SPSP Fellowship

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     Welcome and Introductions

• Background to SPSP fellowship
• Aims
• Ways of working
             Why are we here

•   Learning
•   Doing
•   Developing
•   Leading
•   Sustaining
Ways of working
        • This is your programme
        • Learning:
          – Tools
          – Techniques
          – Application
        • Development:
          – Reflection
          – Mentoring
          – Networking
              Ways of working

•   Supportive
•   Confidential
•   Responsive
•   Stretching
•   Different
•   Fun
                   What’s different

Traditional training               SPSP fellowship
    – Case studies: predictable,       – Real projects: influence
      defined set of                     tools/methods
      tools/methods                    – Theory based approach:
    – Learn by example                   outcomes/solutions
    – Answers known                      unknown
•   Passive learning               •   Active learning
•   Lecture book + handouts        •   Reference materials
•   Subject/ instructor focus      •   Adult learning focus
•   Understanding topics           •   Learning to consult
       Who are we

As individuals……………………..
           As a group !
          Why are you here?

Short introduction of yourself, your project
       and your aspirations………….
              Why am I here ?
• Cancer doctor, clinical academic, international
  trialist, patient centred
• Wish to change the system
• www.scan.scot.nhs.uk
• Lead clinician SEHD
• Equipment:
  – Coaching
  – IA at IHI
  – Mentoring SLF + BEM
• Enjoy learning + sharing

Reliable source of energy, knowledge
  and support to others and for ongoing
  campaign to improve healthcare for
  our current and future patients
Change agents, facilitators, coaches
                              Any others?
                What will we do

• Improve lives of patients, health of communities
  and of healthcare workers
• Work with others to accelerate measurable and
  continuous progress towards
  –   Safety
  –   Effectiveness
  –   Patient centeredness
  –   Timeliness
  –   Efficiency
  –   Equity
         What will we become

Recognised and generous leaders
Trustworthy partners
Source of expertise, help and
for anyone who wants to change healthcare
  for the better!
                 How does that feel?
          How do we get there

• Commit to development and change-
  take the pledge
• Collaborate
• Open to new knowledge and
• Have fun
    NHSQIS + SPSP side of the relationship

• Provide organisation
• Source faculty
• Provide mentors/coaches
• Listen to your needs + be flexible in our
• Introduce you to national and
  international networks
Baseline assessment

          • Identified needs
You never step
 into the same
 river twice
             Kolb’s learning cycle

experimentation                  Reflective

                  concepts       What’ do you do
                  Theorist       with new software
                                 on your PC ?
                Models for types of change

   Behavioural                          Cognitive
Changing behaviours                  Achieving results

  Psychodynamic                  Humanistic psychology
Inner world of change              Maximising potential
People make + constrain change!

       Change influences
           “Punished by rewards”

•   Pay                     •   Achievement
•   Policy                  •   Recognition
•   Supervision             •   Responsibility
•   Working relationships   •   Advancement
•   Conditions              •   Learning
•   Status                  •   Type/nature of the
•   Security                    work

Where are you on this?
       A Universal Vision

 Care that is reliably:
Safe, Effective, Patient
  Centered, Timely,
 Efficient, Equitable
        [IOM, Crossing the Quality Chasm]
         Organisational Context

• Your core values, how do they dovetail with
• Beliefs and attitudes- limiting and replacement
• Feelings: what’s most effective state of being
• Behaviours- specific actions to achieve goals
• Results- desired outcome
  Error Provoking
Hospital Environment!
 Every system is perfectly
  designed to get the results
  it gets
      Don Berwick after Peter Senge

You cannot solve a problem using
 the thinking that got you there
                        Albert Einstein
                  Why errors happen
Organisation      Contributory         Delivery      Detection
 and culture        factors           problems       systems

                 environment             Unsafe
 Management      Team factors
decisions and
organisational                                                   Incident
  processes      Individual              Errors

                 Task factors
                 Patient factors

                                   Latent failures

               “Safety “

What is it?

• Generic concepts, components + drivers
• Learning from others
• Context specific for healthcare
 Patient           Investig-                            Referral           Referral             Referral            Received by        Stamped date
                                     Need to see
 presents to       ations by GP/                        letter - update    letter sent visit    letter arrives at   C. Coordinators    Index search         Pending list
 GP                Hospital                             GP records         completed            Post room            & Med. Secs.      Registration

                                    Appointment         Removed                                 Patient              Retrieve           Request            Liaison with
 Letter shown      Priorities for                                          Appointment
                                    made by Clinic      from pending                            booked into          notes from file    results - tests/   others re: joint
 to Consultant     appointment                                             made
                                    Co-ordinator        list                                    clinic               etc..              stickers           clinics

Prepare for                         Personal                                                                        Patient called
                  Patient reports                      Patient waits      Doctor                 Prep. of                                                  Tests organised
clinic - tapes,                     details checked                                                                 into Consulting    Consultation
                  to clinic desk                       to see doctor      receives notes         equipment                                                 Nurses explain
clinic lists                        with patient                                                                    room

Notes to            Patient sent        75 steps = 94% chance of
                                    Returns with
                                    results - Cons    Seen by Con/
                                                                          Decision made
                                                                          Further test, put    Outcome forms          Notes/tapes
                                                                                                                                       Notes booked
                                                                                                                                       out on PAS &
                                                                                                                                                            Letter sent
C.Co-ordinator      for tests       F/U appt. made    Specialist nurse    on w/list, admis.    completed              to Med Sec                            to GP
                                                 failure                  F/up appt, Dis

                                                       Enter onto         S.R. selects         W/l supervisor       Admission                              Verbal
W/l slips to        Enter onto      Document onto                                                                                      Med secs
                                                       book by date/      patients for         sends letter for     list printed off                       confirmation by
w/l supervisor      PAS
                                    (95% accuracy of each step)
                                    stats forms
                                                       priority           admission            admission            PAS

                   Patien t rings   Patient arrives    Doctor/nurse       Admission by         Patient has           Refer to
Notes pulled                                                                                                                            Prepare              Check list
                   to see if bed    on ward for       made aware of       Doctor, Nurse,       investigations        Physio or
for admission                                                                                                                           for theatre          completed
                   available        admission         patients arrival     Anaesthetist        on & off ward         Spec Nurse

                   Patient          T. Reception                           Theatre             Escort back                              Referral to
Porter arrives                                          Anaesthetic                                                    Post-op
                   escorted to      check list by                          recovery            to ward by                               Physio/OT/         Rehabilitation
on ward                                                 & Surgery                                                      recovery
                   theatre          nurse or ODA                           ITU/HDU              nurse/porter                            Spec. Nurse

                  Discharge                                                                    From ward
                                    Ward clerk        Options: Home       Notes go to                               Coder
Decision made     organised TTO’s                                                              Clerk GP letter                          Completion            Notes go
                                    discharges on     further care, BB,   med. Secs. for                            receives notes
to discharge      OPA Transport,                                                               Gold form to                             of coding            back to file
                                    PAS               other hospital      GP letter                                 from med. secs.
                  rels D/N, G.P.                                                                Coder

                                                                 discharged back
                                                                 to care of GP
                                 Operating Room                   Cockpit
                     % of        % Below     % Above      % Below      % Above
  Behavior       Observations    Standard
                 with a rating               Standard     Standard     Standard
                                   (1 & 2)
                  OR/Cockpit                    (3 & 4)      (1 & 2)      (3 & 4)
Briefings        84% / 85%         90%         10%          23%          77%
Establish team   83% / 83%
                                  66%          34%           8%          92%
Inquiry          54% / 59%
                                  55%          45%           9%          91%
Conflict         10% / 10%
                                  80%          20%          22%          78%
      Where do we start?

 “Patients and healthcare
professionals are part of the
       same system”

    Lawrence J Henderson NEJM, 1025
Steps to improving safety

               1. Recognise and
               2. Leadership =
                  (will+ideas) x
               3. Long term
            Two worlds……..

• Ideal, academic,   • Reality, empirical,
  research based       chaotic
Case study           Mess
Analysis             Improvement objective
Solutions            Changes
Answer               Success + failures
Evidence             Solutions
No or slow change    Sustainable results
           Important concepts

• Design
• Process analysis
• Primary + secondary
• Benchmarking
• Creativity
• Communication
                                   Value Stream Analysis
                                  Define, measure, analyse,
                                        design, verify

100% participation
     Voice of
customer/process                              Quality control
   Rapid cycle                                Infrastructure
  improvement                                  Performance
    Coaching                                     tracking
 Define, measure,                             Organisational
 analyse, design,                                structure
       verify                                 Accountability

               Improve                  Manage

                                                 Ref: Brent James
“You cannot solve
 a problem using
 the thinking that
  got you there”
       Albert Einstein
– One of the commonest
– Assumptions
– Misunderstandings
– Unclear roles and
– Inter-professional barriers
– Hierarchical structure
– Fear and power
          Leadership for Improvement

       Setting Direction: Mission, Vision and Strategy
                                Making the future attractive   PULL
PUSH    Changing the old

        Will                             Execution
               Establish the Foundation
         Board Leadership of Quality
                      1. Set Direction: 100% or Zero
                                                             Make the future attractive PULL

   PUSH Make the status quo uncomfortable

         3. Build Will                                                    5. Execute Change
 • Involve patients and families                                      • Establish accountability for results
 • Understand the gap between              4. Generate                • Establish good oversight process
   your current performance, the                                        on “are we achieving our aims?”
   best in class and the theoretical           Ideas                        •Watch your own dots
   ideal                                                                    •Weekly or monthly data
 • Use stories and data                                                     •25% Board time on quality
 • Go transparent
 • Show courage

• Establish Quality Committee 2. Establish the Foundation                 • Build a board culture of
• Bring knowledgeable quality leaders                                       healthy conversations
onto the board                        • Quality education standards         with clinicians and
                                        for board                           managers

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