Post on 14-May-2022
Crossing the chasm(s):A single approach to quality in Wales
29th November 2018
Public Board meeting
• Focus on the quality cycle in six key areas:o Safer medicines management
o Frail elderly care
o Equitable health and social care services
o Surgery and surgical pathways
o Managing acute illness
o End of life care
A Healthier Wales
• Transformation
• Spread and Scale
• Capability building
• The quality cycle in six key areas:o Safer medicines management
o Frail elderly care
o Equitable health and social care services
o Surgery and surgical pathways
o Managing acute illness
o End of life care
A Healthier Wales – the Quality agenda
• Why are we still discussing scale and spread?
• QI is old fashionedo Current focus on programmes, no coherent whole
o Current multiple delivery approaches / mechanisms (Breakthrough Series Collaboratives, Learning sets, Communities of Practice, Advisory Groups)
o Improving Quality Together isn’t sufficiently well aligned to programmes
o IQT is too narrow in focus
Context – something different
Context
We’ve evolved over many years with many sub-brands to consider
Context
We’ve evolved over many years with many sub-brands to consider
Internally
Uniting us in a flexible and cohesive way in PHW and as a directorate team
Why Rebrand 1000 Lives Improvement?
Our brand has both an internal and external role:
ExternallyDifferentiating us in a credible and engaging way, with a clear value for our target audiences
Rebranding 1000 Lives Improvement
Science of
improvement
knowledge
Subject
Matter knowledge
Improvement
Juran Trilogy:
• Quality Planning
• Quality Improvement
• Quality Control
The Quality Cycle
“Ideas and products and messages and behaviours spread just like viruses do”
Malcolm Gladwell, The Tipping point
neutral staff (P)
potential innovators
(S)
staff willing to be inno-vators (I)
spread of innovation through an organisation
experienced innovators (R)
share experiences
interact with I and R
+ interventions+ impact
These individuals are capable of generating the desired results.
neutral staff (P)
potential innovators
(S)
staff willing to be inno-vators (I)
frustrated drop-outs (D)
spread of innovation through an organisation
indifferent staff (V)
poorly informed staff (Q)
experienced innovators (R)
share experiences
interact with I and R
+ interventions+ impact
disappointment at early stages of applying knowledge
insight produces change of behavior and hence resultsSupport process!!!
These individuals are capable of generating the desired results.
forgetting process combined with building up ignorance
Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile
• Innovators and Early adopters ♥ scarcity
• They want what others don’t or can’t have
• Early/ late majority ♥ social proof
• They want what others have or are talking about
Note: Early adopters have a vested interest in Early majority not adopting the innovation as it takes away from their scarcity needs
Diffusion of improvement and innovation
Scarcity Social Proof
Creator
Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile
Scarcity
Technologist Visionary Pragmatist Conservative Skeptic
Critic/ collector Joiner/ spectator Inactive
Psychographic profile
Social Technographic profile
Social Proof
• Innovators and Early adopters ♥ scarcity
• They want what others don’t or can’t have
• Early/ late majority ♥ social proof
• They want what others have or are talking about
Diffusion of improvement and innovation
Ch
asm
Moore 1991Gladwell 2000
Creator
Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile
Technologist Visionary Pragmatist Conservative Skeptic
Critic/ collector Joiner/ spectator Inactive
Psychographic profile
Social Technographic profile
Scarcity Social Proof
Note: Interesting intersection at around 15% where:
Creators are faced with Critics
Visionaries are faced with Pragmatists
• Early majority are not keen on the language and excitement of the Early adopters. They are pragmatists who communicate with their own.
Diffusion of improvement and innovation
Ch
asm
Moore 1991Gladwell 2000
Creator
Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile
Technologist Visionary Pragmatist Conservative Skeptic
Critic/ collector Joiner/ spectator Inactive
Psychographic profile
Social Technographic profile
Scarcity Social ProofMaloney’s 16% rule:
Once you have reached 16% adoption of any innovation, you must change your messaging and media strategy from one based on scarcity to one based on social proof in order to accelerate through the chasm to the tipping point
A new view of improvement and innovation
Ch
asm Ch
asm
A new view of improvement and innovation
Creator
Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile
Technologist Visionary Pragmatist Conservative Skeptic
Critic/ collector Joiner/ spectator Inactive
Psychographic profile
Social Technographic profile
Chasm
• Creativity• Improvement Science• Measurement• Communications• Psychological Safety• Leadership
Ch
asm Ch
asm
A new view of improvement and innovation
Creator
Innovators Early adopters Early majority Late majority TraditionalistsAdoption profile
Technologist Visionary Pragmatist Conservative Skeptic
Critic/ collector Joiner/ spectator Inactive
Psychographic profile
Social Technographic profile
Chasm
• Leadership• Improvement Science• Spread and Scale Methods • Measurement• Communications• Celebrating Success
Enabling
Excellence in
Health and Social
Care
Improvement
capability
Delivery framework
Dosed IQTTraining Packages – QI,
Measurement, Lean, SDM, IA,
leadership, behaviour change
Horizon scanning / thought leadership
Spread and Scale: 10, 100, 1000
Framework of Quality
Measurement system
Hubs
Networks – Q, Nodes, Faculty
Collaboration
• IQT as part of a suite of improvement science training, complemented by additional advanced moduleso Lean
o Leadership
o Coaching
• Leadership support
• Measurement support
• Support for national networkso Q Network
o Nodes out in each hub
A focus on Capability building
AP – Action PeriodLS – Learning session
LS1 LS2 LS3
AP1 AP2 AP3
P
S
DA
P
S
DA
P
S
DA
Select Topic
IDEATION / LEARNING CYCLE
• Problem definition / Charter
• Research / scanning
• Concept development / theory building & validation
• Case for change / summary report
Quality Planning:• Health boards & trusts• Welsh Government &
stakeholders• International
Quality Improvement
DEVELOPMENT / TESTING CYCLE
• Prototyping• Demonstration• Proof of concept• Define testing unit• Identify sites• Conduct testing
with ongoing feedback
• Consolidate learning
• Updated theory of change
Develop further
TESTING & REVISION
• Data support• Improvement
capability• Leadership
support• Peer network• Faculty leads• Further develop
framework & change package
Innovators
Overcoming Chasm
One & Early
Adopters
Recruit teams
& leaders
Quality Control
Spread to
Late
Majority &
overcoming
Chasm Two
QI experts – Hubs, Q,
nodes & Faculty
Straight to market
Mainstay:• Resource – QI programme team• Pace and timeframe
Spread and scale
10 days 100 days
1000 days
Measurable Impact
Measurement Strategy
Communications StrategyFail
Collaborative
• Need to be the QI in the Quality Framework
• Need to focus on scale and spread
• Need to build capability• Our USP is having the capability to
enable transformation to be scalable
• The ‘what’ then doesn’t matter
The “how” needs to change
• We need to change how we plan, deliver and resource programmes.
• We need to go slower, to go quicker.
• We need all our programmes to be system-level and focused on QI.
• We need all our programmes to follow a standardised delivery framework for spread.
• We need all our programmes to be time-limited.
What this means for quality in health and social care