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![Page 1: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/1.jpg)
The life-cycle of improvement; and how to make it sustainable
Dr. Martin Wale, Exec MD, QRSVancouver Island Health Authority
![Page 2: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/2.jpg)
The non-sustainable change:
• Does not solve the problem – and is therefore dysfunctional
• Creates the illusion of progress – and is therefore dishonest
• Brings improvement into disrepute – causing long-term damage to the process and future chances of success
![Page 3: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/3.jpg)
How to do something different
• “Every system is perfectly designed to deliver the results it delivers” (Berwick)
So change the system
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First and Second Order Change
First-order change Second-order Change
Underlying mental model Unaltered Altered
Specific way we do something
Changed Changed
Relationship to modernization
Predominant current approach to improvement
Enhanced approach; improvement with
creativity and innovation
ExampleReduced DNA’s by patient agreeing date for follow-
up appointment
Question need for follow-up appointment in Acute Trust. Alternatives: by telephone, in primary care, or not required
Impact Incremental improvement Innovation
© NHS Institute for Innovation and Improvement
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Life cycle of an “improvement”
Time
Improvement
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Life cycle of an “improvement”
Time
Improvement Implement
Sign-off
Next initiative
Measure
{
Plan
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Intervention points
Time
Improvement
Planning time
Implementation rate
Efficacy
Fade
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Life cycle of a “real” improvement
Time
Improvement
Planning
Implementation
Efficacy
Learning
?Efficacy
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Conceptual and theoretical bases for spread of innovation
From Greenhalgh et al (2005, fig. 3.5, p 82)
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NHSI Methodology
Co-production, co-production, co-production. And share credit.
© NHS Institute for Innovation and Improvement
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Learning phase
“You have to go down blind alleys. But every once in a while you go down an alley and it opens up into this huge, broad avenue. That makes all the blind alleys worthwhile.”
Jeffrey P Bezos, President & CEO, Amazon.com
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Creativity – discipline cycles
© NHS Institute for Innovation and Improvement
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De Bono: mental valleys model
© NHS Institute for Innovation and Improvement
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De Bono: mental valleys model
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Understand and reframe
• Understand stakeholders
• Observe & inquire
• Frame and reframe
• Understand themes
– Relationship management
– Communications
– Measurement
– Project management
© NHS Institute for Innovation and Improvement
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Understand Stakeholders
• Confirm sponsors, clarify roles
• Identify stakeholders and their roles
– Including for the implementation phase
• Consider
– What change in behaviour are you trying to produce?
– How will you do this?
• Identify key connectors
© NHS Institute for Innovation and Improvement
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Stakeholder analysis model
© NHS Institute for Innovation and Improvement
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Observe & inquire
• People do not always do what they say they do• People do not always do what they think they do• People do not always do what you think they do• People cannot always tell you what they need
From IDEO
“If you are not in the jungle, you are not going to know the tiger”
Tom Kelley
© NHS Institute for Innovation and Improvement
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Observation
• Goals
– To gain new and extended insight into the issue.
– To examine solutions from other industries or healthcare systems.
– To gain inspiration or new ideas
• Wide search
• Think about second order change
• Explore novel connections
© NHS Institute for Innovation and Improvement
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Observation
• Take notes & pictures
• Consider
– ? Observing for understanding
– ? Observing for inspiration
• Within the area
• Outside the area
– Analogous situations
– Extreme users
© NHS Institute for Innovation and Improvement
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Observation techniques
• Keep an open mind
• Talk, so people will talk
• Give people time to talk
• Design tools to open dialogue
• Don’t correct misperceptions
• Five why’s
• Draw it, show me, think aloud
• Sit and watch
© NHS Institute for Innovation and Improvement
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What to look for
• Pauses in action
• Things or qualities which prompt behaviour
• Work-arounds or adoptions
• Body language
• What people care about
• Surprising behaviours or uses of items
© NHS Institute for Innovation and Improvement
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Frame and reframe
• Don’t be afraid to shift your perspective or position
• Present alternatives
• Talk to people
© NHS Institute for Innovation and Improvement
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The Innovation Funnel
© NHS Institute for Innovation and Improvement
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Life cycle of a real improvement
Time
Improvement
Planning
Implementation
Learning
![Page 26: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/26.jpg)
Sustainability (finally)
![Page 27: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/27.jpg)
The non-sustainable change:
• Does not solve the problem
• Creates the illusion of progress
• Brings improvement into disrepute
So you need to know in advance,so you can fix it
![Page 28: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/28.jpg)
Questions?
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Sustainability Tool in actionMAX Group 1 Group 2 Group 3
8.5 Benefits 4.7 4.7 8.5
9.1 Credibility 3.1 9.1 6.3
7.0 Adaptability 7.0 7.0 7.0
6.5 Monitoring 6.5 2.4 6.5
11.4 Involvement/training 6.3 0.0 11.4
11.0 Behaviour 0.0 0.0 11.0
15.0 Senior Leaders 15.0 5.7 15.0
15.0 Clinical Leaders 6.7 0.0 15.0
7.0 Goals & Cultures 3.3 3.5 7.0
9.5 Infrastructure 3.3 0.0 3.3
![Page 30: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/30.jpg)
Life cycle of a real improvement
Time
ImprovementImplementation
![Page 31: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/31.jpg)
Life cycle of a real improvement
Time
Improvement
Efficacy ?Efficacy
![Page 32: The life-cycle of improvement; and how to make it sustainable Dr. Martin Wale, Exec MD, QRS Vancouver Island Health Authority.](https://reader035.fdocuments.us/reader035/viewer/2022070400/56649f125503460f94c256e6/html5/thumbnails/32.jpg)
Questions?Energy
Time