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Clearing the barriers to improvement

Clearing the barriers to improvement. Mandy Smith & Liz Smith Quality Improvement Facilitators Taking Action to Improve Quality Birmingham 25 th March 2014. Achieving successful change requires . . Promoting the vision.

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Clearing the barriers to improvement

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  1. Clearing the barriers to improvement Mandy Smith & Liz Smith Quality Improvement Facilitators Taking Action to Improve Quality Birmingham 25th March 2014

  2. Achieving successful change requires . .

  3. 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?

  4. 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

  5. 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

  6. 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.

  7. 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?

  8. Maximising incentives • Incentives fall into two main categories: • Incentives for organisations • Incentives for healthcare professionals • acknowledgement • professional pride • motivation • outcomes • satisfaction

  9. Maximising incentives • For organisations: • reputation and publicity • high –level assurance • evidence for commissioners • service improvement and development

  10. Maximising incentives For healthcare professionals: • professional pride and reputation • personal development, revalidation • reduction in complaints • improved services

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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.

  16. 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 • .....................!

  17. 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

  18. 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

  19. 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

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