NSAP CQI webinar Implementing change: Challenges to make sustainable improvements to provide support for Carers - Standard 5

Transcription

1 NSAP CQI webinar Implementing change: Challenges to make sustainable improvements to provide support for Carers - Standard 5 Helen Vaz NSAP Quality Manager 28 th August 2014

2 Purpose of Session Go through what is sustainability? What influences it and how? How to make it happen. The evidence for what works Experience from a Service

3 The Improvement frustrations Islands of improvement effect Improvement evaporation effect Clinical Excellence Commission 2008

4 Sustainability what is it? Holding the gains and evolving as required, definitely NOT going back to the old way Ensuring gains are maintained beyond the life of the project When new ways of working and improved outcomes become the norm NHS Institute for Innovation and Improvement

5 Sustainability what does this mean? The thinking and attitudes behind the new ways are fundamentally altered The process and outcomes have changed The systems surrounding the new ways have been transformed to support the changes NHS Institute for Innovation and Improvement

6 Is it sustainable? Idea! PDSA - 1 PDSA - 2 PDSA - 3 Time from admission to assessment of carer needs PDSA - 4 Before Now Later (adapted from presentation by Dr Lynne Maher NHS 2006) Time

7 Influences on Sustainability Jurisdictional Organisational Specialty/Unit Team Improvements Individual

8 The Sustainability Model 10 key factors that increase the likelihood of sustainability and continuous improvement Maher, Gustafson & Evens. NHS Modernisation Agency 2003

9 Using SM in practice Resources available on the NSAP website in the CQI kit Sustainability checklist (provides data that can be tracked) Sustainability worksheet (Provides a plan) These are based on the NHS SM Maher, Gustafson & Evens. NHS Modernisation Agency 2003

10 Sustainability checklist STAFF Executive leadership engagement Clinical leadership engagement Are the senior leaders trustworthy, influential, respected and believable? Are they involved in the initiative, do they understand it and do they promote it? Are they respected by their peers and can they influence others to get on board? Are they taking personal responsibility & giving time to help ensure the change is sustained? Are the clinical leaders trustworthy, influential, respected and believable? Are they involved in the initiative, do they understand it and do they promote it? Are they respected by their peers and can they influence others to get on board? Are they taking personal responsibility & giving time to help ensure the change is sustained? Score: /N yes=1 no=0 /4 /4 Staff involvement and training to sustain the process Do staff play a part in innovation, design & implementation of change? Have they used their ideas to inform the change process from the very beginning? Is there a training & development infrastructure to identify gaps in skills & knowledge and are staff educated and trained to take change forward? /3 Staff attitude/ behaviours towards sustaining the change Are staff encouraged to express their ideas and is their input taken on board? Are staff able to run small-scale tests (PDSA) based on their ideas, to see if additional improvements should be recommended? Do staff think that the change is a better way of doing things that they want to preserve for the future? /3 ORGANISATION Infrastructure for sustainability Do you have enough good quality, trained staff? Are there enough facilities and equipment to support the new process? Are new requirements built into job descriptions? Are there policies and procedures supporting the new way of working? Is there a communication system in place? Has the organisation successfully sustained improvement in the past? Are the goals of the change clear and shared? Is it contributing to the overall organisational aims? Is change important to the organisation and its leadership? Does your organisation have a can do culture? /5 Fit with organisation s strategic aims & culture PROCESS Credibility of the benefits Effectiveness of system to monitor progress (tracking & reporting) Are benefits to patients, staff and the organisation visible? Do staff believe in the benefits? Can all staff describe the benefits clearly? Is there evidence that this type of change has been achieved elsewhere? Does the change require special monitoring systems to identify improvement? Is this data already collected and is it easily accessible? Is there a feedback system to reinforce benefits and progress and initiate action? Are the results of the change communicated to patients, staff, the organisation? Score: /N yes=1 no=0 /5 /4 /4 Adaptability of improvement processes Can the process overcome internal pressures and continually improve? Does the change continue to meet ongoing needs effectively? Does the change rely on an individual or group of people, technology, finance etc to keep it going? Can it keep going when these are removed? /4 Benefits beyond helping patients In addition to helping patients, are there other benefits? For example, does the change reduce waste, duplication and/or added effort? Will it make things run more smoothly? Will staff notice a difference in their daily working lives? /3 Barriers removed Are the staff competent in the new way of doing things? Are there enough resources and equipment to support the new process? Are new requirements built into job descriptions? Are there policies and procedures supporting the new way of working? Is there a communication system in place? /5 TOTAL /44

11 Sustainability Plan Part1. In your group discuss the improvement that you are introducing by answering questions. Part 2. Action Plan Think of the barriers to sustainability of your improvements and identify possible solutions (Nominal Group Technique, Brainstorming) Action: who will be responsible for this, when does it need to happen, and how will you communicate this? Staff Factors Barrier to sustainability Action: What needs to be done? Responsibility & When Executive support e.g. Exec Director not engaged. New form for holistic assessment process has been trialled, but form bogged down in unproductive meetings, and so staff continue to use old form. Mentioned in progress report to Medical Director, but no response. Staff need to know that the organisation thinks that holistic assessment is important. Convince medical director of importance of the project and holistic assessment, and seek help in getting it thru forms committee. Remove old form from computer. Project manager and Unit manager to seek meeting with Med. Dir. next week Draft letter to IT manager on behalf of Medical Director Executive support Clinical leadership

12 Applying the NSH SM Assessed how using the SM prompted Project teams to take action for sustainability Majority used it sporadically The SM enables teams to - Systematically consider determinants of sustainability - Provide timely data to assess progress - Prompt action to create conditions for sustained practice Doyle et al 2013

13 What works Lessons learnt from UK.. It is the result of effective preparation and implementation It will not just happen ; you need to plan for it Improvement programmes will only succeed if the same effort is put into their sustainability as their launch Health Service Management Centre 2002

14 What works Tips Identify what you want to sustain: the change, the outcome, the culture, the relationships Stakeholder must see benefit (WIIFM) Training and education as part of practice Incorporated into policy and procedures Establish continuous measurement

15 Evidence: Supporting Sustainability Early and widespread involvement of staff at all levels especially top management support and advocacy Human resources Motivation, capacity and competence of practitioners Appropriate training Organisational structure Devolved decision making to departments and teams Intra-organisational networks Effective communication across department boundaries From Trish Greenhalgh et. al. Diffusions of Innovations in Service Organisations: Systematic Review and Recommendations. Milbank Quarterly 82 (4) 2004:

16 Resources Enhancing Project Spread and Sustainability. A Companion to the Easy Guide to Clinical Practice Improvement August Clinical Excellence Commission. documents/resources/tools-_and_-toolkits/spread-and-sustainability.pdf The Clinician s Toolkit for Improving Patient Care. Easy Guide to Clinical Practice Improvement. Sustainability Model and Guide. NHS Institute for Innovation and Improvement Doyle et al, Making change last: applying the NHS Institute for innovation and improvement sustainability model to healthcare improvement. Implementation Science : Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD DOI: / CD pub2. Bryan J Weiner. A theory of organizational readiness for change. Implementation Science :67. Grol. R., M. Wensing and M. Eccles. Improving Patient Care: the Implementation of Change in Clinical Practice. Elsevier Straus, S., J. Tetroe, I. Graham. Knowledge Translation in Health Care: Moving from Evidence to Practice. Wiley- Blackwell. BMJ books Greenhaugh, T. Kyriakidou, O. Peacock R. How to spread good ideas: A systematic review of literature on diffusion, dissemination and sustainability of innovations in health service delivery and organisation. University College London. April 2004 National Institute of Clinical Excellence. Identifying Barriers to Evidence Uptake. Feb 2006 Robertson, R. Jochelson, K. Interventions that change clinician behaviour: mapping the literature. NICE, 2006

17 Summary Importance of including sustainability in the planning and implementation for a project Example of how to do this using the sustainability model

18 Acknowledgements Dr Jan Davies Improvement Advisor for NSAP Support for Carer Collaborative Improvement Project (adapted her presentation) Now onto the experience from a Service that participated in the Support for Carers Collaborative Improvement project