NHS

1 A simple guide to improving servicesFirst steps towards quality improvement: Improving QualityNHSEIMPROVEMENT. PEOPLE. QUALITY. STAFF. LEAN. PATIENTS. PRODUCTIVITY. MAPPING. SOLUTIONS. PROCESSES. TOOLS. STRENGTH. SUPPORT. TEST. IMPLEMENT. SCOPE. INNOVATION. DELIVERY. DIAGNOSIS. EVALUATION. NHS. FRAMEWORK. IMPLEMENTATION. 1 - Improvement modelsChapter 2 - Defining the change idea and developing aimsChapter 3 - Managing a successful project Chapter 4 - Levers and drivers framing the work for a wider audienceChapter 5 - Getting the right people involvedChapter 6 - Involving patients and carers in service redesignChapter 7 - Communicating the right things to the right peopleChapter 8 -Improvement tool: Process mappingChapter 9 - Improvement tool: plan , do, study , act cycles Chapter 10 - Measuring your effortsChapter 11 - Improvement tool.

2 Using statistical process control charts Chapter 12 - Human dimensions of changeChapter 13 - Sharing your successAcknowledgements 4681114161822242830343740442/3F I R S T S T E P S T O WA R D S Q U A L I T Y I M P R O V E M E N T: A S I M P L E G U I D E T O I M P R O V I N G S E R V I C E SBefore implementing a solution and changing your service, it isessential to understand your current system by mapping theprocess, collecting and analysing the service data, along withasking patients and staff for their views, in order to determinewhere improvements can be made.

3 Don t rush intoimplementing whole system changes without testing andmeasuring small incremental changes. Learn from experienceand be prepared to be flexible as your first idea may not be thebest or the right solution. This resource is not intended as a complete guide but provides ashort overview with the most relevant tools and other resourcessignposted for further exploration. If you want to deliver sustainable improvements with greaterspeed and confidence, this resource will help you take the firststeps. INTRODUCTIONF I R S T S T E P S T O WA R D S Q U A L I T Y I M P R O V E M E N T.

4 A S I M P L E G U I D E T O I M P R O V I N G S E R V I C E SIf you are involved at any level in improving health orsocial care, this resource will provide the informationyou need for your first steps towards making qualityimprovements, giving your improvement project thebest possible chance of you are experienced at running improvementprojects or not, this blend of project management andimprovement tools, combined with practical know-howand first hand experience gained from working with NHSteams, should prove system isperfectly designedto get the results itachieves Paul BataldenCHAPTER 1 Improvement modelsThere are many models which can supportyour improvement project.

5 However, wepromote two such models: a five stepapproach to successfully manage the change project from initial concept tocompletion, and the Model for Improvementto provide a framework for developing,testing and implementing step improvement approach A five step improvement approach has beendefined to provide a systematic frameworkfrom the beginning to the end of yourimprovement project which will give yourproject a greater chance of sustainablesuccess. Preparation Launch Diagnosis Implementation Evaluation The preparationphase incorporateseverything you need to do before the official start of your project.

6 This includesdefining your project aims and objectives,collecting baseline data for your service, understanding what you are going toaccomplish, identifying a core team toundertake the work and a team to supportthe direction of the work along withidentifying patients and carers to beinvolved. Work should be aligned to bothlocal and national objectives together withstructured plans to measure improvements. Thelaunch phase is the official start of theproject. The team should be formed; projectplans, communication plans and datacollection plans should be in place and anexecutive sponsor identified to support is aboutunderstanding the current process,dispelling assumptions, using data to definethe problem and to build upon the tests andmeasures potential solutions using a plan ,do, study , act (PDSA) cycle (chapter 9),implements the best solution and introducesstandard work and mistake proofing for aquality sustainable process.

7 The final phase is evaluationwhereachievements are celebrated, learning andprinciples are captured and the improvementbecomes the norm. F I R S T S T E P S T O WA R D S Q U A L I T Y I M P R O V E M E N T: A S I M P L E G U I D E T O I M P R O V I N G S E R V I C E SDo I really need a model to improve things? Very often, it is clear that we need toget on and improve things and youmay be tempted to leap in and do , a very high proportion ofprojects fail, and one way to increasethe chances of your own projectsucceeding is to adopt a moresystematic, tried and tested approachsuch as those outlined on this improvement requires the will,the ideas and the execution of thoseideas to succeed very often, we havethe will to make things happen, but byusing models such as these.

8 We canensure we develop the best possiblechange ideas and approachimplementation in a planned andsystematic way to enhance ourchances of Model for ImprovementThe model for improvement is incorporatedinto the five step approach and wasdesigned to provide a framework fordeveloping, testing and implementingchanges that lead to improvement. Toachieve improvements we need to take thetime to plan change and test it out andresist the temptation to rush into wholesalechanges to systems. This way, we will knowwhat is working well, and what is not sosuccessful.

9 Small scale changes can beundone and replaced by alternative sum of all of the change ideas that aretested and successfully implemented will bethe effective redesign of processes or waysof framework, which was developed by ateam at the Institute for HealthcareImprovement in the USA, includes three keyquestions to ask before embarking on achange programme, supported by a processfor testing change ideas using plan , do, study , act (PDSA) are we trying to accomplish? Clear and focused goals that focus on problems that cause concern for patients and staff Consistent with local and national outcomes, plans and frameworks Bold and aspirational With clear numerical will we know if a change is animprovement?

10 What can we measure that will change if the system is improved? How can we obtain this data? Is it available in existing information systems, or will we need to collect this manually? What is the best way to display the data we collect so that we can decide whether we are improving the system and whetherthe improvement is sustainable? Measure the baseline how is the processor system performing before the change is made? Measure regularly during testing what is the impact immediately, and what is the impact over a period of time? Continue to measure after the improvement is implemented, to ensure that the change is changes can we make that willresult in improvement?