Whole Systems Rapid Improvement Events

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• Whole Systems Rapid Improvement Events
• from Sex Ed to Submarines!
• Alastair Mitchell-Baker, Tim Pidsley

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Unclear problems, unknown solutions
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What can you expect?
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Background- What fields of expertise does the
development and delivery of WSRIEs draw upon?
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The Organisation Improvement Territory the
environment for WSRIEs
nature of organisation / issue
nature of the transformation
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The Transformation Continuum examples from
Healthcare
simple
complex
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The Organisation Improvement Territory
online
WSRIE
offline

organisation, issue
complex
simple
transformation
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Key Features of WSRIEs

• Whole system in one room
• Support from experienced facilitators
• Principles to unpick complex, systems problems
• Senior stakeholders back the process and empower
  the team
• Tight timescales creates focus and urgency
• The approach is transferable

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Sex in Stockport an exemplar application

• Primary Care Trust Government funded community
  healthcare provider for town of 200,000
• Contraceptive and Sexual Health Services
• Unclear direction organisation
• Dispersed fragmented service model
• Key facility moving
• Rising demand
• Improved productivity needed

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Submarines in the South an exemplar application

• Partnership with Royal Navy to deliver training
  and manage facilities
• Partnering contract and intent matching
  behaviour?
• 2 regions different client and customer culture
  in each region
• Bitty, organic growth
• Lack of strategic clarity
• Need to save 6m, but have already salami
  sliced to the max
• 50 of delivery through subcontractors
• 5 week deadline

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Process Overview

• Preparation
• Multiple stakeholder interviews
• Map process
• Data collection and analysis

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WSRIE Parameters
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Theory to Practice from game plan to reality
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Interviewing and Analysis understanding the
current system and the nature of the work
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Whole work (process) mapping
Feb
2008
Transfer Service Whole Work Map
Section
5
??
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Systems Mapping
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Franklin Reality Model exploring the way
experiences and beliefs influence behaviours and
results
BELIEFS
BEHAVIOURS
drive
motivate
achieve
EXPERIENCES
RESULTS
(Franklin Quest Corporation)
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Belief GENERAL PRACTIONERS
Behaviour

• PCOS physios dont have the skills to diagnose
• Its insulting for GPs to have their referrals
  checked
• It will better and easier if GPs could refer
  direct to consultants
• PCOS, MSK delay patients leading to chronic
  conditions
• PCOS was imposed on GPs
• Lost of relationship with consultants

• Mistrust PCOS care reports
• Use back door referrals to consultants
• Blame PCOS
• Use dual referrals
• No system learning

Belief PCOS, MSK, Biomechanics
Behaviour

• GPs referrals are information poor
• GPs dual refer
• Not appreciated for reducing non-surgery
  referrals to NCH.
• No one trusts us
• No access to higher clinical authority
• Staff need training skills updated
• Demand is exceeding capacity

• Mistrust and blame the GPs
• Rerefer patients within CSU services
• Apathetic, doing what we can
• No system learning

Belief CONSULTANT
Behaviour

• PCOS staff are under trained dont have
  appropriate diagnostics skills
• PCOS, MSK delays patient flow
• GPs orthopaedic skills are out of date
• GPs cant be bothered to receive additional
  training
• PCOS MSK delays drive patients to private care
• No audit data is recorded in PCOS

• Mistrust of PCOS diagnosis/x-ray interpretation
• Mistrust of GP referrals
• Blame both PCOS GPs
• No system learning

Warrington orthopaedics system ?
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Getting to know each other
Whole system in the room
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Feeding back Numbers!
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Tricord feedback
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Understanding the organisation
We do not think and talk about what we see we
see what we are able to think and talk about (Ed
Schein)
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Stepping into consultants shoes- Designing HMS
Anywhere
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Developing a vision
CY
Adult Hub
Adult CASH clinics
Outreach CY
Adult CASH clinics
Outreach CY
Adult CASH clinics
CASH Central Complex procedures GUM level
12 Gynae CATS with Ultrasound IT, Central
booking admin Staff base
Outreach CY
Adult CASH clinics
Outreach CY
Supported outreach to high risk
groups Homeless, disabled, Gay lesbians,
Asylum seekers Ethnic Minorities
Remodelled Staff skill mix with enhanced
skills incl GUM level 1/2
Training support to GP practices, school
nursing, other services etc
Links with FT GUM service chlamydia screening
centre
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Pitching and Voting
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Facilitators playing different roles
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Consultants stepping back
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Implementation support
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Venues!
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Learning summary of learning from reality of
delivering

• Facilitate the process
• Be clear about roles
• Give organisation and participants ownership of
  process and content
• Models and theory illuminate but dont answer
• Collect data to support observations
• Be prepared for challenges and surprises
• Dont productise be prepared to engage with
  uniqueness
• Challenging
• Engage the necessary support

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Limitations

• Scheduling interviews / workshops.
• Dependency on the client
• An exposing process
• Time for details

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The Future