Consolidating Service Development

Angela Mack
National Improvement Lead, NHS Improvement

Head of Audiology, Bolton Hospitals Trust

angela.mack@improvement.nhs.uk

There is considerable evidence of high failure rate in projects sustaining their efforts (as much as 70%)

Daft & Noe 2000

around 33% of improvement projects had reverted to their previous way of working when evaluated 1 year after the project had formally ended around 33% had maintained the improvement but it had not been adopted by others in the organisation around 33% had maintained the gain and there was evidence of adoption out side of the core change area
NHS Institute for Innovation and Improvement 2006

Sustainability is when new ways of working and improved outcomes become the norm.

Not only have the process and outcome changed, but the thinking and attitudes behind them are fundamentally altered and the systems surrounding them are transformed in support.

Ten factors influencing sustainability

NHS Institute for Innovation and Improvement 2006

Process:
Benefits beyond helping patients making job easier Credibility of benefits obvious, evidence based, believed Adaptability of improved process continuous improvement Effectiveness of system to monitor progress communication of results

Dont under estimate the power real data

Chart showing daily ENT activity, the blue line shows wasted capacity. This visually illustrates the problems caused by poor co-ordination of booking with ENT

Visual Management

Poka yoka devices will not allow errors or people to go back to the old ways!

I think changes are sustainable when the process.

tackles the real underlying issues

focuses on patients and what they want

MRRequest - Scan wc 11th June 2007

100
11

80 60 Days 40 20 0 -20 1 9 17 25 33 41 49 Patients 57 65 73 81 LCL=-18.9 _ X=20.0

1 1 1 1

UCL=59.0

uses FACTS and real up to date DATA

is clear and understood by everyone

Staff
Staff involvement in planning, training and implementation Staff attitudes towards sustaining change empowerment Strong leadership and support from Senior Management Clinical engagement responsibility and advice

Change is situational: new site,

new boss, new team roles, new policy.

Transition is the psychological

process people go through to come to terms with new situations

Change is external, transition is internal.

Bridges, W. (2003) Managing transitions: Making the most of change, 2nd ed London, Nicholas Brearley.

Transition is an emotional journey

Morale Anger Fun? Continuous improvement

Lost Denial Despair Learning

Clues

Understanding

Transition
o transition starts with an ending o the neutral zone is the no-mans-land between old and new o transitions end with a new beginning

ENDING NEUTRAL ZONE BEGINNING

The transition process

The ending
when we acknowledge that there are things we need to let go of when we recognise that we have lost something

The neutral zone

when the old way has finished but the new way is not developed yet when everything is in flux and it feels that no-one knows what they should be doing when things are confusing and disorderly

The beginning
when the new way feels comfortable, right, the only way

Most organisations try to start with a beginning, rather than finishing with it. They pay no attention to endings. They do not acknowledge the existence of the neutral zone, then wonder why people have so much difficulty with change.

To help people through transition

Identify the key groups/individuals and find out what makes them tick Acknowledge what must be achieved and what the team do have the power to influence Value each individuals preferred communication style and contribution to the team Identify what could done to support or destroy Minimise the opportunities for destruction and maximise/sell the things they are interested in Whats in it
for me?

Once changes are in place

How do we best tackle members of the team not using the new ways? Find out why

Training- do they need further instruction or development Confused- have new ways of working been clearly communicated to all team members Lack of time or equipment- can you identify additional resources to help establish the changes Non compliance- are they still moving through the change curve, may need to go back and support the individual as they address their issues Something else- is there a reason an individual will not conform that needs to be addressed

Transition is an emotional journey

Morale Anger Fun? Continuous improvement

Lost Denial Despair Learning

Clues

Understanding

Organisation
Fit with organisations strategic aims and culture Infrastructure for sustainability staff, facilities, equipment Providing audiology closer to home without facilities

Report benefits in terms of QIPP

% of patients given individual care plan Number of patients using loop systems after interactive loop system demonstration

Quality

Innovation

Number of appointment slots used each week

Productivity

Prevention

Number of patients given advice regarding reduction of noise exposure

Celebrate and Share Success

The NHS Sustainability Model

Maher, Gustafson, Evans 2003
NHS Institute for Innovation and Improvement 2006

An easy to use tool to help NHS teams:

Identify & understand key barriers to sustainability for their specific situation Know what they can do to overcome those barriers Monitor progress toward sustainability over time

NHS Institute for Innovation and Improvement 2006

It can be difficult
It is not the strongest species that survive, nor the most intelligent, but the ones who are the most responsive to change." Charles Darwin

References

Buchanan D, Fitzgerald L, Ketley D (2007) , The sustainability and spread of organisational change , London, Routledge NHS Institute for Innovation and Improvement (2007) Improvement Leaders Guide : Sustainability http://www.institute.nhs.uk/ NHS Institute for Innovation and Improvement sustainability model http://www.institute.nhs.uk/sustainability_model/general/welcome_to_sustainability.html The New Improvement Wheel (2005) NHS Modernisation Agency Research into Practice report 14