Quality Improvement Development for NHSScotland Organisational Development Leads

1. Quality Improvement Development for NHSScotland Organisational Development Leads Workshop 4 Sustainability for QI Creativity – new ways of thinking

2. Agenda • Sustainability for QI projects • Creative thinking

3. Objectives • Understand the key elements of sustainability • Learn process for innovation • Learn some tools for creative thinking

4. What is sustainability ? ‘…maintaining the gains and evolving as required…definitely not going back to the old way’ ‘…when new ways of working and improved outcomes become the norm…’ ‘to keep something going over time and continuously…’

5. Evidence for sustainability • 33% of improvement projects had reverted to their previous way of working after a year • 33% had maintained the improvement but it had not been adopted by others in the organisation • 33% had maintained the gain and there was evidence of adoption outside of the core change area Data from NHSI 2010

6. Key considerations Spread Effort Change adoption Winners Losers Leadership Influence

7. Sustainability and project stage

8. Questions for sustainability

9. Sustainability model Monitoring progress Benefits beyond helping patients Training & Involvement Infrastructure Behaviours Leadership Fit with goals & culture

10. Innovation • Effective innovation requires a systematic process? • Think of a new idea for delivery of healthcare • …that will improve the patient experience • …in waiting rooms.

11. IDEO • http://www.youtube.com/watch?v=M66ZU2PCIcM

12. Act Plan Study Do Process for innovation Act on it Define the problem/ situation Create new ideas Select best option(s) Stretch the idea

13. Define the problem • Are we solving the right problem? Broader Problem Why do I want to solve this problem? Original Problem What is stopping me solving this problem? Narrower Problem

14. Broader problem Need for better patient care Narrower problem Find time Adaptive procedures Narrower problem Better time management Overcome cynicism Define the problem Why do I want to solve this problem? Need for improved level service Broader problem Need for improved productivity What is stopping me solving this problem? Morale affects productivity Original problem Low staff morale Insufficient time Procedures too rigid Too much work Staff cynicism

15. Problem hierarchy explorer • 10 minutes • Poor communication

16. De Bono’s Mental Valleys • Separation in:- • Time • Space • Conditions • Fresh eyes Adapted from HM Government Department for business innovation and skills

17. Ideas funnel £ ££s £££s ££££s 1 Idea launched 5 ideas developed 2 ideas tested 10 ideas selected 100 ideas generated Time

18. Tools for creativity • Reverse brainstorming • Fresh eyes • SCAMPER • 9-windows resources • De Bono’s 6 hats Also: • Knowbrainer • TRIZ contradiction matrix

19. 1. Reverse brainstorming • Clearly identify the problem or challenge • Reverse the problem or challenge by asking:"How could I possibly cause the problem?", or"How could I possibly achieve the opposite effect?". • Brainstorm the reverse problem to generate reverse solution ideas. • Now reverse these into solution ideas for the original problem or challenge. • Evaluate these solution ideas. Can you see a potential solution? Can you see attributes of a potential solution?

20. 2. Fresh eyes Patient? Colleague, spouse? Age 5, 10? Airline? Bank?

21. 3. SCAMPER • S – Substitute – components, materials, people • C – Combine – mix, combine with other assemblies or services, integrate • A – Adapt – alter, change function, use part of another element • M – Modify – increase or reduce in scale, change shape, modify attributes (e.g. colour) • P – Put to another use • E – Eliminate – remove elements, simplify, reduce to core functionality • R – Reverse – turn inside out or upside down, or use Reversal

22. 4. Resources • Substance – material (equipment, materials, software, waste) within the system or system’s surrounding • People – within and around system • Financial - (budgets, grants, funding) • Information – tacit and explicit knowledge, Intellectual Capital, other sources e.g. books, internet • Energy Resources – sources of energy available within the system or system’s surrounding, which are not used fully • Space Resources – any unused space • Time Resources – any spare time slots in between, before or after technological processes

23. Resources - example • Making use of unused space • Unexpected skills in the team • Making use of what would otherwise be waste • Allocation of unused time, e.g. patients waiting ?

24. Tangible resources Tangible Resources (people, materials, equipment) PAST PRESENT FUTURE Around system e.g. External System e.g. Company Within system e.g. Team

25. Intangible resources Intangible Resources (information, energy, space, time) PAST PRESENT FUTURE Around system e.g. External System e.g. Company Within system e.g. Team

26. 5. De Bono’s 6 Hats From Edward De Bono – Six Thinking Hats 1985 / 1999

27. Exercise • 2 minutes big picture (blue hat) • 2 minutes positive (yellow hat) • 2 minutes negatives (black hat) • 2 minutes to expand idea (green hat) • 2 minutes feelings (red hat)

28. Triz contradiction matrix

29. Knowbrainer Innovation Tool • Investigate needs • Create ideas • Evaluate solutions • Activate plans From Solutionpeople

30. Tools for selection • By criteria • By dot voting • By matrix selection

31. Tools for selection • By criteria • By dot voting • By matrix selection Easy Difficult High impact Low impact

32. Start here Don’t start here X Current Situation Ideal Final Result Intermediate solutions Tools for stretching ideaIdeal Final Result

33. Tools for stretching idea7 dimensions of performance • Safety • Absence of errors • Prevention of harm • Conformance to standards • Reliability • Effectiveness • Clinical outcomes • Improved quality of life • Free from complications • Timeliness • Waiting time • Time to treatment • Time to complete a task • Efficiency • Cost • Use of resources • Equity • Cultural sensitivity • Greater access and availability • Co-ordination (across all system) • Flow across system/journey • Integration of care plans • Shared information • Patient-centredness • Ease of use • Convenience • Portability • Choice • Ease of understanding • Engagement/involvement in care • Self-management • Fit to needs • Experience of care

34. Act Plan Study Do Process for innovation Act on it Define the problem/ situation Create new ideas Select best option(s) Stretch the idea

35. PDSAs for Quality Improvement Implementing new procedures & systems – sustaining change Ideal Final Result Testing and refining systems Accumulating information and knowledge Good idea

36. Innovation and project stage

37. Resources • Thinking Differently (NHS Institute) • Making a Bigger Difference (NHS Institute) • ‘Creativity, Innovation, and Quality’ Quality Press by Paul Plsek • The 7 Levels of Change: Different Thinking for Different Results by Rolf Smith • www.directedcreativity.com • www.solutionpeople.com