Taking the tool forward:Service Improvement

Author: Ali Ewing, Principal Lecturer Learning and TeachingJuly 2011

The University of NorthamptonPark Campus, Boughton Green Road

NORTHAMPTON, UK. NN2 7AL

What is service improvement?

Improvement is ‘the combined and unceasing efforts of everyone,…to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)’ (Batalden and Davidoff 2007)

Seeing the bigger picture

Adapted from 'The Blind Man and the Elephant' by John Godfrey Saxe (1816 – 1887)cited by Paul Luvera Journal at http://www.paulluvera.com/weblog/2007/03/truth_the_poem_.html

Four Parts to Improvement (Clarke et al 2004)

Stakeholder involvement: listening and understanding

Personal and organisational development: Recognising different cultures and people

Process and systems thinking Effects of different practices and procedures

Initiating, delivering and sustaining improvement:

Plan and measure effects of improvement

Tools for service Improvement

What is the problem? Process mapping: What is the current

process? How long does each part of the process take? What is your demand? What is your capacity? What are your potential constraints? Where are potential for improvement?

Three key questions

What are we trying to achieve?

How will we know that a change is an improvement?

What changes can we make that will result in the improvements that we seek?

PDSA Cycle

Plan, Do, Study Act (PDSA) cycle is a way of testing an idea by putting a change into effect on a temporary basis and learning from its potential impact.

Different from traditional approach where often new ideas are introduced without sufficient testing.

PDSA Cycle

Plan: agree change to be tested or implemented

Do: carry out the test or change and measure the impact

Study : study data before and after the change and reflect on what was learnt

Act : plan the next change cycle or plan implementation

Construct (simple) practical solutions PDSA

For further information on this see the NHS Institute for Innovation and Improvement

‘Plan, Do, Study, Act (PDSA)’.

http://www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/

plan_do_study_act.html

[accessed 01.09.11]

Why test before implementing?

Less time money and risk involved Process is a powerful tool for learning, and

much can be learned from ideas that do not work as well as those that do

Less disruption for everyone After involvement if development and

testing often greater enthusiasm for implementaion.

What might your obstacles be?

The human dimensions – comfort zone The organisation – current systems Over complicate the process Time! Change!

References

Batalden P, and Davidoff F,. (2007) What is ‘quality improvement’ and how can it transform healthcare, Quality and Safety in Health Care, 16, 2-3

Clarke C, Reed J, Wainwright D, McClelland S, Swallow V, Harden J, Walton G, and Walsh A,.(2004) The discipline of improvement: something old, something new, Journal of Nursing Management, 12, 85-96

NHS Institute for Innovation and Improvement www.institute.nhs.uk

This work was produced as part of the TIGER project and funded by JISC and the HEA in 2011. For further information see: http://www.northampton.ac.uk/tiger.

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