Post on 22-Aug-2020
Model for Improvement
By the end of this session you should
be able to…
• understand why Community Planning Aberdeen is using the Model for Improvement
• use the Model for Improvement
• apply core tools and techniques to your improvement projects
• access further reference materials and training
• get started on an improvement project!
Context for today
The thinking
part…
Model for Improvement
The doing
part…
The Model for Improvement:
the thinking part
If you don’t answer the 3 thinking questions before you start your improvement project – be prepared to fail!
The doing part: testing
Plan: How will we ‘test’
doing something differently?
Do: Let’s try!
Study: Did it work?
Act: What’s next?
All improvement requires change, but not all change is an improvement.
DESIGN DESIGN DESIGN DESIGN APPROVE
The Typical Approach
IMPLEMENT
In the real
world
Around
the table
DESIGN
TEST & MODIFY
TEST & MODIFY
APPROVEIF NECESSARY
TEST & MODIFY
Quality Improvement Approach
START TO IMPLEMENT
Around
the table
In the real
world
• Project charter
• Driver diagram
• Run charts
Quality Improvement Tools
Getting started
Why are you improving?
• Rationale for change
• Involving your stakeholders
• Understanding your system
Insanity is doing the same thing over and over again and expecting different results –Albert Einstein
Improvement Project Team
• Sponsor
• Project Manager
• Subject Matter
Expert
• Improvement
Advisor/Coach
• Data Manager
• Practitioner
• Customer/ client
(Not necessarily
different people)
The Model for Improvement
What are you trying to achieve?
Aim statement
• What?
• How much?
• By when?
• Target group
Our improvement project
We work together in a community within
Aberdeen City.
We have recently engaged with the
community to develop the local outcome
improvement plan.
One of the priorities identified was
increasing physical activity for all age groups
in the community.
We completed a survey and only 20% of
respondents said they were doing the
recommended physical activity of 30
minutes, five times a week.
Write an aim statement
• What?
• How much?
• By when?
• Target group
Example:
What are you trying to accomplish?
Aim statement
Support and inspire
people in communities to
participate in physical
activity by providing the
right opportunities and
recognising their efforts
Aim statement
Increase by 50% the
number of people who
report undertaking 30
mins of exercise, five
times a week in Tillydrone
by October 2019
What are you trying to achieve?
Aim statement
• What?
• How much?
• By when?
• Target group
The Model for Improvement
OutcomeAssociated with the project aim
(how best the project can be
measured)
Number of people who report
undertaking 30 mins of exercise,
five times a week in Tillydrone
ProcessTo assess the key processes which
have to be happening reliably to
achieve your aim
Number of people attending the
sports centre every day
BalancingMakes sure that changes to
improve one part of the system are
not causing problems in other parts
of the system – are there any
unanticipated consequences?
Number of mental health referrals
Family of measures
Qualitative data is also valuable
e.g.
‘We really enjoy the Family Fun
activities at the sports centre
and we now exercise together
as a family every week’
Things to consider when collecting
data for your measures
Who will be responsible for
data collection?
What is the data source /
how will the data be
collected?
Frequency of data
collection and when it will be
collected
Do you need any
equipment to measure?
How can data collection be
integrated with work?
What factors might
influence the measure?
Measurement plan
Don’t get caught out with a list of measures that are never collected…
The Model for Improvement
‘Change’ can mean different things
Selecting Changes
• Fixing something or innovative change?
• Where are changes sourced from: literature, evidence, experience of others, hunches and theories
• Steal shamelessly and learn from others
• Use best practice
• Choose the changes you think will have the biggest impact
• Avoid low impact changes
Selecting changes
Example:
Aim: Increase by 50% the number of people who report undertaking 30 mins of exercise, five times a week in TillydroneOctober 2019
Change ideas?
• Better links with organisations
• Meet with partners
• Complete a survey
• Develop a communications strategy
• Study data from our survey
A Practical Need Often Drives
Creativity!
Your Project Charter
• Focus on aim
• Link to strategic priorities
• Rationale for improvement
• Measures (Baseline?)
• Change ideas
• Barriers
• Team
Driver diagrams(improvement tool)
Supports the team to explore all factors that will help achieve the aim
Helps identify measures
Provides an improvement route map or theory of change
Communication tool
Why a driver diagram?
Alignment with purpose
Individual decisions
A tool to help organise our theories and ideas during an improvement effort Langley et al. 2009, p.429
To Lose
3 stone
by end of
June
2019
Calories
In
Calories
Out
Reduce daily
calorie intake
Increase
consumption of
low calorie Foods
Alcohol reduction
Increase weekly
exercise
Track Calories Via
A Food Diary
Plan Meal Menu
For The week
Only Drink Water
For Two Weeks
Walk Dog 5 Days A
Week
Bike To Work
Attend Weekly
Weight Loss Class
Access education
& support
Secondary DriversPrimary DriversAIM Proposed Changes
The 4 Key Components of a Driver DiagramIn order to
achieve
this aim…
We need to
ensure…
Which requires… Change ideas to
ensure this happens.
Increase by
50% the
number of
people who
report
undertaking
30 mins of
exercise,
five times a
week in
Tillydrone
by October
2019
Effective
communication
approaches
Community
Engagement
Share messages about
benefits of physical activity
at all ages
Increase range and uptake
of activities available for all
ages
Weekly Family Fun activity
sessions at the community
centre
Termly ‘clean up day’ at the
park
Walking group for new
Mums
S6 pupils run weekly
exercise sessions in the
park
Include stories about new
activities and the impact for
individuals in the
community newsletter
Develop a shared approach
between school; health
centre & community centre
Secondary DriversPrimary DriversAIM Proposed Changes
Driver Diagram
High quality
facilities and
opportunities
Partnership
Working
Improve communication
about exercise activities
Improve equipment at the
play space
Involve community
members in development of
activities
Improve volunteering
opportunities around sports
and exercise
Outcome Measure:
% of people
reporting 30 mins
of exercise, 5 times
per week
Use ‘My fitness pal’ app to
record fitness levels
Process Measure:
# of people
attending activities
each week
Your Project Charter
• Focus on aim
• Link to strategic priorities
• Rationale for improvement
• Measures (Baseline?)
• Change ideas
• Barriers
• Team
What we’ve covered so far…
• understand why Community Planning Aberdeen is using the Model for Improvement
• use the Model for Improvement
• apply core tools and techniques to your improvement projects
• access further reference materials and training
• get started on an improvement project!
The thinking
part…
Model for Improvement
The doing
part…
Testing a change using PDSA
• A structured approach for making small incremental changes to systems
• A full cycle for planning, implementing, testing and identifying further changes
• A common sense, easy to understand tool for bringing about change
• A tool which can reduce anxiety to change
The doing part: testing!
P
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P
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A
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A
Change:
New Mums’
Walking Group
Change:
Family Fun
Activities
Change:
Stories in the
Newsletter
Iteration
1
2
3
4
PDSA RampsAIM: Increase by 50% the number of people by who report undertaking 30 mins of exercise, five
times a week in Tillydrone by October
The Paper Aeroplane
Challenge
Aim: To create a paper aeroplane that flies
the length of the room by pm.
The Paper Aeroplane Challenge
PLAN DO STUDY ACT
Cycle Aim of test Theory/ plan Predict
length
of flight
Actual
length
of flight
Observations What we will do next
time
Cycle1
EXAMPLE
Discover how
far a short
winged aircraft
can fly
Short wings will ensure
a straight flight path
4
strides
Cycle 2
Cycle 3
Paper Aeroplane: PDSA Recording
Recording: Outcome data
• Consistency of purpose
• Prediction, Planning & Documentation enables learning… and reliable implementation if your test is a success.
• Learning from Failure – one test (PDSA) leads to another until you learn how to succeed or abandon the idea!
• Sharing and Stealing from others can help
The Paper Aeroplane Challenge – key
learning points
Scaling up and
spread
Testing ideas on a small scale
Collecting and using
data to understand
impact
Recording your data
What's wrong with this picture?
Moving forward without data or the information we need is like driving with your eyes closed
Without data, you're just another person with an opinion. – W. Edwards Deming
• With data we can measure the impact of what we are doing
• With data we know if our changes are leading to improvement
• With data we can decide whether to adopt, adapt or abandon
The dangers of going in blind?
• Traditional performance management often focuses on measures gathered at specific points in time.
• This can limit our ability to understand our changes while we are making them.
• One of the most useful benefits of measuring data for improvement is that we gather data and use it in real-time.
• A run chart is one of the best tools to determine if what we are doing is having the impact we want.
How do we analyse data variation for
quality improvement?
Run charts – an improvement tool
Number of Families attending Family Fun Activity Class
School holiday
Horizontal Axis
Ver
tica
l Axi
s
Median
0
2
4
6
8
10
12
14
16Number of Serious Assaults
Improvement?
April 2014 April 2015
Nu
mb
er
of
se
rio
us
as
sa
ult
s r
ep
ort
ed
Number of serious assaults reported
Run charts – an improvement tool
APRIL 2014
↑
‘When you have two data
points, it is
very likely that one will
be different from
the other.’ Deming
↑ APRIL 2015
• Run chart rules help us identify changes that are beyond just the normal variation we would expect as part of a process or system.
• When we use run charts we are looking for changes or trends – we call this a “special cause.”
• Applying Run Chart Rules helps us to interpret the variation in our data and the impact of changes.
• By applying these rules we can carry out analysis and answer the question:
“How will we know if a change is an improvement”
Interpreting Our Data: Understanding
Variation
Interpreting the Data: Three Rules for
Run ChartsA shift: 6 or more
points above or
below the centre
line
A trend: 5 or
more points up
or down
An astronomical
data point
• These rules help us to identify trends and understand variation in our data.
Annotations – telling your story:
• Adding annotations highlights key events, tests or changes carried out.
• Annotations add more information and tell us when key actions carried out or changes were made.
Creating a Run Chart: No. people attending the walking group each month
Plotting Your Chart:
1. Label Vertical scale – Number of people
2. Label Horizontal scale – Month
3. Plot the data points
MonthNumber of people Annotation
Jan 16 75 Start of Annual Programme Feb 16 77Mar 16 87 Free fruit offered
Apr 16 87
May 16 89
Jun 16 95Jul 16 88Aug 16 8 Storm Sally hit Aberdeen Sep 16 83Oct 16 84
Nov 16 80Attended parents evening to publicise programme
Dec 16 83Jan 17 79Feb 17 90 Springwatch guided walkMar 17 94Apr 17 97May 17 98
Plotting Your Chart:
4. Now calculate and place a median or middle line.
The median is the middle number. ... To find the median number: Put all the numbers in numerical order smallest to largest. If there is an odd number of results, the median is the middle number. If there is an even number of results, the median will be the average of the two central numbers.
An example with our walking group attendance data:
8 75 77 79 80 83 83 84 87 87 88 89 90 94 95 97 98
Median
Your finished chart:
NUMBER OF PEOPLE ATTENDING WALKING GROUP
0
10
20
30
40
50
60
70
80
90
100
Number of people
Start of
Annual
Programme
Free fruit
offered
Storm
Sally hits
Aberdeen
Attended
parents
evening to
advertise
programme
Springwatch
guided walk
Month
Interpreting your chart: Rules for Run
ChartsA shift: 6 or more
points above or
below the centre
line
A Trend: 5 or
more points up
or down
An astronomical
data point
• Take a few minutes on your tables to look for any variation in the graph you have created.
• The rules help us identify changes which are beyond just normal variation.
Interpreting Run Charts: Trend
0
10
20
30
40
50
60
70
80
90
100
Number of people
0
10
20
30
40
50
60
70
80
90
100Number of people
Interpreting Run Charts: Astronomical Data Point
Astronomical point – An unusually small or large number in the data –Significantly different to the other values and should be discussed by the team.
Remember: Every data set will have a high and a low - this does not mean the high or low are necessarily astronomical
Start of Annual
Programme
Free fruit
offered
Storm Sally
hits Aberdeen
Attended parents
evening to
advertise
programme
Springwatch
guided walk
0
10
20
30
40
50
60
70
80
90
100
Number of people
Interpreting Run Charts: Shift
Shift – 6 or more consecutive points either all above or all below the median line. Exclude values on the median line.
In this example you may not identify a shift as the project team would probably decide to ignore the storm/astronomical data point.
Start of Annual
Programme
Free fruit
offered
Storm Sally
hits Aberdeen
Attended parents
evening to
advertise
programme
Springwatch
guided walk
• Run charts are a very useful tool for tracking improvement over the course of a project - you now have practical experience.
• Using Run Charts helps you understand the variation in your data and the impact of changes.
• One of the most useful benefits of measuring data for improvement is that we gather data in real-time and react to it.
• Collecting data is crucial - without data we are “driving blind.” We need data to inform decision making and to evidence that what we are doing is worthwhile or showing improvement.
Collecting and using data summary
Reporting for improvement
Improvement Tracking
Further resources
http://communityplanningaberdeen.org.uk/
communityplanning@aberdeencity.gov.uk
Other learning opportunities:
Monthly Project Surgery
Quality Improvement Practitioner
Programme
https://khub.net/group/community-planning-
aberdeen-improvement-practitioners-
network
What we’ve covered today
• understand why Community Planning Aberdeen is using the Model for Improvement
• use the Model for Improvement
• apply core tools and techniques to your improvement projects
• access further reference materials and training
• get started on an improvement project!