Leading Improvementin Safety and Quality

A training and coaching programmeto support general practice in

improving safety, qualityand satisfaction for patients and staff

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ObjectivesThis programme will develop your ability to lead effective and sustainable service improvement with less effort and resistance.

Using a variety of skills and tools, you will be equipped to address any aspect of improving safety and quality – in a way that will inspire and engage the whole team

Intended for

GPs, lead practice nurses, practice managersCCG & federation quality improvement leads

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Benefits

Improve quality safety without just working harder.

Make best use of the new NHS Change Model.

Enthuse, engage and empower staff to continually improve.

Involve patients as partners in improvement.

Build your personal change leadership skills.

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The programme

Practical, challenging and fun. We blend workshop learning with personal reflection, action learning, practical project work and guided reading.

The programme can be adapted to meet your own situation and priorities, including basing it around a specific theme or challenge.

A typical programme involves 6 one day workshops over 6-9 months, with 8 coaching webinars in between workshops.

Inputs can be tailored according to participants’ prior experience, as well as particular learning needs.

Contact Dr Robert Varnam, Clinical Lead for Primary Care, to discuss your needs and begin planning your programme (robert.varnam@institute.nhs.uk).

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The impact

98% of GPs attending our workshops would recommend them to anyone

100% change how they think about improving care

“A lightbulb moment in every session”“Inspiring”

“Why didn’t someone show me this years ago?”

“We’re finally turning good ideas into actual benefits for patients”

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“Very, very impressive”

“Even my difficult colleagues are coming

on board”“The best use of time for our GPs and managers since I don’t know when”

“The whole team have a sense that we can finally do this”

Building a culture of continual learning & improvement

Topics covered

Diagnose Plan, learn & implement Work smarter Share itDefine

Leading people in transition

The case for change

Linking quality, safety, productivity &

happiness

360 degreepracticeappraisal

Quality & safetyculture

Humanerror

Why isexcellence hard?

Guidelineviolation

Understandingvariation

Design bettersolutions

Plan & communicatestrategy

The Modelfor

Improvement

Measuringimprovement

Understandprocesses

Improvereliability

Engage patients

Spreadinnovation

Sustainimprovement

This map is clickable

The case for change

Understand and reflect on the evidence about our current situation:

• patient safety• quality of care• patient experience• staff satisfaction• productivity• rising demand & complexity

Reflection & discussionKnowing How We Are Doing

Linking quality, safety, productivity & happiness

Understand the links between quality, safety, productivity and satisfaction for patients and staff

Develop your case for change, based on the evidence for improving value in care

Making the case for changeThe Transition model (Bridges)Gathering data & stories

360 degree practice appraisal

Get the full picture about safety & quality Focus on solvable problems Stop misusing information Include everyone’s perspective Be more proactive Find easier opportunities to improve Include patients in improvement

Staff & patient safety reportingSafety WalkroundsTrigger tools

Quality & safety culture

Understand the contribution of organisational culture to patient safety and quality

Evaluate your own safety and quality culture Develop a plan to broaden and bolster team engagement in

improvement, addressing specific cultural challenges

Understanding cultureManchester Patient Safety FrameworkImproving culture for quality

Why is excellence hard?

Understand human and system performance Reduce the likelihood of error Identify the reasons for rule violations Make it easier to do the right thing

Understanding human errorUnderstanding rule violationSystems thinking

Understand variation

Learn techniques for measuring and exploring variation in performance, between teams and individuals, and over time

Develop plans for effective recording and analysis of data about variation

Apply the 360 Degree Appraisal model to use information for improvement rather than judgement

Detecting & measuring variationUnderstanding variationDiscussing variation with colleagues

Design better solutions

Reduce error-producing conditions Improve teamwork and communication Improve processes and tasks Eliminate obstacles to effective working

The London ProtocolHuman factors engineeringSBAR communication

Plan & communicate strategy

Review your current approaches to strategic planning & implementation

Brainstorm more effectively using creative tools Use driver diagrams to avoid “silver bullet” thinking Show staff where their contribution fits Make programmes easier to track and evaluate

Driver diagramsMaking a case for changeCreating a compelling vision

The Model for Improvement

Understand why traditional change strategies are hard work and inefficient

Appreciate the principles of small step change Practice using the PDSA methodology to test and refine change

ideas

Reflection & discussionKaizen principlesThe Model for Improvement

Measuring improvement

Understand the different strategies required for research, judging care and improving care

Learn how to measure in real time using statistical process control Choose indicators to provide knowledge, not just data Understand and track variation in real time Avoid acting on impulse Select the right strategies for investigating variation Measure and understand demand, workload and patient flow

Run charts & Statistical process controlUnderstanding variation

Understand processes

Develop methods and skills for mapping processes as they actually are

Identify the parts of your system that serve patients best, using value stream mapping

Pinpoint the changes necessary to maximise the benefit of your hard work

Create the ideal future processes for your patients

Task-oriented process mappingValue stream mappingThe power of observation

Improve reliability

Understand the impact of poor reliability in your practice’s processes

Use simple methods to develop more standardised approaches to common and high risk processes

Prioritise the areas to improve, using FMEA Redesign processes to improve reliability Achieve almost total reliability with barriers, mitigations and

redundancies Select the right indicators to measure improvements and

unintended consequences

Design for reliabilityFailure Mode & Effects AnalysisChoosing metrics

Engage patients

Use new methods to engage patients and carers in highlighting improvement opportunities

Apply the evidence about what patients want to your practice Use experienced based design principles to get better results Help patients to improve patient safety Improve concordance and satisfaction with shared decision

making Plan new evidence based programmes to improve self care and

community care

Experience Based Design360 Degree Patient Safety AppraisalThe new Engagement Cycle

Spread innovation

Appreciate why innovations often spread slowly Assess your local readiness to share learning and collaborate for

improvement Plan new structures and processes to spread innovation within

and between practices Take a lead on improving care within your locality

The NHS Institute Spread ToolStakeholder analysisPeer support

Sustain improvement

Understand the reasons why improvements and innovations are often not sustained

Embed sustainability principles in your plans are sustainable from the outset

Apply specific strategies to improve sustainability

Sustainability ModelReflection & discussion

Building a cultureof continual improvement

Understand & measure your safety & quality culture Choosing & changing priorities Being proactive Engaging the right people Empowering every member of staff to be a change agent Building sustainable change programmes

Innovation culture evaluationInnovation culture planning toolUnderstanding drive (Pink)

Leading peoplein transition

Lead people as effectively as you lead change Developing your leadership style Diagnosing the causes of apathy and opposition to change Using tools to support people through transition Understanding differences in people’s motivation Using different influencing styles to build motivation and

commitment Planning changes in people

The Transition Model (Bridges)Strength Deployment InventoryReflection & discussion