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Issue 3 – December 2019

Improvement Movement Newsletter

Message to alumni from Chief Executive of the CEC

Carrie MarrDear Alumni,

Firstly I would like to acknowledge and thank each of you for your contribution to the “Improvement Movement” that continues to build momentum across the NSW Health System. The shared purpose of this “movement” is to connect and learn together so that we can be purposeful in improving the experience of patients, families, carers and staff.

As leaders in safety, quality and innovation we collectively understand that leading improvement requires relentless attention to leadership and culture. Without a positive safety culture at a local level it will always prove difficult to implement the safety programs required. The mindset, behaviours and values we practice in the service of patient safety are crucial if we are to promote psychological safety, teamwork and meaningful person centred care. Your roles as leaders within your local teams and hospitals is crucial in promoting patient safety.

In closing, I encourage you all to continue to connect and learn from the safety and quality successes across NSW Health and consider how you could adopt best practice to improve your outcomes for patients.

Carrie Marr, Chief Executive Clinical Excellence Commission

Update from ACI – Redesign Graduate Certificate

Partnerships for improving healthcare delivery for Aboriginal people

The Redesign graduate certificate is offering something a little different in 2020. The first school, starting in February, will be focusing on partnerships to improve healthcare delivery for Aboriginal people. Applications are now in from across the state with LHDs partnering with primary health organisations such as Aboriginal medical services and primary health networks to address issues in delivery and receiving care for Aboriginal people in NSW.

The program will be delivered with cultural safety at the forefront and cultural facilitators from the ACI’s Chronic Care for Aboriginal People team are joining us for the face to face component of the school. Principles of the 8 ways of Aboriginal learning methods are being incorporated into the Redesign methodology supporting connection to culture and community.

We look forward to supporting our teams of both Aboriginal and non-Aboriginal participants to partner in successfully addressing the challenges and redesign services to better meet the needs of Aboriginal communities.

The second (and final) school for 2020 will start in July and be open for all projects.

Update from CEC – Clinical Leadership Programs

Over 3000 health leaders trained by the CEC

More than 3000 NSW clinicians have graduated the CEC's clinical leadership programs with the July 2019 graduates including a group of more than 35 senior clinicians. As part of the program, each graduate identifies an area where they feel healthcare improvements could be achieved and presents a clinical improvement project as part of their final work.

Ms Carrie Marr, Chief Executive of the CEC, said she was delighted to view the project posters from the recent graduates. “Our most recent graduates come from far and wide including Dubbo, Sydney and Murrumbidgee. These graduates are the clinical leaders who will guide the health system over the next decade,” Ms Marr said.

“They come to the program with the support of their local executive and a desire to achieve improvements in how they, and their colleagues, care for patients. It’s exciting to see this most recent group exploring avenues to improve patient safety and clinical practice.”

Through the year long program, participants gain enhanced:

  • understanding of the workings of NSW Health
  • knowledge of contemporary approaches to patient safety and clinical quality systems
  • skills in relation to communication, conflict resolution and team leadership
  • ability to influence the direction of health policy, and
  • personal and professional clinical leadership skills.

The Executive and Foundational Clinical Leadership Programs are part of the CEC’s Quality Improvement Academy.

Cohort 21 Executive clinical leadership program graduates – July 2019

Tool time – driver diagrams

A driver diagram is a simple, visual tool that will assist you to systematically plan and structure your improvement project. It can help you understand the logic of your project and where you are heading with your improvement initiative.

A driver diagram is best developed at the start of your improvement project, but it is a living document that can be updated at every team meeting, when drivers and change concepts are discussed and agreed upon.

The diagram organises information on proposed activities to clarify the relationships between the aim of the improvement project and the changes to be tested and implemented. It includes the following.

  • Aim statement – outlines the project goal or vision. This is derived from the problem you are trying to address/what you are trying to accomplish (the first question from The Model for Improvement).
  • Primary drivers – high-level improvement areas that you need to address and influence in order to achieve the desired outcome.
  • Secondary drivers – specific targeted factors or interventions that are necessary to achieve the primary drivers. Each secondary driver will contribute to at least one primary driver (drawn using ‘relationship arrows’)
  • Change ideas – well-defined interventions to address the secondary drivers (e.g. what exactly are you going to do to and how are you going to do it). Each change idea will contribute to at least one secondary driver (drawn using ‘relationship arrows’). The change ideas address the question ‘What change(s) can we make that will result in improvement?’ in The Model for Improvement.

Learn more about driver diagrams or download a copy of the driver diagram starter kit and template from the CEC’s website.

Wendy Jamieson, Senior Manager, Quality Improvement Academy, Clinical Excellence Commission

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Redesign factsheets

A step-by-step resource for collaboration, innovation and better healthcare

A suite of new factsheets about Redesign is now available to view online or download.

Used by NSW Health for more than 11 years, Redesign is a structured yet flexible methodology on implementing successful change initiatives. The approach incorporates project management, change management/ implementation and improvement sciences.

The factsheets go through the Redesign process step by step, offering essential information and tips on creating effective change and service improvement.

There are also links to additional information, tools and training to save you time searching for help.

To access the factsheets, follow the link below or visit the Agency for Clinical Innovation website and search under resources for Redesign factsheets or ask your local Redesign Lead for more information.

In profile – Lynn Hopkinson

We interviewed Redesign Lead, Lynn Hopkinson, and asked Lynn about her role and her redesign journey.

Lynn started out in nursing, predominantly paediatrics, then moved into management roles which finally led to her ‘most favourite role’ as the Redesign Lead for Northern NSW Local Health District.

What year did you graduate from the Redesign program and what was your project on?

I graduated in 2016. The project was called ‘Totally hip (and knee)’ which reduced the length of stay and improved the patient journey for patients undergoing an elective hip or knee replacement at The Tweed Hospital.

How do you think Redesign program shaped your career path?

I was already working in the Redesign world, but undertaking the formal program allowed me to develop a deeper understanding of the methodology. This has shaped my current role into a coaching, consulting and mentoring role for District staff undertaking change projects.

What part of the Redesign Lead role do you find most rewarding?

I get to work with positive people who want to make a difference, who enjoy the challenges that undertaking any change presents. I enjoy working with all levels and staff groups across the district, both clinical and non-clinical, from frontline to executive.

How do you think your role in Redesign influences change in your organisation?

I am currently leading a redesign project looking at how we actually undertake change across the district; our processes, the barriers and enablers to change. So my role, coupled with Redesign methodology, will be key in how we improve our overall change management practices.

If you could go back 10 years, what professional advice would you give yourself?

Even if you don’t have a professional grand plan, take the opportunities that are presented; put your hand up and have a go. You will always learn something new and those skills start to accumulate. It worked for me and now I have a great job!

Spotlight – Psychology of Change

Creating the conditions for success in safety and quality improvement projects: the importance of Deming’s Psychology of Change lens

Healthcare organisations have a strong desire for safety and quality improvement to be a natural part of every frontline clinician’s role. Organisations have invested resources into developing staff capability, yet are still challenged with influencing the perception of the staff member’s role in safety and quality. The key to unlocking staff engagement in safety and quality lies in W.E. Deming’s (1993) System of Profound Knowledge, and specifically what he refers to as the ‘Psychology of Change’ lens. Deming’s System of Profound Knowledge (1993) theory originated as an organisational management philosophy based on systems theory. The theory maintains that each organisation is composed of a system of interrelated processes and people. The success of the system is dependent on organisational management’s capability to orchestrate the delicate balance of the interrelated processes and people for optimisation. According to the literature, the Psychology of Change lens describes how change happens through people, how they act as individuals and how they interact within the system (Langley, et al, 2009). It requires involving people in change, working with resistance to change and is supported by good communication and collaboration behaviours between people. The following model is an outcome of a recent study conducted by the CEC’s Quality Improvement Academy alumni on what constitutes the Psychology of Change lens (Fischer, 2019). Practically, the Psychology of Change lens is illustrated below.

Psychology of Change Model

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Before a group is convened to address a safety and quality improvement opportunity, those individuals in the group must each be self-motivated to contribute. Therefore, safety and quality improvement requires extra-role behaviours (Salanova, et al, 2011). That is  certain behaviours of employees that are not part of their formal job requirements, as they cannot be prescribed or required in advance for a given job, but help in the smooth functioning of the organisation as a social system (Bateman & Organ, 1983). Currently, most healthcare organisations are not designed to protect time for safety and quality improvement project work in the core business. Core business for healthcare organisations is frontline patient care. Albeit, a significant enabler of effective frontline care, the work that underpins safety and quality improvement is not rostered for in a given day for the average frontline clinician (CEC, 2019).

Next, safety and quality improvement work usually involves a formal or informal project team, with a designated person that plays a ‘team leader’ role (Langley, et al, 2009). To be effective as an improvement team, the leader and its members must understandhow to influence positive team dynamics, and specifically ensure there is cohesion and role clarity amongst project team members, so that the work gets done efficiently, and without conflict. Lack of role clarity is a significant predictor of team dysfunction and low productivity (Hu & Liden, 2011).

As the informal and formal safety and quality improvement teams form and identify a group lead, this model requires the group lead to be a skilled leader who can manage dynamics, inspire participation and ensure accountability. Transformational Leadership theory articulates the behaviours that most strongly inspire and influence change in staff. Staff are most likely to change their behaviour when led by leaders who demonstrate transformational leadership behaviour (Antonakis, Avolio, & Sivasubramaniam, 2003). Essentially, safety and quality improvement is about change, in either behaviour, process or both. Transformational Leadership is also a requirement of safety and quality improvement sponsors, who are people in executive roles and who have the ability to scale up and spread the work.

Understanding the technical skills involved with Improvement Science, Clinical Redesign or any quality improvement methodology is important, but not sufficient for success in projects. Working through the Psychology of Change lens to create these conditions for safety and quality improvement project teams is the missing piece of the puzzle.

Sarah Fischer, Lead Organisational Psychologist, CEC

References

  • Antonakis J, Avolio B J, Sivasubramaniam N. (2003). Context and leadership: An examination of the nine-factor Full-Range Leadership Theory using the Multifactor Leadership Questionnaire. The Leadership Quarterly. 14(3):261–295.
  • Bateman TS, Organ DW. (1983). Job satisfaction and the good soldier: The relationship between affect and employee “citizenship”. Academy of management Journal, 26(4):587-595.
  • Clinical Excellence Commission. (2019). Mental Health Patient Safety Program: Explore and Understand Diagnostic Findings. Sydney: NSW Health.
  • Deming WE. (1993). The New Economics. Cambridge, MA: MIT Center for Advanced Engineering Study.
  • Fischer S. (2019) Defining W.E. Deming’s Psychology of Change Lens: Demystifying the Conditions for Engagement in Healthcare Safety and Quality Improvement. Prepping manuscript for submission.
  • Hu J, Liden RC. (2011). Antecedents of team potency and team effectiveness: An examination of goal and process clarity and servant leadership. Journal of Applied Psychology. 96(4):851.
  • Langley GJ, Moen RD, Nolan KM, et al. (2009). The improvement guide: a practical approach to enhancing organizational performance. John Wiley & Sons.
  • Salanova M, Lorente L, Chambel MJ, Martínez IM. (2011). Linking transformational leadership to nurses’ extra‐role performance: the mediating role of self‐efficacy and work engagement. Journal of Advanced Nursing. 67(10):2256-2266.

Alumni opportunities in 2020

International Forum on Quality & Safety in Healthcare - Sydney 2020

Call for forum posters is now open

The CEC is the key Host Country Partner for the Forum in Sydney 2020. Registrations open 18 December 2019.

Registrations made through this site will attract a 30% discount.

The Asia Pacific International Forum on Quality and Safety in Healthcare was held for the first time in Australia in 2016 in Melbourne. In that year, Safer Care Victoria were the lead strategic partner, along with the CEC, the Australian Council on Healthcare Standards and the Australian Commission on Quality and Safety in Healthcare.

Now in its 24th year, the International Forum on Quality and Safety in Healthcare, a collaboration between the British Medical Journal and the Institute for Healthcare improvement, is a biannual gathering of healthcare professionals in quality improvement and patient safety. The International Forum connects healthcare leaders and practitioners worldwide to improve outcomes for patients and communities.

Redesigning the Future of Health Symposium

University of Tasmania, Medical Science Precinct, Hobart, Saturday 7 March 2020

This national symposium, in partnership with ACI and the University of Tasmania, will be of interest to clinical redesign students and graduates, quality and safety professionals, healthcare professionals, health leaders and health system researchers. A not-to-be-missed event, this symposium is timed to coincide with the Taste of the Huon food and drink festival weekend in southern Tasmania. This weekend is a great opportunity to combine continuing professional development, networking and diffusion of innovation with experiences unique to southern Tasmania at the onset of Autumn.

Grab the chance to present or submit a poster!

For more information and registration visit the Redesigning the future of health website.

Brief Bites For Better Care

Brief Bites For Better Care is a series of 12 very brief (1.5 to 3 minute) videos featuring Professor Kim Oates discussing different elements of safe care such as team culture, communication and situational awareness.

These very engaging videos may be of interest for individual viewing. They could also be added to any patient safety related staff development sessions you may be planning.

Videos are presented by Emeritus Professor Kim Oates AMMD, DSc, MHP, FRACP, FRCP, FAFPHM, FRACMA, DCHDiscipline,Child and Adolescent Health, Sydney Medical School Clinical Consultant and Head of Undergraduate Education, NSW Clinical Excellence Commission


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Upcoming Events

Australia

Two Day Improvement Science workshop, CEC
Sydney NSW, 22-23 January 2020

Redesigning the Future of Health
University of Tasmania, Hobart TAS, 7 March 2020

Sydney Nurses Conference
Sydney NSW, 28-29 May 2020

Dementia care delivery summit
Melbourne VIC, 22-24 June 2020

Better care, everywhere: Healthcare variation in practice
Sydney NSW, 20-21 July 2020

IHI/BJM International Forum Asia Pacific
Sydney NSW, 30 Sept – 2 Oct 2020

International

IHI/BJM International Forums 2020
Copenhagen DEN, 28-30 April 2020 and New Delhi IND, 4-5 July 2020

Patient Safety Congress
Manchester UK, 13-14 July 2020

International Society for Quality in Healthcare
Florence ITA, 30 August - 2 September 2020

The Agency for Clinical Innovation (ACI) events calendar

The Clinical Excellence Commission (CEC) events calendar