what changes do we think will result in improvement?
TRANSCRIPT
What changes do we think will result in improvement?
Mothercare Award for Maternity Service of the YearNHS Forth Valley
Philips AVENT Award for Innovation in Midwifery
Maternity telehealthSheona Brown and Dorothy FinlayNHS Greater Glasgow and Clyde
Pregnacare Award for Excellence in Maternity CareVulnerable Families Maternity TeamElaine Moore and Mary GarvenNHS Ayrshire and Arran
The RCM Award for Partnership Working Early Years Assessment TeamRebecca Wade and Linda DavidsonNHS Borders and Scottish Borders Council
The President’s Award for Supervisors of Midwives Supervisor of Midwives TeamNHS Lanarkshire and University of the West of Scotland
NMSF Award for Bereavement CareBereavement care: maintaining a gold standardFamily room organisation and updateEmma CampbellNHS Lothian
Pregnacare Award for Excellence in Maternity CareVulnerable Families Maternity TeamElaine Moore and Mary GarvenNHS Ayrshire and Arran
Scotland Johnson's Baby Mums' Midwife of the Year winner Laura Main NHS Grampian
Early Years Collaborative
Stretch Aims 1. Positive pregnancies which result in the birth of more healthy
babies by end 2015• 15% in the rates of stillbirths and infant mortality
2. 85% of all children reached all of the expected developmental milestones at the time of the child’s 27‐30 month child health review, by end‐2016
3. 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end‐2017
4. 90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021
1. Positive pregnancies which result in the birth of more healthy babies by end 2015
• 15% in the rates of stillbirths and infant mortality
2. 85% of all children reached all of the expected developmental milestones at the time of the child’s 27‐30 month child health review, by end‐2016
3. 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end‐2017
4. 90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021
Stretch Aims
• One year in…
• ‘Superior results in certain locations do not spread to other sites’ WHO/IHI
• Key Changes
Learning Session 4 January 2014
Key changes
• Develop and package interventions for optimal adoption across the EYC
• In alignment with the EYTF expectations and the agreed Single Outcome Agreements.
• Describe the relative advantage over current practice
• ‘Trialability’ and ‘Observability’
• Small pockets of activity (islands of excellence)
• Make it compelling!
Key changes
Focus
Breakthrough items
Big tickets
Concentrated effort
But don’t stop other stuff!
Activity to dateKey Changes event
Engage those not in the room
Develop a menu of key changes by work stream
Paper to EYTF December 2013
Learning session 4 – ‘Key Changes’
Activity todayYour work today – develop and refine the proposed Key Changes
Consider the evidence base
Consider your population
Apply your improvement science learning
Consider your ‘Pioneer’ sites
Share your data…
BECOMING A “PIONEER SITE” IN THIS AREA• A Pioneer Site is an area (specific geographical location,
nursery, clinic, school, community centre etc.) that has:1. The local will and interest to work on this important issue with
their community.2. Leadership support to be the CPP’s Pioneer Site for this issue. 3. Adequate resourcing to do the work required for testing in this
area.4. Some existing work in this area.5. Willingness to share their data and learning with the
Collaborative, warts and all!
Key changes
Cross cutting
Workstream 1
Workstream 2
Workstream 3
Workstream 4
Workstream 5
In 1601, James Lancaster successfully conducted an experiment to illustrate the effectiveness of lemon juice to prevent scurvy. When did the British Fleet
adopt this treatment?
1. 16022. 16893. 17574. 17965. 1865
264 years....264 years....
19
Controlling ScurvyControlling Scurvy
1601 Captain James Lancaster experimented with lemon juice to prevent scurvy
1747 James Lind, another experiment on HMS Salisbury
1795 British Navy adopts innovative prevention on all ships
1865 prevention was adopted across the British Merchant Marine
“Strong evidence for an innovation is necessary but not
sufficient to result in its adoption”
Mark Freeman, 2012, The International Journal of Management Education
Source: Based on Ryan and Gross (1943)
The “Diffusion Curve”:Reaching the Tipping Point
Number of Adopters of Hybrid Seed Corn in Two Iowa Communities
Tipping Point
Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.
Roger’s Adopter Categories
Jason’s preferences…
Roger’s Adoption Attributes
““Up to 70% of improvement Up to 70% of improvement projects never spread”projects never spread”
Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable Company. MIT Sloan Management Review 2012;
53(4): 43-50.
With thanks to Carol Haraden
1. Start with a large pilot
2. Find one person to do it all
3. Be assured…vigilance and hard work will solve the problems
4. Do one small test and then spread everywhere
????
????
5. Get the pilot team to spread the improvement system-wide
6. Only look at the process/quality measures on a quarterly basis (or less frequently)
7. Expect marked improvement in outcomes early on without attention
to process reliability
Memo issued to all staffMust do this!
Memo clearly worked – job done!
Testing and Implementing a Change Idea
What factors What factors influence the influence the
decision?decision?
BELIEF
Low degree of belief
that change idea will lead
to improvement
High degree High degree of beliefof belief
that change idea will lead
to improvement
Current commitment commitment within organisationNoNo
commitmentcommitmentSome Some
commitmentcommitmentStrong Strong
commitmentcommitment
COST OF FAILURE
Cost of failure largelarge
Cost of failure smallsmall
Cost of failure largelarge
Cost of failure smallsmall
Very small scale Very small scale testtest
Very small scale Very small scale testtest
Small scale testSmall scale test
Very small scale Very small scale testtest
Very small scale Very small scale testtest
Very small scale Very small scale testtest
Small scale testSmall scale test
Large scale testLarge scale testSmall scale testSmall scale test
Very small scale Very small scale testtest
ImplementImplementLarge scale testLarge scale test
Testing and Implementing a Change Idea
@jasonleitch