Crossing the chasm(s): A single approach to quality in Wales Public - PowerPoint PPT Presentation

Crossing the chasm(s): A single approach to quality in Wales Public Board meeting 29 th November 2018

A Healthier Wales • 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 – the Quality agenda • 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

Context – something different • Why are we still discussing scale and spread? • QI is old fashioned o 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 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

Why Rebrand 1000 Lives Improvement? Our brand has both an internal and external role: Internally Externally Uniting us in a flexible and Differentiating us in a credible cohesive way in PHW and as a and engaging way, with a clear directorate team value for our target audiences Rebranding 1000 Lives Improvement

Science of Subject Improvement improvement Matter knowledge knowledge

The Quality Cycle Juran Trilogy: • Quality Planning • Quality Improvement • Quality Control

“Ideas and products and messages and behaviours spread just like viruses do” Malcolm Gladwell, The Tipping point

spread of innovation through an organisation These individuals are + interventions experienced capable of generating the desired results. + impact innovators (R) share experiences interact with potential staff willing I and R neutral staff innovators to be inno- (P) (S) vators (I)

spread of innovation through an organisation These individuals are + interventions experienced capable of generating the desired results. + impact innovators (R) insight produces share change of behavior experiences and hence results Support process!!! interact with potential staff willing I and R neutral staff innovators to be inno- (P) (S) vators (I) disappointment at early stages of applying knowledge forgetting process poorly indifferent frustrated combined informed staff (V) with building drop-outs (D) staff (Q) up ignorance

Diffusion of improvement and innovation Scarcity Social Proof Innovators and Early adopters ♥ scarcity Early/ late majority ♥ social proof • • • • They want what others don’t or can’t have They want what others have or are talking about Adoption profile Innovators Early adopters Early majority Late majority Traditionalists 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 Innovators and Early adopters ♥ scarcity Early/ late majority ♥ social proof • • • • They want what others don’t or can’t have They want what others have or are talking about Adoption profile Innovators Early adopters Early majority Late majority Traditionalists Psychographic profile Technologist Visionary Pragmatist Conservative Skeptic Creator Critic/ collector Inactive Social Technographic profile Joiner/ spectator

Diffusion of improvement and innovation Social Proof Scarcity • Early majority are not keen on Note: Interesting intersection at around 15% where: the language and excitement of the Early adopters . They are Creators are faced with Critics pragmatists who communicate Visionaries are faced with Pragmatists with their own. Chasm Innovators Early adopters Early majority Late majority Traditionalists Adoption profile Technologist Visionary Pragmatist Conservative Skeptic Psychographic profile Creator Critic/ collector Inactive Social Technographic profile Joiner/ spectator Moore 1991 Gladwell 2000

A new view of improvement and innovation Maloney’s 16% rule: Social Proof Scarcity 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 Chasm Innovators Early adopters Early majority Late majority Traditionalists Adoption profile Technologist Visionary Pragmatist Conservative Skeptic Psychographic profile Creator Critic/ collector Inactive Social Technographic profile Joiner/ spectator Moore 1991 Gladwell 2000

A new view of improvement and innovation Chasm • Creativity • Improvement Science • Measurement • Communications • Psychological Safety • Leadership Chasm Chasm Innovators Early adopters Early majority Late majority Traditionalists Adoption profile Technologist Visionary Pragmatist Conservative Skeptic Psychographic profile Creator Critic/ collector Inactive Social Technographic profile Joiner/ spectator

A new view of improvement and innovation Chasm • Leadership • Improvement Science • Spread and Scale Methods • Measurement • Communications • Celebrating Success Chasm Chasm Innovators Early adopters Early majority Late majority Traditionalists Adoption profile Technologist Visionary Pragmatist Conservative Skeptic Psychographic profile Creator Critic/ collector Inactive Social Technographic profile Joiner/ spectator

Networks – Q, Nodes, Faculty Dosed IQT Training Packages – QI, Improvement capability Measurement, Lean, SDM, IA, leadership, behaviour change Horizon scanning / thought leadership Enabling Excellence in Health and Social Care Spread and Scale : 10, 100, 1000 Framework of Quality Delivery framework Measurement system Hubs Collaboration

A focus on Capability building • IQT as part of a suite of improvement science training, complemented by additional advanced modules o Lean o Leadership o Coaching • Leadership support • Measurement support • Support for national networks o Q Network o Nodes out in each hub

Quality Planning: • Health boards & trusts • Welsh Government & Quality Control stakeholders • International Spread and scale Select Topic 1000 days Overcoming Chasm 100 days 10 days QI experts – Hubs, Q, One & Early Innovators nodes & Faculty Quality Improvement Adopters TESTING & IDEATION / DEVELOPMENT / Measurable P REVISION P LEARNING CYCLE TESTING CYCLE P Impact • • • Problem Data support Prototyping A D A D • • A D Demonstration definition / Improvement Develop Spread to • Proof of concept Charter capability S S further • S Define testing unit Late • • Leadership Research / Recruit • Identify sites support Majority & scanning teams LS3 LS2 • LS1 Conduct testing • • Concept Peer network overcoming & leaders with ongoing • development / Faculty leads AP3 AP2 feedback AP1 Chasm Two • theory building & • Further develop Consolidate framework & validation learning • • Updated theory of change package Case for change / Collaborative change summary report Straight to market Measurement Strategy Fail Communications Strategy Mainstay: • Resource – QI programme team AP – Action Period • Pace and timeframe LS – Learning session

The “how” needs to change • 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

What this means for quality in health and social care • 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.