staff engaged in health and wellbeing practices

33. Project work: Applying an HFE framework Who How When Why What Where Activity People Environment

34. Human Factors and Ergonomics “Human Factors is the scientific discipline concerned with the understanding of inter-actions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance” International Ergonomics Association “Making it easy to do the right thing” Bromiley M. 2011

35. Driver diagram Aim 1 Driver 2 Driver Change ideas A new healthier me! Lose 7 pounds by end July 2015 Cook evening meals from scratch Calories in meals Reduce portion size Calories in Calories in snacks Keep to shopping list Calories in drinks Replace biscuits/cakes with fruit Max 1 x juice or soft drink per day Calories in alcohol No alcohol Monday to Thursday Calories out Get up from desk to talk, instead of phone or email Work activity Use stairs not lift Leisure activity Walk to a daily step target Swim at least twice a week

36. Organising theories for improvement Aim Change ideas Primary Drivers Secondary Drivers A network of factors that drive the outcome/ aim The changes or proposed interventions that can be tested out to achieve the secondary drivers Secondary factors which will influence delivery of the primary drivers Aim statement: A general description of the desired improvement. (what, how much, by when)

37. Project work: change ideas Use the ‘driver diagram’ approach to generate some change ideas. ? ?

38. Brainstorming frameworks: summary • Brainstorming principles and logistics • Frameworks • Forcefield analysis • Human Factors and Ergonomics • Driver diagram

39. Prioritisation • By the end of this session you will be able to: • use a 2 x 2 matrix (eg Difficulty vs Impact) to prioritise change ideas or drivers • Identify opportunities to use Pareto charts, and analyse Pareto charts to generate and prioritise change ideas.

40. System of Profound Knowledge Deming 2000

41. Prioritisation • Impact/difficulty matrix • Pareto chart

42. Prioritisation Impact/difficulty matrix Pareto chart

43. Matrix: impact vs difficulty

44. New, healthier me! Reduce portion size Swim twice / week No alcohol Mon – Thurs Keep to shopping list Cook from scratch 1 soft drink / day Increase steps Replace biscuits with fruit Use stairs at work

45. Matrix: impact vs difficulty

46. Prioritisation Impact/difficulty matrix Pareto chart

47. What is a Pareto chart? 80:20

48. When to use a Pareto chart • When you can categorise items that have the potential to contribute to the improvement you are considering • When you want to analyse data about the frequency of problems

49. Access to primary care

50. Primary care practice X: reasons given by patients for not attending