From here to eternity

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From here to eternity
30 September 2014
Presenter Mike Davidge
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A leaders walkround
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Stop 1 Theatre
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Stop 2 Ward
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Stop 3 ITU
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Stop 4 Physios
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Stop 5 Pharmacy
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Which future?
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This could be you!
Could it? How?
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How did they get there?

• The wise man built his house upon the rock.
• The rock of reliability

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How did they stay there?

• Sustainability is when new ways of working and
  improved outcomes become the norm.
• Spread is the extent to which learning and change
  principles have been adopted in other parts of
  the organisation that could benefit from them.

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Tips for Sustaining your gains

• WIIFM
• Clear benefit for stakeholders
• Education, education, education
• Training and education, new and old
• Its not what you do, its the way that you do it
• Build the change into the structure of the
  organisation and make it the new standard
• We manage what we measure
• Build in ongoing measurement of key outcomes and
  processes
• Make it part of the day job
• Job descriptions and objectives
• Party time!
• Celebrate, renew and set the bar higher

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How likely are you to slip back?

• Take an area you have recently improved. Discuss
  with your neighbour how many of the 6 factors are
  in place
• Staff involved see the benefit to them
• Training programme in place for new and temporary
  staff
• Change now incorporated into standard way of
  working
• You review regularly 1 measure each of outcome
  and process
• The change is now in any relevant Job
  descriptions and objectives
• You have recently celebrated the success
• Which one do you want to tackle next?

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Sustainability model guide

• www.institute.nhs.uk/sustainability

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How does spread happen?

• Spread is the result of the process of adoption,
  not the other way round.
• In other words, spread happens best when people
  pull the change into their work rather than have
  it pushed (or foisted) on them

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Adopt principles not solutions
Change principle
Change principle
And expect local re-invention
Solution in Area A
Solution in Area B
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Spread v Adoption
Spread
Adoption

• push ideas outward to others

• pull ideas into myself

• my agenda the centre of the larger organisation

• my agenda the sharp end of delivering care

• use of organisational structure and hierarchy

• use of social systems

• tools, techniques and processes

• relationships and facilitation

Taken from Fraser SW and Plsek PE, Translating
evidence into practice Can it be done through
the process of spread?
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Spread strategies

• Cards stacked in your favour
• Choose your partners carefully
• Create pull
• Curiosity, communications, commitment
• Consider infrastructure support
• Concentrate on principles and values
• To leave room for local innovation and adoption
• Carpe diem
• Look out for local initiatives and build on their
  successes

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Spread quiz

• How many have you tried?
• Chosen teams to spread to based on assessing the
  risk
• Planned to weaken resistance where youre working
  next
• Tailored your communications to attract new
  volunteers
• Raised local awareness by using local process
  mapping events
• Encouraged teams to observe the benefits without
  having to commit to change immediately
• Resourced extra staff to facilitate spread
• Built on existing projects

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• The successful projects have obviously not been
  those projects that have gone to a consultant and
  said, Youve got to do this.
• It has been, This is the benefit to you, this is
  the benefit for your patients and its those
  projects that have got groups of clinicians on
  board and then have used those clinicians to sell
  the project to other clinicians, that have been
  the really successful ones.

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W Edwards Deming

• 1. Constancy of purposeCreate constancy of
  purpose for continual improvement of products and
  service to society, allocating resources to
  provide for long range needs rather than only
  short term profitability

treatments
patients
targets
When the going gets tough, the tough hold their
nerve
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Which is your future?