Welcome & introductions

© 2013 AQuA

House keeping

AgendaTIME AGENDA ITEM CONTENT SPEAKER08.30 Registration & coffee  09:00 Welcome & Housekeeping   Andrea

McGuinness09:45 Programme Introduction Faculty, overview,

completion of pre assessments

Andrea McGuinness

10.45 BREAK  11.00 Quality Improvement Tools Aim setting, driver

diagrams, project charters

Jodie WhittleBernie O’Hare

12.30 LUNCH  13.00 Sustainability & Spread NHS Sustainability

Model, spread concepts

Helen Baxter

14.30 Break  14.45 Sustainability & Spread cont    

16.00 Summary of the day Homework & Evaluation  16.30 CLOSE  

Session aims1. All attendees & core faculty to meet

2. Confirmation of programme delivery

3. Clarification of programme aims & objectives

4. Review core Quality Improvement

5. Opportunity to review & discuss skills assessments & how this will be reviewed during programme

6. Agreed expectations & commitments (compact)

7. Safety culture questionnaire referenced

8. Safety Culture tool discussed

9. Safety Culture tool contextualized into programme objectives & project objectives

Programme Objectives

• To support your team to develop a shared purpose and vision for safety• To support your team to deliver a successful safety improvement project• To create an opportunity for teams to learn together in a safe and

stimulating environment • To provide an expert faculty that offers education, information, innovation

and opportunity for teams to challenge and be challenged around safety improvement

• To utilise best practice, critical thinking and current knowledge to support teams and individuals to stretch and develop their safety and quality improvement capabilities

• To identify prior knowledge and skills for teams and individuals, to improve this and the ability to apply it within their roles.

© 2013 AQuA

Overview

© 2013 AQuA

Kirkpatrick New World

Project assessment

Toolkit & workbooks

When you see this sign a tool or template is

available to help you

© 2013 AQuA

Faculty

• AQuA–Jodie–Bernie–Clare–Andrea

• External experts/guest speakers

© 2013 AQuA

Support

• Phone calls• Visits• WebEx

Our rules

Dialogue; the art

of thinking

together!

Getting to know you

• Take a pen & piece of paper• 5 mins to draw a pig• If you have done this before you have 2

options…– Cheat – Don’t cheat!

Feedback

Compacts

Using compacts• Reciprocal agreement• More than a wish list but less than a contract!• It is both an agreed document and a way of

working together for mutual advantage• It achieves better outcomes for people and

communities• It establishes clear rules of engagement• It provides standards for fair and meaningful

consultation

Benefits of a compact

• It advances equality and gives our work a stronger voice

• It aids embedding and developing good practice• It is an agreement that guides and improves

relationships• It is a framework for better partnership working• It is a commitment to work more closely together

so that groups are properly involved

AQuA Compact

• Respect for all opinions & perspectives• No secrets for safety• Core team continuity• Programme delivery as planned• Toolkits & templates made available• Support application of learning to safety project• Show, teach try approach• Additional support alongside workshops• Slides on Portal• Support to drive safety improvement projects• Utilise your evaluation & feedback to improve our

programme

Attendees• Respect all opinions & perspectives• Attend at all sessions• Participate in discussions & activities• Apply learning to safety project• Attend/join on prearranged calls or WebEx

sessions• Evaluate & feedback to AQuA (2 sides

today!)• No secrets for safety

Write your own compacts

• In teams agree your own team compacts• Identify how you will share this within your

organisation

Compact agreement

Feedback

Patient Safety Culture Assessment Tool

• Why• What• When • Where• How

Patient Safety Culture Survey

•Raise staff awareness about patient safety.

•Diagnose and assess the current status of patient safety culture.

•Identify strengths and areas for patient safety culture improvement.

•Examine trends in patient safety culture change over time.

•Evaluate the cultural impact of patient safety initiatives and interventions.

•Conduct internal and external comparisons.

Feedback

Break

Quality Improvement Methodology Basics

A P

DS

Plan

DoStudy

Act

AIM: What are we trying to accomplish?

MEASURES: How will we know if achange is an improvement?

CHANGE: What changes can we makethat will result in improvement?

Model for Improvement

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Solution V’s Problem

© 2014 AQuA

But before we start…………… do you really understand the problem??

© 2014 AQuA

Solution vs Problem

© 2014 AQuA

How do you know what needs improving?

We benchmark poorly

We’re failing our target

Patients who complain

Our Outcomes are poor

Quantitative data

Patients we interview

Qualitative data

Staff feedback

© 2014 AQuA

X

Why, why, why?!‘Results indicate that when preschoolers ask "why" questions, they're not merely trying to prolong conversation, they're trying to get to the bottom of things.’

© 2014 AQuA

http://www.sciencedaily.com/releases/2009/11/091113083254.htmFrazier et al. Preschoolers' Search for Explanatory Information Within Adult-Child Conversation. Child Development, 2009; 80 (6): 1592 DOI

Maps

© 2014 AQuA

Process Map

Value Stream Map

Diagrams

© 2014 AQuA

Measles / Dot

Diagram

Spaghetti

Fishbone

Analysing qualitative data

Thematic analysis: Look for

the common themes

Construct a story around typical

findings

The power of a good quote

Lack

of Tim

e

Lack

of Consis

tency

Poor Inform

ation

Delayed Treatment

Incompetence

Poor Care

0

50

100

150

200

250

0

10

20

30

40

50

60

70

80

90

100

Pareto Chart

Num

ber

%

Qualitative Data

Structuring Projects

Project Charters• A Project Charter is a tool • A clear statement of what you intend to

achieve,• How you are going to measure success • What you are going to work on to achieve

success.• A Charter is a concise outline of a project

What should a Charter include?

It should answer three questions:

1. What are we trying to accomplish?

2. How do we know that a change is an improvement?

3. What changes can we make that will lead to improvement?

Aims

Setting an Aim• What are you trying to accomplish?• How good? By when? For whom(or what

system)SafeTimelyEffectiveEfficientEquitablePatient Centred Crossing the Quality Chasm: A New Healt

h System for the 21st Century, 2001 Institute of Medicine

48

Aim StatementGood Bad Ugly

We aim to reduce harm and improve patient safety for all of our internal and external customers.

By June of 2012 we will reduce the incidence of pressure ulcers in the critical care unit by 50%.

Our outpatient testing and therapy patient satisfaction scores are in the bottom 10% of the national comparative database we use. As directed by senior management, we need to get the score above the 50th percentile by the end of the 1st Quarter of 2012.

We will reduce all types of hospital acquired infections.

According to the consultant we hired to evaluate our home health services, we need to improve the effectiveness and reliability of home visit assessments and reduce rehospitalisation rates. The board agrees, so we will work on these issues this year.

Our most recent data reveal that on the average we only reconcile the medications of 35% of our discharged inpatients. We intend to increase this average to 50% by 1/4/12 and to 75% by 31/8/12.

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Aim StatementBrief rationale.(What’s the problem? Why is it important? What are we going to do about it?)

What exactly are you trying to achieve?

For whom are you going to improve it for?

By how much will you improve it?

By when are you aiming to achieve it?

Final Aim Statement

50

Adapted from

Group Work

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Driver Diagrams

Driver Diagrams – why use them?• Breaks down any broad aim, graphically, into

increasing levels of detailed actions that must or could be done to achieve the stated aim

• Helps to focus on the cause and effect relationships that exist in complex situations.

• Well defined drivers that can form the focus of improvement efforts.

NHS Tayside 53

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AimPrimary

Outcome (Measure)

Primary Driver

Primary Driver

Primary Driver

Secondary DriverA.B.C.D.

Secondary DriverA.B.C.D.

Secondary DriverA.B.C.D.

Driver Diagram

Primary drivers are system components which will contribute to moving the primary outcome.

Secondary drivers are elements of the associated primary drivers. They can be used to create projects or change packages that will affect the primary driver.

Developing Drivers• Dedicate time for team and subject matter experts –

ask them to come prepared!• Revisit your aim statement.• Brainstorm potential Primary Drivers & check

– ’If I made an improvement in this driver what would it achieve?’

– ’If I could influence (or improve) against all of these drivers is there anything else that could go wrong and prevent me achieving my aim?’

• For each Primary, brainstorm Secondary Drivers & check

• Add relationship arrowsNHS Tayside

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© 2010 AQuA 57

Aim

A reduction in incidents of violence&

aggression by 20% in the STAR Unit

during 2012/13

Care Planning

Environment

Workforce

A. Raise awarenessB. Introduce a SU advanced statement re management of V&A.

A. Post all records (agreed actions) of the community meetings in a central area.B. Post a weekly activity programme at a central point on the ward.

A. Develop a formal process regarding the planning of social & therapeutic activities.B. Introduce a community meeting.C. Redesign role of staff member – activity co-ordinator.

Driver Diagram - STAR Unit

Primary drivers are the systems changes which will contribute to

achieving the Aim outcome measure.

Secondary drivers are interventions associated with primary drivers. They

can be used to create projects or change packages that will affect the

primary driver.

A. Review and compare data – make data easily available to staff..B. Identify specific times/places/ personnel involved in V&A. C. Provide poster for staff comments re new PDSAs.D. Provide staff with written updates re V&A to inform staff on return from days off.E. Recruit permanent staff to vacant posts.

Therapeutic

Interventions

Primary DriversSecondary Drivers

90% of patients in

Bay 1 receive their lunch of

choice everyday by 12.30 by July

2013

Know what patients want / need for lunch

Lunch & equipment

arrives on time

Ward Staff are available to give

out lunch

Patients are available to

receive lunch

Menu cards distributed

Choices recorded & communicated

Diet requirements understood

Numbers established & communicated

Time for delivery agreed

Access to ward available

Allocate lunch dutyComplete other tasks prior

to lunch arrivalStaff appropriately

trained

Schedule inpatient appts appropriately

Appropriately positioned

Maintained at appropriate temperature

Aim / Outcome Primary Drivers Secondary Drivers

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Feedback

Break

Helen Baxter

Sustainability & spread

Next steps

Today 1. Complete and return evaluations (2

sides!) please

2. Assess project against scale provided

3. Agree next contacts as a team

4. Decide support from AQuA & contact Clare to arrange this

Next session

Day 2 Tomorrow• Same venue• Same start time!