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Issue 2 – November 2018

Improvement Movement Newsletter

Message to alumni from the Chair of the ACI / CEC Board

EQ CEC Brian McCaughan

Message from Brian McCaughan

Dear Alumni,

I am delighted to welcome you all to the inaugural edition of the ACI Redesign and CEC Clinical Leadership Alumni newsletter. Both the ACI and CEC have an important history of skilling our improvement leaders in NSW Health and this is an exciting opportunity to join the network of champions in our health system. Over my many years in health I have always valued my opportunity to learn skills in service improvement which have helped me provide high quality care to patients across the system.

As the Board Chair of both the ACI and the CEC I am immensely proud when I witness the same passion in many of you, when you’re presenting your projects at graduation and beyond. The future of NSW Health relies on people like yourselves striving to improve and innovate, finding ways to deliver contemporary and evidence based care that supports the system always keeping the patient at the forefront.

I encourage you all to get involved and reconnect with colleagues and like-minded champions of change as we grow and develop the Improvement Alumni. Your contribution and commitment is highly regarded and this is yet another step towards building the critical mass of skilled leaders ready and willing to lead the way for change.

Inaugural Alumni event

An evening with Dr Peter Lachman

The joint ACI-CEC Alumni was launched at an event in October 2018. The alumni members caught up, networked and enjoyed hearing from guest speaker, Dr Peter Lachman, CEO of the International Society for Quality in Health Care (ISQua).

ISQua is a member-based, not-for-profit community and organisation dedicated to promoting quality improvement in health care. They do this through education, knowledge sharing, and external evaluation, supporting health systems worldwide and connecting like-minded people through health care networks.

Dr Peter Lachman has extensive experience as a paediatrician and improvement leader, and in addition to his medical leadership work in health services he has been an improvement Leader at the Institute for Healthcare Improvement prior to his role with ISQua.

Peter shared many of his insights from his global work to demonstrate the need for system reform – away from acute to primary based services.

Peter shared his learning and tips on Spread and Generalisability around the heart, head and hands principles of change. The heart speaking to the why, the head to the what and the hands to the how. Peter challenged us to see if we have the ‘habits of improvers’ reflecting on our own improvement pathway and how we influence, communicate and maintain resilience as health change leaders. You can use the chart in the slide deck to self-reflect and consider your own habits of improvers (link below).

Peter demonstrated how improvements in our own health system have supported safety initiatives in places like Mozambique where the ‘Between the Flags’ initiative was spread and adapted to improve the quality of care and save lives in the Hospital Geral Jose Macamo. By adapting the principles they were able to increase early detection and significantly decrease mortality rates. Inspiring indeed!

The alumni heard about The Spread Challenge, a report released in September 2018 from the Health Foundation in the UK. The report, based on the National Health Service (NHS) highlights key recommendations for clinicians and health managers on uptake of innovations and improvements in health. Challenging traditional thinking and encouraging adoption as well as innovation, the report suggests the concept of co-innovation in spread, using the early adopters as co-innovators to build and adapt the initiative in the local context.

Read the report

It was great to see the alumni together and many met up with colleagues past and present. Some of our live streamers met up in groups and enjoyed the opportunity to link in from across the state. Take a look at the photos and we hope to see you at the next event – watch this space!

Dr Peter Lachman’s slides from the evening

https://www.isqua.org/

Tricia Cummins, Capability Design manager, Centre for Healthcare redesign, ACI

Update from CEC - Executive Clinical Leadership Program

Cohort 20 of the ECLP have just completed Module 5 which covered Patient Safety, Human Factors, Clinical Risk and Coaching for Improvement. This is the first time within CLP that the coaching day has been designed to specifically address coaching for improvement and there was a great energy in the room. Part of the workshop used the triad method which involved groups of three participants, one coachee, one coach and one observer.

The coachee (the person being coached) presented an issue or concern that had not been solved during the diagnostic phase of their project.

The coach used open ended questions to identify and unpack what might be contributing to the issue. The coachee was then assisted by the coach, probing further, to come up with possible solutions to the issue, explore these and decide which options were available to try and address the concern.

The observer took a back seat and watched what questions, practices or body language worked well and those that didn’t. They also provided constructive feedback to the coachee and coach.

The feedback from participants suggested that Coaching for Improvement be introduced earlier in the ECLP program and that it would be beneficial for the projects and project teams.

With these new skills under their belts they are now returning to their project teams to undertake more Plan, Do, Study, Act (PDSA) cycles and collect more measures, before their final oral and poster presentations at the end of February 2019.

https://researchportal.coachfederation.org/Research/PortalFAQs

Cohort 21 of the ECLP have just completed their 3rd module – Motivating, Managing & Communicating across Genders, Generations and Cultures, facilitated by Avril Henry and Influencing and Negotiation facilitated through Academy Global.

Cohort 22 of the ECLP commences in February 2019 and applications are due to local sponsors at LHD/SHNs by 16 November 2018 via the link below:

http://www.cec.health.nsw.gov.au/quality-improvement/improvement-academy/qi-academy-curriculum/statewide-scheduled-training/exec-clp

Cathy Vinters, Program Lead, Quality Improvement Academy
Clinical Excellence Commission

School update – Graduate Certificate in Clinical Redesign

The third Redesign school cohort for the year is in full swing. About 100 students have gone through the program in 2018 and preparations are underway for 2019.

What’s new?

This year we sought to bring patient experience to new heights by enhancing the tools and techniques offered in the curriculum. The tools developed by the ACI Patient Experience and Consumer Engagement (PEACE) team were further integrated into the program, including personas and reframing techniques. With these great resources, students are able to put the spotlight on the consumer perspective and support a true human centred approach.

On the fast train to consumer engagement

In our latest school we created an experience that saw our students heading out on the train. Students were asked to take a short return journey and take on various roles in collecting qualitative data around a transport consumer experience. Experiential learning gave students the opportunity to discover what it’s like to be the interviewer, observer and consumer in an experience data collection exercise, and how to turn that data into valuable information in an improvement project.

Instructions were given then race was on! The groups encountered hurdles (did you know the new ticket machines don’t take cash?) and found out what qualitative data collection is all about. Students found the exercise enlightening and were especially surprised by how challenging it felt to be the consumer in the spotlight.  Plenty of food for thought when they go to interview and observe patient experience back in their work settings!

Tricia Cummins, Capability Design Manager, Centre for Healthcare Redesign
Agency for Clinical Innovation

Tool Time - Personas

Why use personas?

Personas allow you to empathise and connect with the people your work will affect. Using them will help you see problems and unmet needs from a consumer perspective, and can provide insight into why people act in certain ways. Personas developed from your patient experience data are a great tool for maintaining the patient voice throughout your project.

When should you use personas?

Personas are best used during the diagnostics and solutions phases of your improvement project. If you are using experience-based co-design methodology, personas can be useful in the gather and understand phases.

Using personas for improvement

So you’ve done your patient experience surveys and analysed the data; maybe you’ve also done a few focus groups or patient interviews. But how do you make sure those experiences don’t get lost during the project? Particularly if you can’t have any consumers or carers directly involved.

A persona highlights the consumer identity and is a tool that can focus the team to ask ‘what would Barry do?’ when you may need to reframe the issue or solution into ‘Barry’s’ voice’.   This can be particularly useful in reframing discussions that may be heading out of scope. Continue to refer back to your personas, particularly when important decisions are being made, to give your improvement work the best possible chance of achieving sustainable change.

Develop your project personas by using the persona tool

For more on Experience experience-based co-design, access the toolkit

Caroline Kovacic,  A/Manager, Patient Experience and Consumer Engagement (PEACE), ACI
Contact: caroline.kovacic@health.nsw.gov.au

International Forum on Quality & Safety in Healthcare

The International Forum on Quality & Safety in Healthcare (IHI/BMJ conference) was held at the Melbourne convention centre from 10th – 12th September 2018 with the theme Connect; Co-Create; Communicate. The conference hosted 1500 consumers and healthcare professionals from 35 countries.

What a great opportunity for networking and hearing about the latest improvements and innovations taking place in healthcare both nationally and internationally. We asked some of our alumni what their learnings and highlights from the forum were:

  • A visit to the Alfred to see in practice the “AAA” stewardship programs such as the principles of Antimicrobial stewardship which has been extended to include two other high risk medications being Anticoagulants and Analgesia.
  • Achieving change at scale reaffirmed that while this is difficult there are strategies that work. The importance of promoting behavioural change through ownership of the change was emphasised with an anecdote from Dr Don Berwick about Betty Crocker. When this company first introduced powdered cake mix, sales weren’t high. After consulting psychologists, the powdered egg was removed from the mix so that people could add their own eggs and the sales increased significantly. The lesson from this is that while you should provide the basic essentials you can also allow teams to adapt and adopt their own ways to implement a change.
  • Dr Kevin Stewart HSIB – Health Safety Investigation Branch (HSIB - UK)  An independent body funded by the Department of Health that have a team of experienced safety investigators (not all from health backgrounds). The team investigates around 30 safety incidents each year so that safety recommendations are made and shared across the whole of the healthcare system to help prevent repeating mistakes.
  • This connected well with another strong message from the conference around learning from our mistakes in health, ‘Don’t waste a good mistake, learn from it’. Many of the incidents that occur in health happen again in a different healthcare setting because the learnings are not spread.
  • Dr Jason Leitch, National Clinical Director, Scottish Government spoke about the gains they have made in community awareness of sepsis program through the ‘Sock it to sepsis’ campaign. The program utilised the concept of spreading the message through the community from sender to receiver within the right environment (context) – and the message just kept on spreading!  Dr Leitch described how 77% of the general population of Scotland know the signs and symptoms of sepsis which is testament to the great work being undertaken. Read more on this campaign here
  • Dr Cat Chatfield (BMJ) with Dr Dominique Allwood (Health Foundation) presented an informative session on Engaging clinicians in QI. Research shows that engaging clinicians, can result in “lower staff turnover and decrease in absenteeism”, “decreased infection rates”, increased patient satisfaction” and “lower patient mortality”. Read the article to find out more about their work on engaging clinicians (Employee engagement and NHS performance – West & Dawson 2012).

Exciting news from the forum was that Sydney will host the International Forum on Quality & Safety in Healthcare in September 2020.

There is an opportunity to start preparing now for Sydney 2020, let’s showcase the great work that is being undertaken in NSW within our programs.

For most of the presentations from Melbourne: https://internationalforum.bmj.com/handouts-melbourne-2018/

Cathy Vinters, Program Lead, Quality Improvement Academy
Clinical Excellence Commission

In Profile CEC

Kristen BrownWe interviewed Kristen Brown, an alumni from 2014 to see where the improvement journey has taken her and what advice she may have for new alumni.

Hi Kristen, can you start by telling us a little on your background and current role

I started my career as a Registered Nurse working in Haematology in SESIAHS, which led to working as a Clinical Nurse Consultant for Blood Management. In 2015 I moved to MLHD where I continue to work as a CNC for Blood Management, along with a project officer for Paediatric Integrated Care for MLHD and the SCHN.

When did you do the Clinical leadership Program?

I completed the CLP program in 2014 and my project was aimed at improving the informed element of consent for blood products.  I have since completed the ACI redesign program in 2017, looking at early identification and management of Iron deficiency in the community setting.

Where has improvement training taken you since completing the program?

Both the CEC CLP and ACI Redesign programs, have provided me with the skills necessary to understand the importance of inclusion of families, patients and carers, who are pivotal in creating useful, valued care services.  I have also developed skills necessary to engage with other health staff and key stakeholders to create successful, sustainable change.  I apply the underpinning principles of both courses every day I head into the office, particularly relating to leadership and change.

What are your biggest Achievements since graduating?

I have been a finalist for 3 District Health Excellence awards for both my roles in SESIAHS and MLHD, have been provided the opportunity to present at 5 conferences (Rural Congress x2, integrated care conference, Blood Conference x 3, Patient experience Symposium and a poster presentation for the International integrated care conference).  My greatest achievement I consider is the ability to really improve outcomes for patients, particularly assisting with local families and their ability to access care locally.

Congratulations, that’s a great achievement and something to be very proud of. What advice would you give to new alumni?

Always welcome an opportunity to learn and grow!

In Profile ACI

We check in with Gerard Groth and Samantha Gavin, members of the Mid North Coast LHD team from Redesign School in 2017. Their project Hit the Ground Running focused on improving access to Pulmonary Rehabilitation.

Tell us about your project, what was the goal and objectives?

Our goal was to improve access to Pulmonary Rehabilitation and embed it as standard practice for suitable patients following admission to Coffs Harbour Health Campus for exacerbation of chronic obstructive airways disease (COPD). Because service demand already far exceeded existing service capacity, achieving this goal was heavily reliant on improving program capacity via enhancing service efficiency, and ultimately, securing increased resources.

The primary objectives for our project were:

  • Improving pre assessment clinic attendance rates to 90%
  • Maintaining Pulmonary Rehab group occupancy levels at greater than 85%
  • Increasing inpatient referral rates for patients following a COPD exacerbation from 13% to 50%
  • Increasing the number of individuals completing the program annually from 55 to 105.

What was the most challenging phase of your project?

Diagnostics, definitely – not so much the process, but what we unearthed. At the end of Diagnostics phase, we realised we were trying to solve the wrong problem! This epiphany triggered a strong ‘fight or flight’ response for both of us … necessitating a frantic telephone call to a ‘cool and calm’ Redesign Project Coordinator, an urgent meeting with a ‘surprised but supportive’ Project Sponsor and a significant re-jig of the agenda for an imminent Steering Committee meeting.

The end result was a significant change in the course of our project and consequently a repeat of Diagnostics phase. Great support from Bronwyn Paton and from our project sponsor, allowed us to change our project goal, which led us to much better outcomes for our COPD patients.

What thing surprised you most about the Redesign Methodology?

The greatest surprise was how wellit could be applied across such a diverse range of projects. The projects undertaken within our cohort were broad in respect to focus and setting yet we were able to witness some really impressive phase and project outcomes.

What were the outcomes of the project – at the end of implementation? Now?

The ‘Implementation Phase’ saw a number of strategies successfully employed.  Processes to routinely inform and influence key staff responsible for program referral were enacted.  The gymnasium was redesigned enabling an increase in group size. The necessary gymnasium time and staff hours permitting provision of an additional pulmonary rehabilitation group were secured.

A recent review (September 2018) of key program measures indicated the project remains on target to deliver on the predicted goals set for completion in December 2018. These goals include those associated with referral rates, program occupancy levels and program completion rates.

How did the service change or benefit from the outcomes?

The outcomes achieved during the project have resulted in enhanced service capacity and improved service efficiencies. They have also served to lift the profile of Pulmonary Rehabilitation at both a clinical and executive level at CHHC. This is perhaps best demonstrated by the fact that the LHD’s Winter Planning Strategy in 2018 incorporated provision of additional resourcing for delivery of a 4th Pulmonary rehabilitation group at CHHC.

Any advice for others thinking about doing improvement project work?

Don’t underestimate the amount of time and energy that is required to initiate and sustain meaningful change. Adopt a proven improvement process and then remain patient, committed and true to the process.

Redesign e-learning moves to My Health Learning

From your time at Redesign School you may remember the online platform GEM, where you completed your eLearning and submitted your deliverables. At the end of October, we farewelled GEM and transitioned to the NSW Health platform My Health Learning. This transition aligns with NSW Health education standardisation on the common platform and benefits users by providing a record of your learning.

The good news is that if you are a NSW Health employee then you will continue to have full access to the Redesign eLearning modules via the My Health Learning platform. All you need to do is login as normal and then search ‘redesign’. This will give you easy access to over 50 modules as a great refresh for yourself or guiding others to improve their redesign skills. Topics include project management, capturing patient experience, process mapping, data capture and analysis, designing solutions, introduction to cost benefit analysis and sustainability.

Any non-NSW Health employees are advised to download any document that you wish to retain access to from GEM as this will be closing soon.

If you are unable to download your previous submissions made to GEM please feel free to contact Amelia Giles amelia.giles@health.nsw.gov.au who can supply these to you.

Redesign Graduate certificate conversion opportunity ending soon

Did you complete the Diploma in Project Management, as originally offered through the Redesign School? If so, you only have one more year to upgrade your qualification to a Graduate Certificate in Clinical Redesign!

This ‘conversion’ program was developed as partnership offering between the ACI and the University of Tasmania (UTAS) as a short-term 100% scholarship program and is only available to past ACI Redesign students.

The program involves enrolment in four UTAS units studied over two semesters, with submissions based off your original deliverables in addition to a new unit of learning Translation Research and Health Service Innovation.

Enrolments for semester 1 (Feb 25 2019) are now open and semester 2 (July 2019) will be the final offering.

For more information on the program and enrolment prerequisites please contact ACI-CHR@health.nsw.gov.au. If you completed the diploma prior to 2012 please contact Dr Pieter Van Dam pieter.vandam@utas.edu.au to organise a more detailed discussion.

Upcoming Events

IHI/BMJ
Glasgow, 27th – 29th March 2019

IHI summit on improving patient care
San Francisco California, 11th – 13th April 2019

NHS Improvement
Manchester Central, 2nd – 3rd July 2019

IHI/BMJ
Taipei, 18th – 20th September 2019

IHI/BMJ
Call for abstracts now open
Cape Town, 20th – 23rd October 2019

In Sydney

7th Annual NHMRC Symposium on Research Translation
Sydney, 27-28 November 2018

4th Dementia Care Delivery Summit
Mercure Sydney, 27-29 November 2018

2019 Patient Experience Symposium
ICC Sydney, 29-30 April 2019

Sydney Nurses' Conference
Surry Hills Sydney, 30 - 31 May 2019

The Agency for Clinical Innovation (ACI) events calendar

The Clinical Excellence Commission (CEC) events calendar