Dr. Peter Chamberlain

BSc MBChB MRCP MRCGP

General Practitioner

Clinical Commissioner

Health Foundation Quality

Improvement fellow

@drpjchamberlain

The Building Blocks to Effective

Continuous Quality Improvement

Across an Organisation (#QIBBF)

Inputs leading to Building Blocks Framework

1 IHI training programs• IA program / Patient safety officer / HSPH• Fellows seminars

2 15 site visits to highly effective organisations

3 Cross examination of other frameworks

4 Presentations internationally renowned leaders for critique & iterative feedback• IHI mentors, health executives• The Health Foundation• Kings Fund

5 Testing: Face value and score thresholds (2 organisations)

6 Testing: Collaborative scoring mechanism (1 NHS organisation)

7 Testing: Applicability with variety (15 NHS organisations)

8 Testing: Longitudinal use with coaching support (3 NHS organisations)

South Huntington Primary Care

Attributes of Highly Reliable Organizations (Studer)

"…exceptionally consistent in accomplishing their goals and avoiding potentially catastrophic errors"

1. Sensitive to operations 2. Reluctance to accept "simple" explanations for

problems3. Have a preoccupation with failure4. Defer to ‘expertise’ at the front line5. Display resilience and relentlessness

The Trajectory

Time

Ou

tco

me

Steve Spear

http://www.thehighvelocityedge.com/

The Trajectory

“Sustainable competitive advantage has to be

won by creating the internal capacity to

improve and innovate – fast and without let

up. Simply put, today’s leading organizations outrace

their competition by outlearning them.”

Time

Ou

tco

me

Steve Spear

Mechanism – (what)(seed)

Context - (where) (soil)

Process – (how)(Gardener: Light, water)

Outcome

Motivation – (why)

Mo + Me + C + P = O

Cultural & Infrastructure

Essentials

Learning System

Essentials

Person & Family

Centered Care

The principles to direct continuous improvement

The mechanisms to sustain continuous improvement

The foundations to support continuous improvement

Person & Family

Centered Care

Learning System

Essentials

Cultural & Infrastructure

Essentials

Person & Family

Centered Care

Learning System

Essentials

Cultural & Infrastructure

Essentials

Without this we won’t have the right values to continually improve

Learning System

Essentials

Person & Family

Centered Care

Person and Family Centered Care

Cultural & Infrastructure

Essentials

Without this we won’t have the right values to continually improve

Family as a unit of care

Partnership in PersonalizedCare

“What’s the matter?” to “what matters to me”

System Co-designRepresentation

Stories & Voices

Learning System

Essentials

Person & Family

Centered Care

Person and Family Centered Care

Cultural & Infrastructure

Essentials

Co-design, representation,Stories & Voices

Family as a unit of care

Partnership in Personalized Care

What matters to me

Co-design, representation,Stories & Voices

Family as a unit of care

Partnership in Personalized Care

What matters to me

Co-design, representation,Stories & Voices

Family as a unit of care

Partnership in Personalized Care

What matters to me

www.myopennotes.org

Personalized Care Clinic- ‘family consult area’

Family Wellness Warriors

KP “My Health”

Co-design, representation,Stories & Voices

Family as a unit of care

Partnership in Personalized Care

What matters to me

Co-design, representation,Stories & Voices

Family as a unit of care

Partnership in Personalized Care

What matters to me

Without this we won’t have the right values to continually improve

Learning System

Essentials

Person & Family

Centered Care

Cultural & Infrastructure

Essentials

Cultural & Infrastructure Essentials

Without this we won’t have the right values to continually improve

Valued Workforce & Psychological Safety

‘Team’ ethos: Clinical &

Informatics Integration

Increasing staff capacity

& capability in QI & innovation

Learning System

Essentials

Person & Family

Centered Care

Leadership with relentless

focus who connect with

the ‘front line’

Cultural & Infrastructure

Essentials

Cultural & Infrastructure Essentials

We believe that the time

has come for business to stop looking at people as resources and to start looking at them as human beings..

..Put your staff first, your customers second & your shareholders third – you will benefit all three.

“Vecna® was founded on the idea that people matter….

https://www.youtube.com/watch?v=Zrq0m2nY1Q4&feature=youtu.be

• Staff sickness 10%• Financial surplus• 30% drop deaths

2009-13• Achieved 18w waits

across all specialities

Alaska Native Medical Center Values-Driven System Design

R E L A T I O N S H I P

Weekly “Standup”

CLINICAL

INFORMATICS

FINANCIAL

CLINICAL

KP Health Plan

EPIC

Physician Group

Organisation