Scale Up and Spread...9 Methods for spread and scale up: Massoud, Donohue, McCannon 2010 1. Natural...

Scale Up and Spread

#QIconf

The Sequence of Improvement

Sustaining improvements and Spreading changes to other locations

Developing a change

Implementing a change

Testing a changeTheory and Prediction

Test under a variety of conditions

Make part of routine operations

Scale-up and Spread

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SpreadNew working methods developed in one setting are adopted, perhaps with modifications, across an organisation

A

Scale-up

A more conscious, deliberate process in which new working methods are tested by an increased number of teams, increasing degree of belief they work and overcoming system/infrastructure issues that arise.

A

P8System View: Population + Administrative Unit

e.g. 2 million people: 16 hospitals

Scale up task 2: seeding scale up

across region

A

“As the bits of the cube start moving, keep communicating and coordinating”Rosabeth Moss Kanter, Harvard Business School

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Time for a story…

J

Intervention ship – 3 tsp lemon juice per sailor per dayNo fatalities from scurvy

Control ships – no intervention 110/278 sailors dead from scurvy

J

How long do you think it was

until provision of citrus fruits

became standard practice in

the British Navy?

J

Why?

J

“Strong evidence for an innovation is necessary, but not sufficient, to result in its

adoption”

Mark Freeman, 2012, The International Journal of Management EducationJ

Everett Rogers (1962)A

Readiness to take on new ideas

A

The “S” curve…What readiness for change means for

take up of innovations

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% usage of Twitter and Facebook by UK population2017

J

How much diffusion of these innovations has there been amongst the people in this

room?

J

Experiment: How to diffuse ideas further?

Instructions

• In a moment we are going to ask you to have conversations with each other about these 3 areas of innovation (either using Twitter, using Facebook or being active in a QI project)

• You need to be in small groups of 2-4 with at least one person who is a user of one of the innovations and others who are not

• Decide on one innovation to talk about at a time

• Existing users, you are trying to convince others to try changing their behaviour to use the innovation.

• You will have 10 minutes for this exercise. Try to have at least 2 conversations with different people…

• And finally… 1 more move…

J

Discussion: the benefits of using this innovation

JFacebook Twitter QI

So what affects the rate of adoption of a

new idea?

A

Relative advantage

“It took a decade to

make any impression

on the mainstream –

people stuck with

cassettes for recording,

and Walkmen and

Discmen for portability –

and almost as soon as

it did, it was killed by

the MP3 player”

A

CompatibilityA

Complexity/SimplicityA

TrialabilityA

ObservabilityA

Rodgers’ guidance on how people experience change

Concerns about risk and

uncertainty

The need for reassurance and

trust

J

1. The power of peer to peerJ

2. Reinvention by adopters

Rodgers’ guidance on how people experience change

J

Attributes of Innovations that successfully spread

1. Relative Advantage

2. Compatibility

3. Complexity/Simplicity

4. Trialability

5. Observability

A

How people experience change: Key drivers

1. Peer to peer

2. Reinvention by adopters

What kind of methods tend to be used for adoption?

Optional Collective Authority

A

What kind of methods tend to be used for adoption?

Optional Collective Authority

Natural diffusion

Executive mandates

Extension agents (training & mentoring)

Emergency mobilization

Affinity group(disseminate superior model to other sites)

Collaborative

Wave sequence

Campaigns

Hybrid approachesA

9 Methods for spread and scale up: Massoud, Donohue, McCannon 2010

1. Natural diffusion - spread ideas without intentionality2. Campaigns - shared, quantitative aim connected to a targeted social

system (evidence-based intervention, measurement, communications, and distributed field operations)

3. Collaborative (physical or virtual) – networked structured learning and exchange around shared aims, measures, and goals

4. Extension agents - spread through training and mentoring.5. Emergency mobilization – rapid efficient assembly of plans, materials,

supplies. 6. Affinity group - develop superior model, then dissemination to other sites

in the system.7. Executive mandates – policy, guidelines, protocols8. Wave sequence - systematic spread within integrated multi-level systems

9. Hybrid approaches - where combined elements from different approaches form a new approach.

Massoud MR, Donohue KL, and McCannon CJ. 2010. Options for Large-scale Spread of Simple, High impact Interventions. Technical Report. Published by the USAID Health Care Improvement Project. Bethesda, MD: University Research Co. LLC (URC).A

Make connections!A

Violence reduction at ELFT

Our (current) journey of scale-up and diffusion…

J

Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)

Brick Lane Ward

Mill harbour

Rosebank

Lea Ward

Globe Ward

Roman Ward

Ruth Seifert Ward

Brett Ward

Joshua Ward

Gardner Ward

Bevan PICU

Mother and Baby

Unit

ConollyWard

Topaz Ward

Opal Ward

Emerald Ward

Sapphire Ward

Jade Ward

Ruby Triage

Crystal PICU

City and Hackney

Newham

Tower Hamlets

Globe Ward

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“Whenever I have the opportunity to hear more about this work, I’m reminded of the time Andy Cruickshank came to see me

to say that he wanted to work on violence reduction…

I will be very honest with you now and say that I was rather sceptical of whether

he would be able to work on this and whether change was truly possible in this

area…”

J

“I’ve been a nurse here for 20 years and I just thought

this was how it was… Now I can see that it doesn’t

have to be this way… ”

J

“I’ve been a nurse here for 20 years

and I just thought this was how it was… now I can see that

it doesn’t have to be this way”

“Whenever I have the opportunity to hear more about this work, I’m

reminded of the time Andy Cruickshank came to see me to say that he

wanted to work on violence reduction… I will be very honest with you now

and say that I was rather sceptical of whether he would be able to work on

this and whether change was truly possible in this area…”

J

Safety Discussion in Community Meetings

Safety Huddles

Broset Violence Checklist

Safety Cross

A

Plan

DoStudy

Act

J

5.78 2.47

UCL

0

2

4

6

8

10

12

14

16

No

. o

f In

cid

ents

per

10

00

OB

D

Incidents resulting in physical violence (Acute wards only)per 1000 occupied bed days (OBD) - U Chart

DIR

ECTO

RA

TE L

EVEL

(TO

WER

HA

MLE

TS)

BASELINE DATA(BEFORE)

PDSA DATA(AFTER)

57%

Learning Set 1

Test

ing

be

gin

s

05/10 Learning Set

6: Time of Day & General

Adult wards go smoke free

10/11 Learning Set 7: Prediction + Safety Huddle Observation

Pre

-wo

rk /

en

gage

me

nt

12/01 Learning Set 8: Prediction PDSAs + Scale-up

prep

Learning Set 4

Learning Set 3

Learning Set 2

13/08 Learning Set 5: Safety

Huddle outcomes + Safewards

24/02 Learning Set 9: Effective Safety Huddle

PDSAs

24/03 Shift

pattern changes

26/04 Learning Set 10: Reflecting on why and PDSAs

17/04 Gender specific wards

34.98

17.05

UCL

0

10

20

30

40

50

60

70

80

90

06

-Jan

-14

20

-Jan

-14

03-

Feb

-14

17-

Feb

-14

03-

Mar

-14

17-

Mar

-14

31-

Mar

-14

14-

Ap

r-14

28-

Ap

r-14

12-

May

-14

26-

May

-14

09-

Jun

-14

23-

Jun

-14

07-

Jul-

14

21-

Jul-

14

04-

Au

g-14

18-

Au

g-14

01-

Sep

-14

15-

Sep

-14

29-

Sep

-14

13-

Oct

-14

27-

Oct

-14

10-

No

v-14

24-

No

v-14

08-

Dec

-14

22-

Dec

-14

05

-Jan

-15

19

-Jan

-15

02-

Feb

-15

16-

Feb

-15

02-

Mar

-15

16-

Mar

-15

30-

Mar

-15

13-

Ap

r-15

27-

Ap

r-15

11-

May

-15

25-

May

-15

08-

Jun

-15

22-

Jun

-15

06-

Jul-

15

20-

Jul-

15

03-

Au

g-15

17-

Au

g-15

31-

Au

g-15

14-

Sep

-15

28-

Sep

-15

12-

Oct

-15

26-

Oct

-15

09-

No

v-15

23-

No

v-15

07-

Dec

-15

21-

Dec

-15

04

-Jan

-16

18

-Jan

-16

01-

Feb

-16

15-

Feb

-16

29-

Feb

-16

14-

Mar

-16

28-

Mar

-16

11-

Ap

r-16

25-

Ap

r-16

09-

May

-16

23-

May

-16

06-

Jun

-16

20-

Jun

-16

No

. o

f In

cid

ents

per

10

00

OB

D

Incidents resulting in physical violence (PICU wards only)per 1000 occupied bed days (OBD) - U Chart

51%

24/06 Learning

Set 11

J

42%Acute Wards

excluding Brett

84%Acute Wards including

Brett

90%Brett Ward

66%Gardner

Ward

67%Joshua Ward

67%Bevan Ward

86%Emerald

Ward

64%Topaz Ward

J

“We’re no longer fire-fighting all the time… ”

“I think there is a shift. Before we started this, no one talked about it. Now we are bringing it up, which says 'it is not ok‘ ”

“It is more calm and relaxed”

“I'm just really pleased that it's permeating out and patients are feeling able to broach the subject”

“It’s been a good few months… we are moving fast now”

“The team feels more confident and are having better discussions around issues that may arise”

“A service user has said she is impressed by the atmosphere… “

“4 months ago I was really scared to come to work, but it’s getting better”

“There’s a better therapeutic environment and patient satisfaction. You can feel the lowered levels of stress for staff and patients”

"Well, what can I say, the team are fantastic! Thank you for helping all the patients here. You save lives and give us a second and third chance”

J

Lea Ward September Safety Huddle Champion George enjoying his prizeJ

Leadership roleContext and

readinessEnergy and

Engagement

Phased approach

Design of support and

learning systems

Key considerations

A

Scale Up and Spread...9 Methods for spread and scale up: Massoud, Donohue, McCannon 2010 1. Natural...

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Transcript of Scale Up and Spread...9 Methods for spread and scale up: Massoud, Donohue, McCannon 2010 1. Natural...