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Making change happen at the sharp end. The role of GPs and the primary care team in improving local systems.
| Date post: | 23-Feb-2017 |
| Category: |
Health & Medicine |
| Upload: | nhs-improving-quality |
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Making change happen at the sharp end.
The role of GPs and the primary care team in improving local systems.
WHY
MY WHY
OUR TEAM WHY
HISTORICAL SECONDARY CARE
NATIONAL IMPROVEMENT FOCUS
Went back to underlying improvement principles then built approaches with Primary Care for Primary Care
WHY?
WHAT?
HOW?
https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?language=en
WHAT HAVE WE
DONE
CCG work with senior
system stakeholders
Prime Ministers Challenge Fund work with frontline Primary Care staff and patients
Place based support – working with senior teams and frontline Primary Care
staff & patients
CCG work with senior
system stakeholders
Prime Ministers Challenge Fund work with frontline Primary Care staff and patients
Place based support – working with senior teams and frontline Primary Care
staff & patients
CCG work with senior
system stakeholders
Prime Ministers Challenge Fund work with frontline Primary Care staff and patients
Place based support – working with senior teams and frontline Primary Care
staff & patients
MIND THE GAP
CCG work with senior
system stakeholders
Prime Ministers Challenge Fund work with frontline Primary Care staff and patients
Place based support – working with senior teams and frontline Primary Care
staff & patients
UNTAPPED LEADERSHIP CAPACITY
CCG work with senior
system stakeholders
Prime Ministers Challenge Fund work with frontline Primary Care staff and patients
Place based support – working with senior teams and frontline Primary Care
staff & patients
SUSTAINBILITY ISSUES
CCG work with senior
system stakeholders
Prime Ministers Challenge Fund work with frontline Primary Care staff and patients
Place based support – working with senior teams and frontline Primary Care
staff & patients
LOSS OF ENERGY (Fuel for change)
CCG work with senior
system stakeholders
Prime Ministers Challenge Fund work with frontline Primary Care staff and patients
Place based support – working with senior teams and frontline Primary Care
staff & patients
FILL THE GAP
CCG work with senior
system stakeholders
Prime Ministers Challenge Fund work with frontline Primary Care staff and patients
Place based support – working with senior teams and frontline Primary Care
staff & patients
Shared purpose
Narrative
Measurement Creative thinking
Shared purpose
What is your personal ambition for the piece(s) work that you are doing at the moment?
Share a fact that your work colleagues are unlikely to know about you.
How do you make this happen
• Time out from everyday practice• (Ideally) a neutral space• Facilitation – a neutral broker• Honest conversations
Narrative
Creating your compelling narrative (story)
to help you engage others
a skill to motivate others
to join you in action
A narrative approach may help?
PROJECT INITIATION DOCUMENT
- Run searches on practice population
- Undertake case note reviews on patients identified as being at risk
- Complete reflective template
Based on social movement theory and body of evidence
Developing your key messages into an engaging narrative that is bespoke to each audience can help to really enthuse others
It can really help to view those involved in improvement work with you as volunteers….focuses the mind on how to truly engage
We need to develop multiple key messages (adapted stories) for our different audiences to truly
- Engage and connect - Energise behind change- Share authentically- Engineer commitment first before we use compliance
Consider how you would describe the changes to ….
a locum GP joining the practice
a friend at the school gate
a patient
a carer / family member for an elderly relative
a neighbour
Strengthen your narrative by using vivid details and real life examples
How do you make this happen
• There are well established rules to help develop your narrative
• Authenticity is crucial• Adapt your story • Practice, Practice, Practice!
Measurement
2011-14 2011-30 2011-46 2012-9 2012-25 2012-41 2013-4 2013-20 2013-36 2013-520
100
200
300
400
500
600
Weekly Attenders
Data Average ULC LCL
The traditions of measurement
• eg A-B comparison, average, huge dataset
Research
• eg one-to-many benchmarking comparison, average, large dataset
Judgement
• eg continual analysis of single changing process over time
Improvement
How do you look at your data ?
G
VQ
% of patients with 3 key processes complete
K
How do you make this happen?
• Choose what you measure carefully• Link to shared purpose and system drivers• Measure often• Think about how displaying your data will engage staff
and service users
Creative thinking
Thinking differently
Key concepts
1st & 2nd Order
Change
Idea Generation
Rules
Mental valleys
Attention, Escape,
Movement
Convergent, Divergent thinking
cycles
Structure for thinking
1st & 2nd Order Change
Incremental Improvement
1st Order changeIs good and required
Transformation
2nd Order changeIs good and required
Healthcare example
“McJab - Do you want fries with that…?”
1st & 2nd Order Change
Incremental Improvement
1st Order changeIs good and required
Transformation
2nd Order changeIs good and required
If we did both – simultaneously – the results would be amazing?
Rules for idea generation
Criticism is ruled out Encourage wild ideas Build on the ideas of others Promote equality of contribution Answers not just from leaders Go for quantity to avoid ‘silver bullet’ thinking Think about conducive environment to create
transformational space
ImaginativeWhat If…
PositiveThis is great because…
NegativeThis won’t
work because…
FactualEvidence
suggests…
EmotionalI feel that…
Thinking is better when we put some
structure around it
Structured Thinking
How do you make this happen?
• It’s ok (and good!) not to have all the answers• Tools and structure c an be used to help ideas creation • Create space and time to allow frontline staff to
innovate• Leaders can help by providing the ‘air cover’ • Allow experimentation
WHY?Real lasting change across the system occurs when we utilise core improvement principles in all areas that are adapted for each setting.
Quality improvement is the way to deliver true high quality care with the least amount of resources.
WHAT?
Flexibly supporting local systems to deliver their change by focusing on work with senior leaders, management and frontline staff across the whole system.
HOW?
Our emails: [email protected] [email protected]
youtube.com/c/transformingcareOur YouTube channel packed with online webinars (measurement, capacity & demand etc), team videos/case studies and Productive General Practice resources
NHSIQ.nhs.ukGo to the Transforming Care team pages for tools and resources.
Twitter: @TransformCare
