Format for Workstreams sessions• Introductions at your table• Improvement Bootcamp overview and other

improvement journeys• Components of a learning system – how does our work

stack up?• Workstream presentations – 30 mins each including

Q&A• Table top reflection on own learning and application of

improvement methodology

The Bootcamp Experience : from this…..

The Bootcamp Experience : to this……

Components of a Learning System

1. System level measures

2. Explicit theory or rationale for system changes

3. Segmentation of the population

4. Learn by testing changes sequentially

5. Use informative cases: “Act for the individual learn for the population”

6. Learning during scale-up and spread with a production plan to go to scale

7. Periodic review

8. People to manage and oversee the learning system

From Tom Nolan PhD, IHI

Our Work to Tackle Poverty in South LanarkshireKay McIntosh , South Lanarkshire Council

Our Community Planning Partnershiph

The South Lanarkshire Community Planning Partnership works to improve the quality of life for people in South Lanarkshire by improving service delivery.

Current Projects

1. Parenting skills and fostering good attachment in children – increasing uptake of income maximisation service for pregnant mums /new families

2. Working to reduce the impacts of substance misuse on children - work to increase uptake of LARC by women accessing substance misuse services.

3. Supporting children to achieve their potential at age 2, 5 and 8 – work to increase attendance at 27-30 month assessments

Income Maximisation…..Why?....

• Around 18% of children in South Lanarkshire live in poverty

• Can be as high as 60% in some communities

• Lack of money /debt can have impacts on children and parents health

• Welfare Reform having negative impacts on the poorest families

• Starting a family can trigger additional money worries/issues

Our Aim

To increase the proportion of referrals to the Money Matters Telephone Advice service from Midwifery Services (ensuring early intervention at pregnancy stage) and increasing uptake of benefits

Applying the Science….

Midwife identifiedBaseline establishedConsider tests of changeTestMeasureAnalyseTest, measure ………

Key Wins…

6 of Midwife’s clients have accessed the service

5 have benefited financially

NHS referrals have increased from 4 a month to 25 in August

Next Steps

Scale up …..

• E Kilbride Locality - 1 midwife - new referral process

• Hamilton – midwife to share knowledge and practice across the team and apply new referral process

• Money Matters to provide monthly feedback on NHS referrals

Key Lessons Learnt

• A good opportunity to raise awareness of EYC• Starting small is manageable• Get all key stakeholders involved from day 1• Involve the people we want to support• Run charts – best in delivery offices• Regularly review progress• Don’t be put off by unexpected/poor results

Key Wins in the Area of Measurement

Test new referral process.All women given case studies leaflets/encouragement

data protection issues raised re case studies. Midwife not to use. Midwife only working 1 day this week

referral process changed Women (with an interest or need) contact details phoned into helpline

Midwife on A/L

Lessons Learned in the Area of Measurement

Don’t wait until the end of the year to look at numbers/data.

Everyone needs to be measuring … not just managers

A good story needs told with words and 1,2,3,….

Testing and Lessons Learned

Start small

Simple = Effective

Common sense

Time to reflect

Plans for next 3-6 months

Continue to test the scaled up model.Ongoing review discussions with key partners.If outcomes are positive - further scaling up.Manage the implications of this…

Healthy Start Vouchers - Orkney

Orkney CPP

In Orkney, the people working with children and young people strive to make sure that each day, each child and young person gets

`the right help, at the right time, in the right way`

Current Projects

•Reduce by half the number of failed appointments across NHS Orkney dental services for all children age 0-8 by March 2014

•95% of eligible families will receive healthy start vouchers by Jan 2014

Key Wins in Presented Area of Work

Empowerment of families

Commitment of shopkeeper to help

Collaborative working

Key Lessons Learnt

Initially thinking too big

Attention to detail

Dramatic scale that can be achieved

Concentrate on finding the right people to get on board with you

Key Wins in the Area of Measurement

Collaborative working commenced

Prior to EYC - local activity to advertise and promote healthy start vouchers

Focus of activity to engage geographically hard to reach families using PDSA

Antenatal survey has told us……

Lessons Learned in the Area of Measurement

Ownership of data

Patience and trust in methodology

The power of a run chart

Key Wins in the Area of Testing

Understanding methodology

Sharing successes

Families sharing with each other

Building confidence

Lessons Learned in the Area of Testing

• Specific aim – being clear about what we want to achieve

• Follow up – learning what works/doesn’t work

• Scaling up – reaching out to all families who can benefit

Plans for next 3-6 months

Introducing PDSA activity with another health visitor for Hoy and then for other islands with other health visitors.

Look at availability of healthy start vouchers on the islands.

TABLE DISCUSSION• Who are individuals and/or teams currently

working on/in this area? Are they currently using Quality Improvement methods/PDSA cycles to guide their learning?

• Reflecting on the emerging knowledge within this area, and today’s plenary session on scaling up your work, what are some considerations you need to plan for to get to scale for your project?