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

29th November 2018

Public Board meeting

• Focus on the quality cycle in six key areas:
• Safer medicines management
• Frail elderly care
• Equitable health and social care services
• Surgery and surgical pathways
• Managing acute illness
• End of life care

A Healthier Wales

• Transformation
• Spread and Scale
• Capability building
• The quality cycle in six key areas:
• Safer medicines management
• Frail elderly care
• Equitable health and social care services
• Surgery and surgical pathways
• Managing acute illness
• End of life care

A Healthier Wales – the Quality agenda

• Why are we still discussing scale and spread?
• QI is old fashioned
• Current focus on programmes, no coherent whole
• Current multiple delivery approaches / mechanisms (Breakthrough Series

Collaboratives, Learning sets, Communities of Practice, Advisory Groups)

• Improving Quality Together isn’t sufficiently well aligned to programmes
• 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:

Externally Differentiating 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 results Support process!!! These individuals are capable of generating the desired results. forgetting process combined with building up ignorance

Innovators Early adopters Early majority Late majority Traditionalists Adoption 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 Traditionalists Adoption 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

Chasm

Moore 1991 Gladwell 2000 Creator Innovators Early adopters Early majority Late majority Traditionalists Adoption 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

Chasm

Moore 1991 Gladwell 2000 Creator Innovators Early adopters Early majority Late majority Traditionalists Adoption profile Technologist Visionary Pragmatist Conservative Skeptic Critic/ collector

Joiner/ spectator

Inactive Psychographic profile Social Technographic profile Scarcity Social Proof

Maloney’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

Chasm Chasm

A new view of improvement and innovation

Creator Innovators Early adopters Early majority Late majority Traditionalists Adoption 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

Chasm Chasm

A new view of improvement and innovation

Creator Innovators Early adopters Early majority Late majority Traditionalists Adoption 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 IQT

Training 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 modules

• Lean
• Leadership
• Coaching
• Leadership support
• Measurement support
• Support for national networks
• Q Network
• Nodes out in each hub

A focus on Capability building

AP – Action Period LS – Learning session LS1 LS2 LS3

AP1 AP2 AP3 P S D A P S D A P S D A

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 &

• vercoming

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 Strategy

Fail 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