Introduction to service redesign

1
Introduction to service redesign
Making sense of improvement tools
Ian Golton
2
Todays menu
Introduction
The Model for Improvement
Process mapping
PDSA cycles
Measurement and data
3
The Model for Improvement
4
A model for improvement...
The fourthquestionhow to make changes
5
The Model for Improvement
Useful framing for improvement work
Incorporates the key principles Use as a
touchstone to measure you plans against
Reminds of simplicity Provides a common
vocabulary
6
Process mapping
7
Process mapping in a few words

• A way to understand the main steps in a
  particular journey (or process).

• Writing the recipe for the way the something
  happens

• Drawing a flowchart of how the organisations
  work together

8
Example 1 Brighton
9
Process map example
?
10
Process redesigned
11
Example 2 Hull
12
Before...
Referral and Discharge Letters
Cardiac catheterisation lab, Hull Royal Infirmary
13
after.
14
A real-life process map
15
Why bother with process mapping?

• Possibly the most useful tool in improvement work
• Works within organisations and/or between
  organisations
• Understand current systems
• Identify areas to investigate/change/improve -
  particularly handoffs, duplication and why on
  earth do we do that?
• Team-building process - helps shared
  understanding and building links etc.
• Frame of reference for future

16
Exercise
17
Having a go at process mapping?

• Pick a process you can all comment on- going on
  holiday- getting up in the morning- attending
  an improvement workshop- responding to a heart
  attackor anything else your imagination
  suggests
• Map the key steps in the process

18
Hopefully helpful hints

• Define the scope- what process are you going to
  map?- what are the start and end points?
• Make sure everyone comments - if not, why not
• Try not to get too cognitive - keep based
  mostly on practical actions
• Start off by trying to get a first draft map of
  the high level process - six or seven steps -
  then pick aspects to map in more detail
• Bonus points for finding areas for improvement in
  the CHDC workshop process!

19
PDSA
20
PDSA is
Plan
how to explicitly test a small change
what you have planned to do
the outcomes, expected and unexpected, of the
test
on the results to modify and improve
21
The PDSA Cycle
Act
Plan

• Objective
• Questions/predictions
• Plan to carry out the cycle
• (who, what, where, when)
• Plan for data collection

• What changes
• are to be made?
• Next cycle?

Study
Do

• Complete the
• analysis of the data
• Compare data to
• predictions
• Summarize what
• was learned

• Carry out the plan
• Document problems
• and unexpected
• observations
• Begin analysis
• of the data

22
Developing improvement with PDSAs
23
Developing improvement with PDSAs
24
PDSA cycles

• Have a long pedigree
• Are similar to techniques such as audit cycles,
  plan-do-check, etc.
• Natural to health care
• Small in scope and build incrementally
• Used and developed by participants in the
  Collaborative

25
Objective Make Mondays easier. Increase
same-day capacity on our busiest day for same-day
requests by not booking follow-ups on Monday
Plan Abolish follow-ups by all doctors on
Mondays (except 8.30am-9.30am 5pm-6pm - popular
times for our working population). Monitor GP 3rd
available appointment Test on next 4 Mondays
26
Advantages of PDSA approach

• Makes processes and learning explicit...which is
  especially useful for team working
• Enables testing of ideas to- customise change
  for to local conditions- evaluate
  side-effects- improve the idea based on
  learning- reduce risks
• Minimise problems with getting started-
  persuading the reluctant- longest journey/first
  step stuff
• Promotes bitesized chunks

27
Most common mistakes

• Too big- size matters make it manageable and
  realistic, break down big changes into
  less-than-elephant sized pieces
• Too vague- need some detail, although to a
  practical, not obsessive, level
• Too qualitative- qualitative data important, but
  best if complemented by quantitative
• Too trivial (or too vital)- must provide useful
  information, but not cause panic and anxiety

28
Measurement
29
Measurement

• Serves many purposes
• Has had a bad press
• Simple and few
• Balanced
• Support improvement work

30
What does measurement do?
31
Uses of measurement
for judgement (are things good or
bad?) for monitoring (are things
ticking over nicely?) for improvement
(how do we know the impact of the changes were
making?)
32
Instrument panels
33
However
34
Exercise
35
In your work

• What measurements are routinely collected?
• How useful are they?
• What would help you to a) judge, b) monitor and
  c) improve your work?
• What is/are your speedometer/temperature
  gauge/warning lights
• How could you collect these measurements?

36
Hints about measurement
Be aware of why youre measuring Ideally -
useful and practical How will you and your
colleagues use it? Make best use of routine
measurement How can you make data collection
as simple as possible
37
Measurement in the boardroom!
38
and finally
39
Why should I change?because there is a benefit
to change
Three types of change

• Internal dissatisfactionPerceived problems or
  shortcomings that cause dissatisfaction
• Internal developmentThings are comfortable or
  adequate, but there is perceived benefit from
  doing even better
• External influenceThe context changes what was
  acceptable is no longer so new technologies or
  ideas develop those outside the organisation
  clamour for change

40
The most important things
Analyse - understand - improve Start small
and keep going Make it a team effort Use
measurement effectively and sensibly Clear
about benefits and expenses Leadership support
41
More information
Your local MA programmes/projects Trust/PCT
improvement leads/staff www.modern.nhs.uk
www.ihi.org/resources/qi/index.asp