www.hqip.org.uk quality improvement tools kate godfrey national lead for quality improvement and...
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www.hqip.org.uk
Quality Improvement ToolsKate GodfreyNational Lead for Quality ImprovementAnd Development
The one constant you can rely on…….
Leading Change• Communicate the vision and
share all possible information as widely as possible
• Involve those affected by the change in planning and implementing
• Encourage people to air their feelings / ask for advice
• Explain the impact of change on individuals not the organisation
• Be honest about the benefits and challenges change will bring
• Celebrate milestones large and small
Facilitating Change• Understand the goals of the
meeting and the organisation• Keep the group focussed on the
agenda and moving forward• Involve everyone in the
meeting, including drawing out the quiet participants and controlling the domineering ones
• Make sure that decisions are made democratically
Two tools for making group decisions
Driver Diagrams
• Driver diagrams help to break down an overall improvement goal into underpinning goals -
‘drivers’
• This allows you to easily define the changes that you need to undertake
• Driver diagrams are structured charts with three or more levels
Driver Diagrams
1. The improvement goal is the desired outcome determined from the audit findings
2. The primary drivers are the high-level factors that you need to influence in order to achieve this aim
3. The secondary drivers are the specific activities that influence these factors
Improve the outcome for people following stroke
First hours bundleRapid recognition tool e.g. ROSIERConfirmation of diagnosisStart aspirin
First day bundleCT scanAdmission to co-located bedsSwallow screen
First 3 days bundle
36h continuous monitoringManual handling assessmentNutritional assessmentPhysiotherapy assessment
First 7 days bundle
OT assessment commencedMDT goal setting meetingInformation sharing with patients/carers
Reduce the number of episodes of avoidable harm
Interventions identified by the Global Trigger Tool analysis
The improvement goal is set by agreement after reviewing the audit findings
Improve the outcome for people following stroke
First hours bundleRapid recognition tool e.g. ROSIERConfirmation of diagnosisStart aspirin
First day bundleCT scanAdmission to co-located bedsSwallow screen
First 3 days bundle
36h continuous monitoringManual handling assessmentNutritional assessmentPhysiotherapy assessment
First 7 days bundle
OT assessment commencedMDT goal setting meetingInformation sharing with patients/carers
Reduce the number of episodes of avoidable harm
Interventions identified by the Global Trigger Tool analysis
Primary drivers are agreed by discussion then grouped by the audit lead or facilitator
Improve the outcome for people following stroke
First hours bundleRapid recognition tool e.g. ROSIERConfirmation of diagnosisStart aspirin
First day bundleCT scanAdmission to co-located bedsSwallow screen
First 3 days bundle
36h continuous monitoringManual handling assessmentNutritional assessmentPhysiotherapy assessment
First 7 days bundle
OT assessment commencedMDT goal setting meetingInformation sharing with patients/carers
Reduce the number of episodes of avoidable harm
Interventions identified by the Global Trigger Tool analysis
Then everyone has the chance to contribute ideas for secondary drivers
http://cccmiddlemore.co.nz
Group Work
Primary Drivers• To eat more of what
is good for me
• To eat less of what is bad for me
Secondary DriversMore fruit and vegetablesMore lean meat / vegetarian alternativesFat free / low fat alternatives
Less full fat dairyLess red meatLess biscuits and sweets
Desired Outcome: To eat a healthier Diet
Edward De Bono’s Six Thinking Hats©
thethinkingbusiness.com
White Hat:This means focussing on the data available. Looking at the information you have, and seeing what you can learn from it. It includes looking for gaps in your knowledge and either trying to fill them or taking account of them. This is where you also analyze past trends, and try to extrapolate from historical data
Green Hat: stands for creativity. This is where you can develop
creative solutions to a problem. It is an unrestrictive way of thinking, in which no idea is a bad idea.
Black Hat:means looking at all the bad points of the decision(s) and the counter balances. Look at it cautiously and defensively. Try to see why it might not work. This is important because it highlights the weak points in a plan. It allows you to eliminate them, alter them, or prepare contingency plans to counter them
Red Hat: involves looking at problems using empathy, intuition and emotion. You need to try to think how other people will react emotionally and anticipate the responses of people who do not fully know your reasoning.
Yellow Hat: helps you to think positively. It is the optimistic viewpoint that helps you to see all the benefits of the decision and the value in it. Yellow Hat thinking helps you to keep going when everything looks gloomy and difficult and also helps you to catalogue the benefits to share with your teams
Blue Hat: stands for process control. This is worn by the facilitator or chair throughout the meeting. For example, when running into difficulties because ideas aren’t forthcoming, they may direct activity into Green Hat thinking. When contingency plans are needed, they should switch to Black Hat thinking.
Group Work
Moving Home– White Hat – What information do you need?– Black Hat – What is the down side of moving?– Red Hat – How do you feel about moving? What
emotions may be stirred up in the family during the process?
– Yellow Hat – What are the good things about moving home?
– Green Hat – What is the best and most creative solution to the problems identified?
Strategies for change
STRATEGY A• Form the committee of
experts• Spend at least 6 months
and many hours developing the perfect solution
• Educate all the staff over 2-3 days
• Implement house-wide tomorrow
• Look for it in 12 months!
STRATEGY B• Use front-line knowledge• 1 doc, 1 nurse, 1patient,
one PDSA• Reassess and learn from
initial test• Repeat, progressively
increasing confidence in solution then….
• Test under varying conditions before….SPREAD
Using the PDSA cycle
A rapid change cycle used to test and develop an idea:
Define the question Gather information and resources (observe) Form hypothesis
Perform experiment and collect data
Analyze and interpret data
Generate new hypothesis and retest
ACT PLAN
STUDY DO
Any Questions?
Round up of the day
• Evaluation Forms – today• Evaluation calls – 3 months• Workbooks– hard copy• Certificates, slides and workbooks via email
www.hqip.org.uk