spreading and sustaining improvement: myths models and magic
TRANSCRIPT
@rosielhunt
It took over a century for handwashing to become mainstream practice and it is still not universal.
We are now beginning to understand the challenge of spread and scale-up in complex systems.
#improvefalls
@rosielhunt
A study of healthcare
interventions from the 1960s
to the 1990s found it took an
average of 17 years until
they became standard care.
Balas, E.A. and Boren, S.A. (2000) ‘Managing clinical knowledge for health care improvement.’ In Bemmel, J. and McCray, A.T. (Eds.) (2000) ’Yearbook of Medical Informatics 2000: Patient-Centered Systems.
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@rosielhunt
David AlburyInnovation Unit
A leading thinker in the field of spread and scaling-up innovation
5 myths of spread
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@rosielhunt
Talk about the five myths:
Do we do any of them?Myth 1: Scaling-up is about spreading informationMyth 2: Spreading means transferring from one context to another Myth 3: Innovation and spread are separate and sequential processesMyth 4: The more innovations we come up with the more spread we will getMyth 5: The key agents of spread are professionals
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@rosielhunt
Productive Ward spread rapidly across the NHS and further afield and is widely cited as an example of large-scale change
@rosielhunt16
What are we spreading?
How Does It Work?
Simplicity
Cultural Fit
Business Case
Tools
Implementation Support
Demonstrated Sustainability
Demonstrated Transfer
Adaptability
Unintended Consequences
Does It Work?Will It Work Elsewhere?
Comparative Performance
Outcome vs. Process
Improvement Attributable to
Practice
Strength of Evidence
Logic Model
Key Components
Specific Processes
OrganizationalEnablers
Barriers and Risks
Will It Spread?
© Kaiser Permanente 2016 reproduce by permission only
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@rosielhunt17
Assessing the context
OrganizationalEffectiveness
Staff Skills and Capacity
Space and Equipment
Technology
Champion
Project Management
Training
Measurement and Monitoring
Alignment and Sponsorship
Implementation Infrastructure
Strategic Alignment with
Goals and Priorities
Sponsorship & Leadership
Oversight Structure
Operational Effectiveness
Relationships among Units
Readiness for Change
Practice Resources
© Kaiser Permanente 2016 reproduce by permission only
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What is the best way to spread new knowledge?
Source of data: Nick Milton http://www.nickmilton.com/2014/10/why-
knowledge-transfer-through.html
Social connection/discussion is
14 times more effective
than
written word/best practice
databases/toolkits etc.
Source of image: www.happiness-one-quote-time.blogspot.com
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“Stages of change” Transtheoretical model of behaviour change
Prochaska, DiClemente & Norcross (1992)
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@rosielhunt
I am not aware my smoking is a
problem – I have no intention to quit
I know my smoking is a problem – I
want to stop but no plans yet
I am making plans & changing things
I do in preparation.
I have stopped smoking!
I am continuing to not smoke.
I sometimes miss it – but I am still not
smoking
“Stages of change”
Smoking
Prochaska, DiClemente & Norcross (1992)
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@rosielhunt
The reality of our change situation
Our tools are often not effective at the stage of change that most people we work with are at
It’s hard to engage people in change
It’s hard to get people to make the changes we want them to make
People get irritated, defensive, irrational
We feel powerless in our ability to lead or facilitate the change
90% of the tools available for health and care change agents are designed for the “action” stage
#improvefalls@rosielhunt
Talk about what you are
spreading/scaling-up.
What’s going to work for you?
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Finding the magic:
Building energy for
change
Psychological
Physical
Spiritual
Social Intellectual
@rosielhunt
Building spiritual energy
Where are the projects that align with our purpose?Could they use us? Lets give them a boost!
Finding
vehicles for
change
Building psychological energy
• A culture of improvement starts with personal and individual growth
• What is your personal limitation?
• Build trust by sharing it with colleagues and getting them to help you grow
Kegan et al (2016) An Everyone Culture: Becoming
a Deliberately Developmental Organization
@rosielhunt
People who are highly connected have twice as much power to influence
change as people with hierarchical power
Leandro Herrero
http://t.co/Du6zCbrDBC
@rosielhunt
“The QI community’s role is in creating the learning environments for studying, adapting, trying out, sometimes failing but always refining”.
Don Berwick IHI, 2017
@rosielhunt
Building energy for change through the creation of learning environments
http://www.patientvoices.org.uk/flv/0032pv384.htm