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Patient Safety & Quality Improvement in Action Conference
Thursday 16 April 2015
@weahsn#PSCQI
Welcome
James ScottChief Executive Royal United Hospitals Bath NHS Foundation Trust
@weahsn#PSCQI
Work Programme for Patient Safety
Anne PullyblankClinical Director for Patient SafetyWest of England AHSN
@weahsn#PSCQI
Colorectal Surgeon NBT
AHSN
A Network of Member Organisations
5 Community
Health Services
Providers
3 Universities
2 Mental Health Trusts
6 Acute Trusts
1 Ambulance
Trust
7 Clinical
Commissioning Groups
How will the AHSN add value?
• Builds on Safer Care South West• Collaborative• Across all health system• Add innovation
West of England AHSN – Patient Safety Collaborative Initial Priorities 2015/16
Hein Le RouxTasha Swinscoe
• All practices reporting adverse events• All practices responding appropriately • Reduction in priority adverse events
Incident reporting in Primary Care:To develop a system for reporting & responding to adverse
events occurring in primary care settings
Anne Pullyblank/ Emma RedfernDeborah Evans
• All organisations agree an approach• All organisations using single EWS• Reduced emergency/cardiac arrest calls
Single Early Warning Score (EWS):To agree and implement a unified approach to scoring
observations that indicate severity of acute illness, deterioration and need for escalation of treatment
Steve BrownDeborah Evans
• All organisations participating in the network• Reduced medication related problems in
priority areas
Medicines:To develop a medicines network and associated improvement
programme across the West of England
Tricia WoodheadLindsay Scott
• All organisations using sepsis six care bundle or other agreed evidence informed practice
• Reduced sepsis-related mortality
Sepsis:To implement evidence informed practice for the identification
and treatment of patients with sepsis
Anne PullyblankCarol Peden
• Six standards in Emergency Laparotomy• Using national audit tool
Emergency Laparotomy:To implement evidence informed practice
Karen GleaveJane Hadfield
• All eligible staff trained• Reduced adverse events at handover
Human Factors for Bands 1-4 & supervisors:To improve practice at interfaces of care by taking account of
human involvement in processes
Priorities and objectives: Measures : Leads:
Shaun CleeCorinne Thomas
• Reducing self-harmMental Health Collaborative:
Providing Support To:
Engagement
ENABLERS
Capacity & Capability Measurement & Evaluation
Leadership
• Single Early Warning Score (EWS):• To agree and implement a unified approach to scoring observations that
indicate severity of acute illness, deterioration and need for escalation of treatment
NEWS
Across the system
A Common Language
Human Factors for Bands 1-4 & supervisors:To improve practice at interfaces of care by taking account of human involvement in
processes
• Incident reporting in Primary Care:• To develop a system for reporting & responding to adverse events occurring in
primary care settings
Patient Harm-The Evidence
• 10.8% of patients experience an adverse event during a hospital admission1
• 1/3 of adverse events lead to severe disability or death
• 50 % avoidable
1. Adverse events in British hospitals: Vincent et.al: BMJ 2001;322: 517-9
2. Patient safety incidents in an NHS hospital: Ali Baba-Akbari et.al. BMJ 2007;334:79.
We Normalise Harm
• Recognised complications
• ‘Surgery is a risky business’
• HCAI
How do we know a hospital is safe?
• Incident reporting• Audit• Complaints• HSMR• Staff sickness• Staff survey• Structured Mortality
Reviews
Incident Reporting
Type of Incidents
0500
10001500200025003000
Falls
Med
icatio
n
Equipm
ent
Staffin
g
Docum
enta
tion
Comm
unicat
ion fa
ilure
Press
ure
ulce
rs
Delay
ed tr
eatm
ent/.
..
Breac
h of
Poli
cy
Infe
ctio
n Con
trol
Blood
Tra
nsfu
sion
Oth
er
2008/09 2007/08
Incidents reported• Between 1st October 2010 – 31st March 2011 - Degree of Harm
NoneNone LowLow ModerateModerate SevereSevere DeathDeath
1,2651,265 283283 1717 1212 33
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
NBT
Large acute trustcluster
NBT 80.1% 17.9% 1.1% 0.8% 0.2%
Large acute trustcluster
71.7% 21.9% 5.5% 0.7% 0.2%
No harm
Low harm
Moderate
Severe harm
Death
What does better look like?
Emergency Laparotomy:To implement evidence informed practice
Emergency Admissions:A journey in the right direction?
Emergency Laparotomy Quality Improvement Care Bundle
•All emergency admissions to surgical assessment area have a (M)EWS completed. Outreach to review all patients with (M)EWS of 4 or more.•Broad spectrum antibiotics to be given to all patients with suspicion of peritoneal soiling or with septic shock.•Once decision is made to carry out laparotomy patient takes next available slot on emergency list (or within 6 hours of decision made).•Start resuscitation using goal directed techniques as soon as possible or within 6 hours of admission.•Admit all patients after emergency laparotomy to ICU.
25% reduction
p = 0.0830% reduction
Medicines:To develop a medicines network and associated improvement programme
across the West of England
Providing Support to:
Mental Health Collaborative:
Providing Support to:
Sepsis:To implement evidence informed practice for the identification and treatment of
patients with sepsis
West of England AHSN – Patient Safety Collaborative Initial Priorities 2015/16
Hein Le RouxTasha Swinscoe
• All practices reporting adverse events• All practices responding appropriately • Reduction in priority adverse events
Incident reporting in Primary Care:To develop a system for reporting & responding to adverse
events occurring in primary care settings
Anne Pullyblank/ Emma RedfernDeborah Evans
• All organisations agree an approach• All organisations using single EWS• Reduced emergency/cardiac arrest calls
Single Early Warning Score (EWS):To agree and implement a unified approach to scoring
observations that indicate severity of acute illness, deterioration and need for escalation of treatment
Steve BrownDeborah Evans
• All organisations participating in the network• Reduced medication related problems in
priority areas
Medicines:To develop a medicines network and associated improvement
programme across the West of England
Tricia WoodheadLindsay Scott
• All organisations using sepsis six care bundle or other agreed evidence informed practice
• Reduced sepsis-related mortality
Sepsis:To implement evidence informed practice for the identification
and treatment of patients with sepsis
Anne PullyblankCarol Peden
• Six standards in Emergency Laparotomy• Using national audit tool
Emergency Laparotomy:To implement evidence informed practice
Karen GleaveJane Hadfield
• All eligible staff trained• Reduced adverse events at handover
Human Factors for Bands 1-4 & supervisors:To improve practice at interfaces of care by taking account of
human involvement in processes
Priorities and objectives: Measures : Leads:
Shaun CleeCorinne Thomas
• Reducing self-harmMental Health Collaborative:
Providing Support To:
Engagement
ENABLERS
Capacity & Capability Measurement & Evaluation
Leadership
West of England AHSN Patient Safety Team
Quality Improvement and the Academy approach
Anna BurhouseQuality Improvement FellowDirector of QualityWest of England AHSN
#PSCQI
@weahsn
Why is Quality Improvement Important?
‘At present, the evidence is clear that healthcare is not always safe and can lead to poor patient experience and outcomes. At the same time, the economic downturn means an end to year-on-year financial increases. Healthcare services are being challenged to respond to this not through indiscriminate cuts, but by improving efficiency, driving up quality and reducing levels of harm.’
The Health Foundation 2014
PopulationHealth
Experienceof Care
Per CapitaCost
The Triple Aim
Don Berwick 2015
PopulationHealth
Experienceof Care
Per CapitaCost
Five Year Forward View and Triple Aim
• Chronic Disease Coordination
• Sepsis• Kidney Damage• Mental Health Care• A&E
• “Radical Upgrade in Prevention and Public Health”
• Diabetes Prevention• NHS Staff Well-Being
• Demand• Efficiency• Revenue
Don Berwick 2015
Reducing Variation
The Journey so Far……
NHS Scotland
Action for Sustainability
Improvement Requires
1. A reason to do it2. An aim3. A toolkit of methods4. Staff, patients and public
who have knowledge about Quality Improvement Science and the confidence to apply it in real life settings
5. A willingness to change6. A ‘Just Culture’
Our Triple Aim
Establish an Innovation and Improvement Academy to:
Increase the number of staff across the patch who are knowledgeable and confident in their use of quality improvement science, innovation and know how to work with industry.
Provide a range of learning options to meet the needs of a wide variety of staff – from those just learning about quality improvement through to highly experienced practitioners and leaders, via a 3 step methodology.
Develop quality improvement approaches to the involvement of patients, carers and people with lived experience in our communities, to help improve local services. 41
Improvement Requires
1. A reason to do it2. An aim3. A toolkit of methods4. Staff, patients and public
who have knowledge about Quality Improvement Science and the confidence to apply it in real life settings
5. A willingness to change6. A ‘Just Culture’
WEAHSN QI Pareto Effect
We would need to have at least 9000 confident staff to achieve the QI Pareto effect for our West of England health community
43
The Knowledge Base for Continual Improvement
44
Subject andDiscipline Knowledge
Knowledge for Improvement Systems Variation Psychology Improvement techniques
+
Continual Improvement
Adapted from Don Berwick 2015
Capacity and Capability – DriversCapacity and Capability – Drivers
Create Capacity and opportunities to implement Improvement
Create Capacity and opportunities to implement Improvement
Build a critical mass of people with QI expertise including patients
Build a critical mass of people with QI expertise including patients
Design and establish a QI infrastructure and measure linked to strategy
Design and establish a QI infrastructure and measure linked to strategy
Create a culture of learning with senior advocates
Create a culture of learning with senior advocates
Increase capacity and capability for QI to further improve patient safety and care
Increase capacity and capability for QI to further improve patient safety and care
46
3 Step Model for Quality Improvement
What Improvement Skills are Needed for Each Role?
Experts
OperationalLeaders
(Executives)
ChangeAgents
(Middle Managers, project leads)
Everyone
(Staff, Supervisors)
• Setting goals and measures
• Identifying problems
• Mapping process• Testing change• Simple waste
reduction• Simple
standardization• Team behaviors
• Setting goals and measures• Identifying problems• Mapping process• Sequencing tests of change• Simple understanding variation• Implementation and spread• Simple waste reduction• Simple standardization
• Setting direction and big goals
• Results leadership• Portfolio selection and
management • Managing oversight of
improvement• Being a champion and
sponsor• Understanding variation to
lead• Managing implementation
and spread
• Analysis, prioritization of portfolios
• Deep statistical process control
• Deep improvement methods
• Leadership team advisory re portfolio selection, process
• Effective plans for implementation and spread
IHI 2015
People support what they help to create
Action for Spread
Pre CePT an exampleQuality Improvement in Action
Clinical Lead Dr Karen Luyt
Consultant Senior Lecturer
Neonatal Neuroscience University of Bristol
Chief Executive Sponsor Robert Woolley University Hospitals Bristol NHS Foundation Trust
Magnesium Sulphate for Preterm birth as neuroprotection for the baby
• Preterm birth is a major risk factor for CP (motor disability).
• 10% of very low birth weight babies develop CP (650-1300 cases per year).
• Until recently no intervention available to prevent CP in preterm babies.
Preterm Birth and Cerebral Palsy
54
Benchmarking: Magnesium Sulphate
25% of UK tertiary units don’t have a guideline in place
Working initially with 5 local Trusts
University Hospitals Bristol NHS Foundation Trust North Bristol NHS Trust Gloucestershire Hospitals NHS Foundation Trust Royal United Hospital Bath NHS Trust Great Western Hospitals NHS Foundation Trust Swindon
Supported by the South West Obstetrics Network
PReCePTEvidence into Practice Example
The Pathway and Pack
Clinical Guidelines
Proforma for patient notes
Patient information leaflet designed in
conjunction with Bliss and local parents
Poster to raise awareness
Training PDSA Cycle
Bespoke adaptations for
each Trust
Lead by Research
Midwives and
Obstetricians
Various training tools are
available
The Results
Aimed to train 584 core staff, 664 people trained since September
An overall compliance rate of 85+% Putting the 5 maternity units in amongst the best known performers in
the world.
61
63
Improvement Requires
1. A reason to do it2. An aim3. A toolkit of methods4. Staff, patients and public
who have knowledge about Quality Improvement Science and the confidence to apply it in real life settings
5. A willingness to change6. A ‘Just Culture’
Why?
The most important single change in the NHS ….. would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end……….
Don Berwick
Transforming the Quality, Reliability & Experience of End of Life Care
Tricia WoodheadQuality Improvement FellowAssociate Clinical Director for Patient Safety West of England AHSN
#PSCQI
@weahsn
The Improvement of Complex Systems
2
What Matters to You?
‘How people die remains in the
memory of those who l ive on’
Dame Cicely Saunders Founder of the Modern Hospice
Movement
Are we afraid of asking how good we could be?
First national VOICES survey of bereaved people:
https://www.gov.uk/.../first-national-voices-survey-of-bereaved-people-k...
3 Jul 2012
The VOICES questionnaire, was first developed in the 1990s-
The National Picture- 2014- average
Source – Quality watch
How Good Could We Be ?
2
Probability of on-time successful completion at each step
Steps 90.00% 99.00% 99.90% 99.99% 99.999%
1 90.00% 99.00% 99.90% 99.99% 99.999%
2 81.00% 98.01% 99.80% 99.98% 99.998%
4 65.61% 96.06% 99.60% 99.96% 99.996%
8 43.05% 92.27% 99.20% 99.92% 99.992%
16 18.53% 85.15% 98.41% 99.84% 99.984%
32 3.43% 72.50% 96.85% 99.68% 99.968%
64 0.12% 52.56% 93.80% 99.36% 99.936%
128 0.00% 27.63% 87.98% 98.73% 99.872%
Quality and timeliness, compasion and action
If the reliability of each step is 90% then the overall reliability for the 4 steps
together is only 65.61% (.90^4=.6561)
Aim: “90% compliance with Overall Policy and Compassionate care ” (4
step process)
Complexity and Reliability
“Never believe that a few caring people can't change the world. For indeed that's all who ever have”. Margaret Meade
Systematic Approach – across SW
• Medical Director training sessions x 2 (10/14 & 12/14)
• EOL leads project planning and training sessions x 2 (03/15 &05/15 plus follow up half day 09/15)
• Strategic Clinical Network Sponsorship
1. Models for Improvement 2. Plan do study approach to
testing front line ideas and build reliability
3. Measurement to check improvement- on going
4. Peer connections to support and share
5. Management and Leadership engagement
6. Recognition and Celebration of work done
Address the complexity in astructured way
The lens through which an Improver looks at a problem
Driver diagrams structure complexity
PRIMARY DRIVERProvision of information relevant to parties present
PRIMARY DRIVERProvision of information relevant to parties present
SECONDARY DRIVERS•Good quality Crosscare record with Active Problems, Agreed Plan•Information from overnight changes•Exclusion of irrelevant information•Prioritisation
SECONDARY DRIVERS•Good quality Crosscare record with Active Problems, Agreed Plan•Information from overnight changes•Exclusion of irrelevant information•Prioritisation
PRIMARY DRIVERFeedback given on quality of handover and ways to improve
PRIMARY DRIVERFeedback given on quality of handover and ways to improve
SECONDARY DRIVERS•Open culture•Mechanism for feedback•Evidence of action on feedback
SECONDARY DRIVERS•Open culture•Mechanism for feedback•Evidence of action on feedback
PRIMARY OUTCOME
Improve quality and timeliness of
handovers
PRIMARY DRIVERTimely and concise transfer of information
PRIMARY DRIVERTimely and concise transfer of information
SECONDARY DRIVERS•SBAR – concise, structured information•Awareness of time limits•Sensitivity to the needs of those present
SECONDARY DRIVERS•SBAR – concise, structured information•Awareness of time limits•Sensitivity to the needs of those present
Primary drivers are system components which will contribute to moving the primary outcome
Secondary drivers are elements of the associated primary driver. They can be used to create projects or change packages that will affect the primary driver
PDSA Testing builds new approach advanced care planning
Cycle 1A: 11/02/14 Identification patients by respiratory FY1 by putting a Q beside their name on ward board and handover sheets
Cycle 1B: 3/03/14 Teaching the other side of the ward- gastro FY1’s
Cycle 1D: 24/04/14 “re-inform & support” with Hannah & thank you cookies
Cycle 1C: 14/04/14 disseminate the Q project- targeted 5 medical wards a)sign sheet b) Cert to do one c) Cert to teach one
Cycle 1E: 7/05/14 Consultant lead to boost confidence in identifying Q patients
© 2009 R C Lloyd and IHI
Example of a Family of MeasuresTopicTopic Outcome Outcome
MeasuresMeasuresProcess Process
MeasuresMeasuresBalancing Balancing MeasuresMeasures
Improve care
at the end of life
Meet/ exceed 5 Priorities
1) Place of death as preferred
2) Symptoms control maximized (Voices ?)
3) Family consider 3) Family consider there was a good there was a good deathdeath
Percent compliance priorities 1, 2-4, 5,
1) Likely death identified
2-4) Clear and compassionate communication5a) Documented holistic plan
5b) Plan delivered completely
Staff acceptance Staff acceptance
Financial costFinancial cost
Coding / Coding / performance performance indicator indicator deterioration deterioration
Using Improvement Methods to rethink the idea and the reality
Between the idea and the reality, between the motion and the act, falls the shadow TS Eliot
Shine Project
Emma RedfernConsultant in Emergency Medicine & Associate Medical Director for Patient SafetyUniversity Hospitals Bristol NHS Foundation Trust
#PSCQI
@weahsn
Improving safety in Improving safety in overcrowded urgent overcrowded urgent
care systemscare systemsSHINE projectSHINE project
Dr Emma RedfernConsultant in Emergency Medicine
What are the problems? What are the problems? • Delays in discharge from acute trusts• Lack of available beds• Overcrowding in ED• High medical acuity• Ambulance queue• Agency staffing • Outliers
Perfect stormPerfect storm
What we have observedWhat we have observed• Higher rates of clinical incidents due to basics not
being done – timely ECG in chest pain, vital sign measurements missed
• High rates of clinical incidents for queuing patient • High rates of incidents for certain outliers
SHINE projectSHINE project• Standardise the delivery of high quality care across
the peaks and troughs in demand
2 parts2 parts• Design and implement a safety checklist – time
based list of tasks that need to be completed for EVERY majors/resus/queue patient
• IT innovation to ‘prealert’ site team if have patient who should not outlie – stroke, DKA, chest drain, tracheostomy, GI bleed, NOF
ChecklistChecklist• One off tasks• ECG performed and seen by Dr• CT ? Stroke, XR ? NOF• Start specialty proforma – sepsis/DKA
• Recurring tasks• Vital signs and EWS• Pain score and pain relief• Offer refreshments
Benefits - checklistBenefits - checklist• Can be completed by ED nurse, agency nurse,
SWAST paramedics = resilience• Standardised framework – ensures basics are done• Reduces freehand writing in notes
‘‘nudge’- bleeplessnudge’- bleepless
Benefits of nudgeBenefits of nudge• Right patient, right bed
• Accepting the fact that sometimes we can’t achieve this for everyone, nudge helps to get the highest risk patients into an appropriate bed
Results so farResults so far
Pain score and analgesiaPain score and analgesia
SepsisSepsis
Going forwardsGoing forwards• Project continues until June• Then evaluation• Checklist formally incorporated into ED notes • Spread to other ED
KEYNOTE ADDRESS
Dr Helen BevanChief Transformation OfficerNHS Improving Quality
#PSCQI
@weahsn
the change agent of the future
Helen Bevan
Chief Transformation Officer@HelenBevan
and staying in it:
“New truths begin as heresies” (Huxley, defending Darwin’s theory of natural selection)
Source of image: installation by the artist Adam Katzwww.thisiscolossal.com
Via @NeilPerkin
@HelenBevan #dopconf
Starts on the fringe (at the edge)
Starts with the activistsGary Hamel
always
@HelenBevan #dopconf
SEISMIC SHIFTS
@HelenBevan #dopconf
DIGITALCONNECTION
SEISMIC SHIFTS
@HelenBevan #dopconf
Work complexity
SEISMIC SHIFTS
DIGITALCONNECTION
@HelenBevan #dopconf
DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work complexity
@HelenBevan #dopconf
DIGITALCONNECTION
SEISMIC SHIFTS
Hierarchical
power
Work complexity
Change from the edge
@HelenBevan #dopconf
Leading change in a new era
Dominant approach Emerging direction
@HelenBevan #dopconf
Leading change in a new era
Dominant approach Emerging direction
Most health and care transformation
efforts are driven from this side
Most health and care transformation
efforts are driven from this side
@HelenBevan #dopconf
John Kotter, the most influential thought leader globally, recognises new approaches are needed
FROM
@HelenBevan #dopconf
John Kotter: “Accelerate!”
• We won’t create big change through hierarchy on its own
• We need hierarchy AND network• Many change agents, not just a
few, with many acts of leadership
• At least 50% buy-in required• Changing our mindset
• From “have to” to “want to”
TO
@HelenBevan #dopconf
From “have to” to “want to”
Source of image s:www.slideshare.net/mexicanwave/champions-trolls-10-years-of-the-cipd-online-community
The Network Secrets of Great Change AgentsJulie Battilana &Tiziana Casciaro
1. As a change agent, my centrality in the informal network is more important than my position in the formal hierarchy
2. If you want to create small scale change, work through a cohesive network
If you want to create big change, create
bridge networks between disconnected groups
People who are highly connected have twice as much power to
influence change as people with positional power
Leandro Herrero
http://t.co/Du6zCbrDBC
“I have some Key Performance
Indicators
for you”
oror
“I have a dream”
Source: @RobertVarnam
@HelenBevan #dopconf
is the new normal!
“By questioning existing ideas, by opening new fields for action, change agents actually help
organisations survive and adapt to the 21st Century.”
Céline Schillinger
Image by neilperkin.typepad.com
@HelenBevan #dopconf
What happens to heretics/radicals/rebels/mavericks
in organisations?
Source of image: findingmyself.net
@HelenBevan #dopconf
@HelenBevan #dopconf
Ostracism is experienced in the brain as deeply as physical pain
@HelenBevan #dopconf
What is a rebel?
•The principal champion of a change initiative, cause or action
•Rebels don’t wait for permission to lead, innovate, strategise
•They are responsible; they do what is right•They name things that others don’t see yet
•They point to new horizons
•Without rebels, the storyline never changes
Source : @PeterVan http://t.co/6CQtA4wUv1
@HelenBevan #dopconf
We need boatrockers!
• Rock the boat but manage to stay in it• Walk the fine line between
difference and fit, inside and outside• Able to challenge the status
quo when we see that there could be a better way• Conform AND rebel• Capable of working with others
to create success NOT a destructive troublemaker Source: Debra Meyerson
Source : Lois Kelly www.rebelsatwork.com
There’s a big difference between a rebel and a troublemaker
Rebel
@HelenBevan #dopconf
Reflection• What are your insights around “rebels” and
“troublemakers”?• What moves people from being “rebel” to
“troublemaker”?• How do we protect against this?
Source : Lois Kelly www.rebelsatwork.com
There’s a big difference between a rebel and a troublemaker
Rebel
@HelenBevan #dopconf
1. able to join forces with others to create action2. able to achieve small wins which create a sense
of hope, possibility and confidence3. More likely to view obstacles as challenges to
overcome4. strong sense of “self-efficacy”
belief that I am personally able to create the change
Four things we know about successful boat rockers
Source: adapted from Debra E Meyerson
CHANGE
me
BEGINS WITH
@HelenBevan #dopconf
Self-efficacy
“If you think you
can or think you
can't, you are right.”
Henry Ford
“The ability to act is tied to a belief that it is possible to do so”
Albert Bandura
There is a positive, significant relationship between the self-efficacy beliefs of a change agent and her/his ability to facilitate change
and get good outcomes
Source of image:www.h3daily.com
@HelenBevan #dopconf
Source: @NHSChangeDay
@HelenBevan #dopconf
Source: @NHSChangeDay
What is the issue here?
“permission” ? (externally generated)
or
Self efficacy ? (internally generated)
@HelenBevan #dopconf
Building self-efficacy: some tactics
1. Create change one small step at a time
2.Reframe your thinking:• failed attempts are learning opportunities• uncertainty becomes curiousity
3. Make change routine rather than an exceptional activity4. Get social support5. Learn from the best
Image copyright: http://13c4.wordpress.com/2007/02/24/50-reasons-not-to-change/
@HelenBevan #dopconf
@HelenBevan #dopconfSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
@HelenBevan #dopconf
Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
@HelenBevan #dopconfSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
@HelenBevan #dopconf
Source: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
@HelenBevan #dopconfSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
Make it a personal PERFORMANCE target.
@HelenBevan #dopconfSource: http://www.slideshare.net/AndreaWaltz/gfn-slidesharegfnhandling-rejectionpositively
@HelenBevan #dopconf
Research from the Sales industry:How many NOs should we be seeking to get?
• 2% of sales are made on the first contact• 3% of sales are made on the second contact• 5% of sales are made on the third contact• 10% of sales are made on the fourth contact• 80% of sales are made on the fifth to twelfth
contact
Source: http://www.slideshare.net/bryandaly/go-for-no
@HelenBevan #dopconf
“Papers that are more likely to contend against the status quo are more likely to find an opponent in the review system—and thus be rejected —but
those papers are also more likely to have an impact on people across the system, earning them more citations when finally published”
V. Calcagno et al., “Flows of research manuscripts among scientific journals reveal hidden submission patterns,”
Science, doi:10.1126/science.1227833, 2012.
—
@HelenBevan #dopconf
Avedis Donabedian
“Ultimately, the secret of quality is love.…… If you have love, you can then work backward to monitor and improve the system”.
@HelenBevan #dopconf
Key tactic :Out-love everyone else
Source of image: Bradley Burgess
@HelenBevan #dopconf
“Tomorrow’s management systems
will need to value diversity, dissent and
divergence as highly as conformance, consensus
and cohesion.”
Gary Hamel
Source of image: www.fastcompany.com
@HelenBevan
@HelenBevan #dopconf
As you create your roadmap for the future, make sure you are part of the
steamroller, not part of the roadSaavik Wilcox-Hamilton
Source of quote: http://slidesha.re/1B6jrZw
“ “
@HelenBevan #dopconf
1. Follow on Twitter
@HelenBevan
@NHSIQ
2. Subscribe to
3. Get materials from The School for Health and Care Radicals: www.theedge.nhsiq.nhs.uk/school
TheEdge.nhsiq.nhs.uk
Three ways to connect!
@School4Radicals@TheEdgeNHS
@HelenBevan #dopconf
References and linksBaron A (2014) Preparing for a changing world: the power of relationships Battilano J, Casciaro T (2013) The network secrets of the great change agents Harvard Business Review, July-August Bevan H, Plsek P, Winstanley (2011) Leading Large Scale Change - Part 1, A Practical Guide Bevan H (2011) Leading Large Scale Change - Part 2, The Postscript Bevan H, Fairman S (2014) The new era of thinking and practice in change and transformation, NHS Improving Quality Change Agents Worldwide (2013) Moving forward with social collaboration SlideShareDiaz-Uda A, Medina C, Schill E (2013) Diversity’s new frontierFuda P (2012) 15 qualities of a transformational change agentGrant, M (2014) Humanize: How people centric organisations succeed in a social world http://prezi.com/usju20i0nzhd/humanize-how-people-centric-organizations-succeed-in-a-social-world/ Hamel G (2014)Why bureaucracy must dieJarche, H (2013) Rebels on the edges
@HelenBevan #dopconf
Jarche H (2014) Moving to the edges
Kotter J (2014) Accelerate! Harvard Business Review Press
Merchant N (2013) eleven rules for creating value in the social era
Llopis G (2014) Every leader must be a change agent or face extinction
Meyerson D (2001) Tempered Radicals: how people use differences to inspire change at work Harvard
Meyerson D (2008) Rocking the boat: how to effect change without making trouble Harvard BP
Perkins N (2014) Bats and pizzas (agility and organisational change)
Schillinger C (2014) Top-Down is a Serious Disease. But It Can Be Treated
School for health and Care radicals (2014) www.changeday.nhs.uk/healthcareradicalsShinners C (2014) New Mindsets for the Workplace Web Stoddard J (2014)The future of leadershipWilliams B (2014) Working Out Loud: When You Do That… I Do This Weber Shandwick (2014) Employees rising: seizing the opportunity in employee activismVerjans S (2013) How social media changes the way we work together
References and links
Q & A Panel Session
#PSCQI
@weahsn
Q&A Panel Session
Panel Job Title Organisation
James Scott Chief Executive Royal United Hospital Bath
Dr Jim Moore GP Stoke Road Surgery/ Gloucestershire CCG
Dr Helen Bevan Chief Transformation Officer NHS Improving Quality
Jane Jones Associate Director of Improvement
West of England AHSN
Ian Tulley Chief Executive Avon and Wiltshire Mental Health Partnership NHS Trust
THANK YOU
#PSCQI
@weahsn