Crossing the chasm(s):A single approach to quality in Wales

29th November 2018

Public Board meeting

• Focus on the quality cycle in six key areas:o Safer medicines management

o Frail elderly care

o Equitable health and social care services

o Surgery and surgical pathways

o Managing acute illness

o End of life care

A Healthier Wales

• Transformation

• Spread and Scale

• Capability building

• The quality cycle in six key areas:o Safer medicines management

o Frail elderly care

o Equitable health and social care services

o Surgery and surgical pathways

o Managing acute illness

o End of life care

A Healthier Wales – the Quality agenda

• Why are we still discussing scale and spread?

• QI is old fashionedo Current focus on programmes, no coherent whole

o Current multiple delivery approaches / mechanisms (Breakthrough Series Collaboratives, Learning sets, Communities of Practice, Advisory Groups)

o Improving Quality Together isn’t sufficiently well aligned to programmes

o IQT is too narrow in focus

Context – something different

Context

We’ve evolved over many years with many sub-brands to consider

Context

We’ve evolved over many years with many sub-brands to consider

Internally

Uniting us in a flexible and cohesive way in PHW and as a directorate team

Why Rebrand 1000 Lives Improvement?

Our brand has both an internal and external role:

ExternallyDifferentiating us in a credible and engaging way, with a clear value for our target audiences

Rebranding 1000 Lives Improvement

Science of

improvement

knowledge

Subject

Matter knowledge

Improvement

Juran Trilogy:

• Quality Planning

• Quality Improvement

• Quality Control

The Quality Cycle

“Ideas and products and messages and behaviours spread just like viruses do”

Malcolm Gladwell, The Tipping point

neutral staff (P)

potential innovators

(S)

staff willing to be inno-vators (I)

spread of innovation through an organisation

experienced innovators (R)

share experiences

interact with I and R

+ interventions+ impact

These individuals are capable of generating the desired results.

neutral staff (P)

potential innovators

(S)

staff willing to be inno-vators (I)

frustrated drop-outs (D)

spread of innovation through an organisation

indifferent staff (V)

poorly informed staff (Q)

experienced innovators (R)

share experiences

interact with I and R

+ interventions+ impact

disappointment at early stages of applying knowledge

insight produces change of behavior and hence resultsSupport process!!!

These individuals are capable of generating the desired results.

forgetting process combined with building up ignorance

Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile

• Innovators and Early adopters ♥ scarcity

• They want what others don’t or can’t have

• Early/ late majority ♥ social proof

• They want what others have or are talking about

Note: Early adopters have a vested interest in Early majority not adopting the innovation as it takes away from their scarcity needs

Diffusion of improvement and innovation

Scarcity Social Proof

Creator

Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile

Scarcity

Technologist Visionary Pragmatist Conservative Skeptic

Critic/ collector Joiner/ spectator Inactive

Psychographic profile

Social Technographic profile

Social Proof

• Innovators and Early adopters ♥ scarcity

• They want what others don’t or can’t have

• Early/ late majority ♥ social proof

• They want what others have or are talking about

Diffusion of improvement and innovation

Ch

asm

Moore 1991Gladwell 2000

Creator

Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile

Technologist Visionary Pragmatist Conservative Skeptic

Critic/ collector Joiner/ spectator Inactive

Psychographic profile

Social Technographic profile

Scarcity Social Proof

Note: Interesting intersection at around 15% where:

Creators are faced with Critics

Visionaries are faced with Pragmatists

• Early majority are not keen on the language and excitement of the Early adopters. They are pragmatists who communicate with their own.

Diffusion of improvement and innovation

Ch

asm

Moore 1991Gladwell 2000

Creator

Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile

Technologist Visionary Pragmatist Conservative Skeptic

Critic/ collector Joiner/ spectator Inactive

Psychographic profile

Social Technographic profile

Scarcity Social ProofMaloney’s 16% rule:

Once you have reached 16% adoption of any innovation, you must change your messaging and media strategy from one based on scarcity to one based on social proof in order to accelerate through the chasm to the tipping point

A new view of improvement and innovation

Ch

asm Ch

asm

A new view of improvement and innovation

Creator

Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile

Technologist Visionary Pragmatist Conservative Skeptic

Critic/ collector Joiner/ spectator Inactive

Psychographic profile

Social Technographic profile

Chasm

• Creativity• Improvement Science• Measurement• Communications• Psychological Safety• Leadership

Ch

asm Ch

asm

A new view of improvement and innovation

Creator

Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile

Technologist Visionary Pragmatist Conservative Skeptic

Critic/ collector Joiner/ spectator Inactive

Psychographic profile

Social Technographic profile

Chasm

• Leadership• Improvement Science• Spread and Scale Methods • Measurement• Communications• Celebrating Success

Enabling

Excellence in

Health and Social

Care

Improvement

capability

Delivery framework

Dosed IQTTraining Packages – QI,

Measurement, Lean, SDM, IA,

leadership, behaviour change

Horizon scanning / thought leadership

Spread and Scale: 10, 100, 1000

Framework of Quality

Measurement system

Hubs

Networks – Q, Nodes, Faculty

Collaboration

• IQT as part of a suite of improvement science training, complemented by additional advanced moduleso Lean

o Leadership

o Coaching

• Leadership support

• Measurement support

• Support for national networkso Q Network

o Nodes out in each hub

A focus on Capability building

AP – Action PeriodLS – Learning session

LS1 LS2 LS3

AP1 AP2 AP3

P

S

DA

P

S

DA

P

S

DA

Select Topic

IDEATION / LEARNING CYCLE

• Problem definition / Charter

• Research / scanning

• Concept development / theory building & validation

• Case for change / summary report

Quality Planning:• Health boards & trusts• Welsh Government &

stakeholders• International

Quality Improvement

DEVELOPMENT / TESTING CYCLE

• Prototyping• Demonstration• Proof of concept• Define testing unit• Identify sites• Conduct testing

with ongoing feedback

• Consolidate learning

• Updated theory of change

Develop further

TESTING & REVISION

• Data support• Improvement

capability• Leadership

support• Peer network• Faculty leads• Further develop

framework & change package

Innovators

Overcoming Chasm

One & Early

Adopters

Recruit teams

& leaders

Quality Control

Spread to

Late

Majority &

overcoming

Chasm Two

QI experts – Hubs, Q,

nodes & Faculty

Straight to market

Mainstay:• Resource – QI programme team• Pace and timeframe

Spread and scale

10 days 100 days

1000 days

Measurable Impact

Measurement Strategy

Communications StrategyFail

Collaborative

• Need to be the QI in the Quality Framework

• Need to focus on scale and spread

• Need to build capability• Our USP is having the capability to

enable transformation to be scalable

• The ‘what’ then doesn’t matter

The “how” needs to change

• We need to change how we plan, deliver and resource programmes.

• We need to go slower, to go quicker.

• We need all our programmes to be system-level and focused on QI.

• We need all our programmes to follow a standardised delivery framework for spread.

• We need all our programmes to be time-limited.

What this means for quality in health and social care