PreciSSIon awarded Quality Improvement Team of the Year

We are delighted to announce that PreciSSIon – a regional collaborative to reduce surgical site infection after elective colorectal surgery – has scooped an award in the Quality Improvement category at The BMJ Awards 2021.

The project – in partnership with Royal United Hospitals Bath NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust; North Bristol NHS Trust; University Hospitals Bristol and Weston NHS Foundation Trust; and Great Western Hospitals NHS Foundation Trust – was awarded the accolade for using original ideas in quality improvement to better outcomes for patients.

Anne Pullyblank, Medical Director, West of England AHSN said:

“This has been a fantastic project to be a part of, and the figures we have been able to achieve at such a challenging time for many in hospitals are absolutely incredible. Combined regional average baseline figures showed surgical site infection (SSI) was 18% pre-November 2019. Implementation of the PreciSSIon bundle elements in all trusts between November 2019 and June 2021 resulted in an amazing almost 50% improvement in SSI rate, leading to a regional average of just 9.5%; a significant improvement in patient experience.

The collaborative element enabled staff and trusts to support each other during the difficulties of the COVID-19 pandemic and engagement was high, with theatre teams in particular being empowered to make a difference. It’s amazing for the hard work of everyone involved to be recognised at the BMJ Awards in the Quality Improvement category.”

Read our Celebrating PreciSSIon article: Reducing SSI rates by 50% with estimated savings of over £500k.

The BMJ Awards ceremony took place on the evening of Wednesday 29 September.

This follows PreciSSIon winning the Perioperative and Surgical Care Initiative of the Year at September’s HSJ Patient Safety Awards. The collaborative project was also shortlisted for the Infection Prevention and Control Award.

Find out more about PreciSSIon.

Tracheostomy community of practice supports improvements in patient safety

A national Patient Safety Collaborative programme, led by NHS England and delivered by the AHSN Network, commenced in 2020 to improve the care of patients with tracheostomies within acute hospitals. The programme focussed on ensuring that all patients had three elements:

  • a bedhead sign and emergency algorithm,
  • emergency equipment and
  • a daily care bundle.

A short-term Community of Practice (CoP) with the tracheostomy teams from across Bristol, North Somerset, South Gloucestershire; Gloucestershire and Bath, North East Somerset, Swindon and Wiltshire was set up by the West of England AHSN to facilitate shared learning across the teams to improve the care of tracheostomy patients.

What did the Tracheostomy CoP hope to achieve?

Following an audit to understand how the elements were used in the region’s hospitals, it was established that while most trusts did have the elements in place there was room for improvement in their consistency. The teams therefore set out to improve the consistency and efficiency of their internal systems and to align to the national guidelines for tracheostomy care.

What were the outcomes of the Tracheostomy CoP?

  • Positive multi-disciplinary collaboration for improvement projects
  • Alignment of paperwork to national guidance and inclusion of Response Team number
  • Making emergency equipment boxes the same colour throughout the trust
  • Sealing the emergency equipment boxes to ensure equipment is not removed and reduce the need for regular full checks
  • Training resources developed and delivered to targeted areas e.g. to oncology and ICU,
  • Improved processes for Datix
  • Updated policies
  • Development of a tracheostomy team with the Acute Care Response Team
  • Minimising variation between teams

In University Hospitals Bristol and Weston (UHBW), the tracheostomy programme spearheaded a larger Quality Improvement project involving a group of multidisciplinary enthusiasts. The project aims to reduce the number of preventable tracheostomy related incidents to zero by December 2022 through the change ideas shown in the driver diagram below:

Isabel Barfield, Patient Safety Improvement Nurse, at UHBW said:

“In UHBW it has been great to get the multidisciplinary team across the newly merged trust working together on such an important project. Tracheostomy care has needed streamlining for a while now, so far we’ve written new care plans, discharge documentation, incorporated the NTSP videos into our training, and identified emergency boxes and bedside trolleys to facilitate the best care.”

Mark Juniper, Respiratory Consultant and Clinical Lead at the West of England AHSN said:

“It’s always a privilege to bring acute teams together to enable sharing of learning and ultimately improve patient safety – COVID provided an additional challenge but I am proud of the work we’ve completed as a collaborative. The Tracheostomy Community of Practice has gone from strength to strength and the great work we’ve started will now continue – I am particularly looking forward to hearing more about the progress made in UHBW (as part of their on-going tracheostomy quality improvement work).

I know that any improvements or new ways of working will now be shared with acute trusts across the region, so all tracheostomy patients can benefit”.

What’s next?

The tracheostomy programme has now closed, however teams are continuing on their improvement journeys to enhance tracheostomy care safety with their own local projects.

The tracheostomy community of practice is one element of the national Adoption and Spread Patient Safety Improvement Programme. Find out more about our work on the programme here.

Quality improvement for primary care workshops launch

The West of England Academy are hosting a new series of five free-to-attend interactive online workshops each Friday from 16 April.

Attendees will gain a basic understanding and practical knowledge of applying Quality Improvement (QI) techniques to real-world challenges in primary care.

Modelled on our hugely successful QI Summer and Winter Series, this five-week course, held over 90-minutes each Friday from 12noon can be joined as single sessions or a series.

The workshops have been developed, and will be delivered by, the West of England Academy team alongside guest speakers. Topics include stakeholder mapping, process mapping, data management and the basics for change management.

Attendees can be in any role and/or grade within their organisation, for example from clinical, administration or facilities.

Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.

Find out more about QI for primary care and book here. 

The West of England Academy offers a wide range of free resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email weahsn.academy@nhs.net.

Introducing the quality improvement (QI) winter series

The West of England Academy are hosting a series of five online workshops each Wednesday from 27 January on quality improvement (QI). Free to attend, and for any innovator or employee within healthcare, each one-hour session is standalone so you can choose individual workshops or sign up for the series.

Each workshop will be interactive, so you can apply learning in real-world scenarios. The workshops will be beneficial regardless if you are working on a specific QI project or not. If you encounter challenges in your role (or outside work), and want to consider how these can be tackled through QI, these sessions will help.

Attendees can be in any role or level within their organisation or business; for example clinical, product development, administration or facilities.

Our academy works hard to welcome attendees from a broad range of backgrounds creating a safe and open environment for learning and sharing ideas.

The West of England Academy offers a wide range of free resources to healthcare professionals and innovators across the region. To find out more, visit our Academy pages or email weahsn.academy@nhs.net.

Reflections on hosting virtual interactive workshops

In this Q&A our West of England Academy Project Managers Kate Phillips and Vardeep Deogan share their reflections on the delivery of the Academy’s recent Quality Improvement (QI) Summer Series. They led 10 hours of online interactive workshops and delivery of QI theory by 12 different facilitators to around 60 delegates per session from across the West of England region and beyond. The Academy team have also compiled a series of slides with their top tips on hosting virtual learning.

Vardeep talks about virtual learning

  1. What did you enjoy about the QI Summer Series?

Vardeep: Every part of our workshops had a purpose, so being creative and thinking outside the box with activities without making them complicated was really important. Supporting our guest facilitators was a pleasure too. After our fifth session, we really felt a sense of achievement, and we cannot wait to deliver future online workshops.

Kate: An unanticipated pleasure was coaching our guest facilitators. Vardeep and I were the main hosts, but wanted the series to reflect the wealth of knowledge and range of experiences of working with QI across the West of England. We also figured that our voices might be a bit dull for two hours straight! Considering that online training was a fairly new concept, this meant that Vardeep and I mentored our guest facilitators to deliver their 25 minute activity. The feedback from the guest facilitators was lovely – they felt challenged by the experience but also supported. I think they were all very proud of themselves which was great to see.

The overwhelmingly positive response to the sessions has also been wonderful. Vardeep and I cooked these sessions up, combining our knowledge and experiences and we seemed to have stumbled upon a winning formula!

“Exceeded my expectations – I learnt so much.”

    2. What are the differences between online and face-to-face delivery?

Vardeep: When delivering face to face it’s much easier to ‘read the room’ for non-verbal communication and how people interact with each other, and as a facilitator you respond accordingly. We had to think differently about how to get this feedback during and throughout each workshop. This involved designing activities and including opportunities for feedback using functions like slido, the chat box and voting.

We also considered different learning styles and made certain to include activities that reflected these. Using liberating structures supported this.

Kate: The whole experience is different- quite often I’d be looking at only one or two faces in the corner of my screen, but knowing I was talking to 50+ delegates who had prioritised our training over other work, it’s a bit of a barmy experience really! I think delivering online sessions brings a different type of nervous energy…the adrenaline flows!

   3. Can you tell us about your biggest ‘aha’ moment?

Vardeep: As the series progressed, even though we may have been delivering our fourth or fifth session (and at times felt we were repeating ourselves with instructions for activities etc.) we kept in mind that this may be someone’s first experience on zoom or of virtual learning. I realised the value of clear instructions from the positive feedback we received where our clarity was praised. This was a key learning point.

Kate: For me, a lovely moment during our second session was when Vardeep asked a delegate to turn their mic on and share their experiences verbally with the entire group. We regularly asked delegates to share feedback via the Zoom chat box, but giving individuals the platform to voice their thoughts brought the session alive. It did mean having to relinquish some control, but it was worth it every time. Sharing the platform was important.

“I think I’ve learned more in this two-hour online session than any other face-to-face course I’ve attended!”

    4. Have you learnt any new skills with online facilitation/delivery?

Vardeep: I’ve learnt you have to be even more adaptable and fluid when delivering online. Anything can happen at any time (tech issues!) and you have to be able to step in and pick up anything, whether this is the delivery of a session or an aspect of facilitation. Every member of the team needs to be able to pick up any role and this really stretched me and took me out of my comfort zone – we survived a few hairy moments.

Kate: I had delivered a few online webinars before, but they were very much ‘chalk and talk’ style. I’ve loved learning about, and using, Liberating Structures to keep delegates engaged and to facilitate interaction between them. I’ve also enjoyed thinking creatively to convert traditional face-to-face QI training for online delivery.

   5. Have you learnt anything about yourselves during this project?

Vardeep: Working alongside Kate to plan every session in detail, really enabled me to be fluid and agile to the needs of others, particularly guest facilitators. I’ve learnt that with the right team around you, you can adapt to any last minute change and for it to still feel under control and most importantly – fun.

Kate: I’ve learnt that my happy place is extremely organised and where I’m in control. Fortunately Vardeep is very good at making me feel safe enough to step outside of that and allow space for spontaneity and discussion, and that’s where the magic happens! On the flip-side, I’ve learnt to value the skill of organisation and I don’t think we could have pulled off this series without it.

“Really good workshop today – best I’ve attended during this whole pandemic, so thanks to you and your colleagues”.

  6. What has been the biggest challenge?

Vardeep: You never truly know how you’re being received online until you read the feedback.  Over the five sessions I got used to smiling and talking to a camera instead of being able to make eye contact and responding to non-verbal cues. That often felt odd but it’s vital to the person the other side of the screen.

Kate: At the start I was overwhelmed with the task that lay ahead of us, thinking about all the details. Fortunately I work with brilliant colleagues who made this series a true team effort. I was able to focus on planning and delivering the sessions in a step-by-step way, knowing that the event logistics and marketing of the series were being expertly handled. Breaking down the roles, tasks and working as a team was crucial.

 7. Do you have any top tips for online delivery?

Vardeep: Plenty….

  • As a facilitation team agree a way of communicating with each other behind the scenes (such as Whatsapp). This allows you to adapt, adjust or abandon as you go along.
  • Plan your sessions with timings in mind. This is invaluable and is a skill – things often take longer virtually. This also includes prepping any guests.
  • Allow time for a team pre-brief and de-brief after each session. Kate, Shomais and I always spent time reflecting on what went well, what didn’t go so well and we also captured new ideas to incorporate for the next session on ideaz boards or jamboards.

Kate: I think one of my favourite phrases from this series was “team work makes the dream work”. We couldn’t have delivered such a slick series without the designated online technical support that our colleague Shomais provided. Having clear roles and responsibilities in the team was important, e.g. being clear on who is responding to questions in the chat box, who is co-ordinating break-out rooms and who is introducing facilitators and welcoming delegates back from breaks. I think the clarity of roles and knowing we could depend on each other, created a safe space to do each of our jobs really well.

Thanks to Kate and Vardeep for sharing their experiences.

Further information about the West of England Academy’s online resources and future events can be found here.

Sharing learning from our QI Summer Series

During July and August 2020 the West of England Academy, aided by guest facilitators and speakers, held weekly Quality Improvement (QI) webinars. This season of learning, known as the QI Summer Series, was fully booked with a lengthy waiting list. We are also delighted to say the series received 100% positive feedback from attendees, no mean feat in a world where virtual fatigue is setting in.

Before and during the series our Academy team compiled their thoughts and tips on hosting learning sessions via webinar:  To download the slides as a PowerPoint, please click here

In the coming weeks, our Academy team will also be sharing a Getting Started with QI Guide alongside a blog about their experiences organising and leading the QI Summer Series.

The West of England Academy will be hosting further QI webinars, alongside other virtual events.

You can browse the full range of AHSN events here.

Quality Improvement in the age of COVID – launching PERIPrem

Noshin Menzies, Senior Project Manager, shares her experiences of launching a Quality Improvement programme during COVID.

If you’d told me 4 months ago we would be where we are today with PERIPRem, I’d have wondered what planet you were from. This exciting, ambitious care bundle, the vision of two extraordinary neonatologists, was going to launch in April and change the way that perinatal care is delivered across the entire South West region. It was a seed reliant on collaboration. However, 2020 had other plans…

The fundamentals of PERIPRem – nurturing a regional clinical community dedicated to improving outcomes for our most vulnerable babies and working side by side with women and their families – were, in an instant, stopped in their tracks.

Pre-COVID, I had been lucky enough to attend the Royal College of Obstetrics and Gynaecology’s “Let’s Talk about Race” event for International Women’s Day. The stories I heard further cemented the commitment we had to reducing inequalities.  We could not deliver a perinatal quality improvement project without ensuring that we were actively listening – and considering how to chip away at the barriers that result in Black and Minority Ethnic women being 5 times more likely to die in childbirth and their children to experience poorer outcomes. This was even before we knew the increased risk of COVID to people of colour and the raised chance of preterm labour for those women unfortunate enough to contract the virus whilst pregnant.

Just as we finalised plans for launch, and to get out into the communities and find every opportunity to involve those who lives are imprinted by the experience of preterm birth, COVID hit. Our PERIPRem teams were now on the battle lines, and we were nestled behind our laptop screens, shell shocked. Our ability to be agile and adapt to novel ways of working mattered now more than ever.

I’ll admit, I was sceptical how we could launch what was still a seedling of a programme to twelve units across the whole of the South West, when we were unable to leave our kitchens, let alone realise our plans to provide fertile ground for the creation of a regional PERIPRem clinical community. Without a physical launch, how could we provide space for those small but mighty moments, that when cultivated, have more of an impact than any toolkit or presentation?

I often struggle when I have to describe QI; in my experience it is much bigger than a framework or a process by which you can input your problem and wait for gold-standard results. For me, QI has its foundations in the people, the team and the culture. It is the introductions to new faces, teams huddled together around meeting tables, clinicians whispering to colleagues they had not seen for years and the camaraderie brewed alongside the substandard coffee.  We grow highly functioning teams, and the most exciting part of any QI project, on these blocks. It was boom or bust but I needn’t have worried.

We have formed strong bonds as a PERIPRem team; we have even managed a team social. My treasured counterpart in the South West AHSN and I have never met, we joke that we do not know what each other look like from the shoulders down. We have bonded over the many cameos from the PERIPRem teams’ children – or Assistant QI Coaches as they are now known.

Most importantly, the PERIPRem perinatal teams have flourished. Whilst in the pressure cooker of the pandemic, we gave space and time to focus on delivering patient care – when they got a handle on what it meant for them as clinicians, they came back raring to go.  We have digitised all of our resources and are now holding webinars on each of the bundle elements – they are so well attended we cannot fit on a screen!

People have pushed through discomfort to record themselves sharing the clinical fundamentals and to provide the presence (all be it through a screen) we all miss. We are exploring new ways to engage with the women we were so keen to meet and listen to, and we are forever indebted to our patient representatives who are now pillars of our PERIPRem team.

The takeaway message from that tired trope of “these unprecedented times” is that we are stronger than we think. At the end of each exhausting day, when we have had our fill of fighting for bandwidth with Xboxing teenagers, with tired mouths from calmly saying, “you’re on mute”, we have been and will continue to be successful. More significantly, we have supported frazzled teammates, butted horns and laughed until we cried.

There is a sense of freedom this way of working has granted us. Whilst before, there was a tendency to stick to the tried and tested method of engaging and working with our clinical communities, COVID allowed us to think again. We used technology to enable hospital teams scattered across the entire southwest to meaningfully engage in PERIPRem without ever having to leave their wards. I was worried connecting through screens and keyboards would reinforce the distance between us all, but I am surprised to realise that it has in fact accelerated relationships and in turn progress.

Having to rely on the written word in email has meant that tone and intonation have been more carefully considered and the periods of chat offered through video calls means each sentence really counts. Of more significance, is a flattening of the hierarchy within our team. Each person no matter what their seniority is vital in keeping the PERIPRem wheel turning – be it because they know how to record a MS Teams meeting, or because they have the complex clinical knowledge of a perinatal intervention.  It is not that we did not appreciate this before, but the situation forced us to see beyond the limitations of a job description.

I have reflected on whether, upon return to ‘normality’, if we as a team will revert to the pre-COVID way of working. Whilst I would like to think there would be a time when we are able to sit in offices and meet with units, I do not think that is the whole question. I can honestly say I hope we do not – I do not want to forget our swift response to the restrictions placed on us, or our unwavering faith in our ability to make improvements.

I believe that we have fundamentally changed the way we will approach projects such as this in the future. We are braver in our ways of facilitating community, we have lived experience of delivering change programmes utilising technology rather than travel and we know that when needed, we can free ourselves of the legacy of traditional and more restrictive ways of working.

What’s your best-fit coaching style?

Our quality improvement project support officer, Kate Phillips reflects on her learning from the West of England Academy Improvement Coach Programme…

I recently took part in a great two-day improvement coaching event hosted by the West of England AHSN, funded by The Health Foundation. The event was attended by 26 of the West of England Qs, a group of people who I am really enjoying getting to know as we share a passion for driving quality improvement (QI) in healthcare. Sue Mellor and Dee Wilkinson, our fabulous facilitators, guided us through three coaching approaches with an emphasis on finding our ‘best fit’ coaching style. This encouragement for honest reflection ensured I left with a bounty of personalised counselling tools.

We started the course by working out our Honey and Mumford personality type which led to conversations around team dynamics and how to make the most of individual talents. I felt a sense of belonging and of ‘finding my people’ as the room was buzzing with personality type ‘private’ jokes. A particularly comical moment was when three ‘activists’ were first up to grab the board pen, while the ‘theorists’ were still discussing the merits of the process!

I initially joined the ‘pragmatists’ as I thrive on finding evidence-based logical solutions. However, following an insightful conversation with a colleague, I scooted myself closer to the ‘reflectors’. She had noticed how I often approach tasks with a reflector mindset, which I reckon comes from a desire to learn best practice from more experienced colleagues (experienced in QI and identifying personality types!).

Having very recently made a jaunty sidestep away from a career in teaching, I am still finding my QI feet… Interestingly I think personality types are fluid and can change depending on the situation we find ourselves in.

For example, if I was to stroll back into a classroom and teach a class about displacement reactions (fire!) you would see a pragmatic Kate, but put me in the office answering the phone you would firstly see me very flustered as I juggle the telephone voice, demands of the caller and transferring the call. However after my heart rate has returned to baseline, I will reflect on the success of the phone call and how I can make it less of an ordeal next time (more fire?).

As I’m sure a lot of QI projects involve taking people out of their comfort zones, I think it is important to recognise that personality types may take a detour away from ‘the norm’ during the changing situation. I can imagine this having quite a big impact on team dynamics.

As the two-day programme unfolded, Sue and Dee skilfully balanced theory-based learning with opportunities to ‘play’ with different coaching approaches, always with the focus on our own QI projects. We worked in triads to explore the benefits of three different coaching approaches:

GROW – Goal, Reality, Options, Will

CLEAR – Contracting, Listening, Exploring, Actions, Review

OSCAR – Outcome, Situation, Choices, Actions, Review.

As both coach and coachee, the chance to experiment with these approaches and to work with different Qs was an invaluable opportunity for me.

As a coach I grasped the power of suspending judgement, in allowing silence to fall in a conversation and the truth that can be discovered by tapping into the conversation energy level as it peaked and troughed. My favourite approach was GROW, as I found the acronym was easy to remember and the conversation often flowed quite naturally along this path.

In the position of a coachee I learnt to approach the conversation honestly and openly. As a result I was rewarded with multiple light bulb moments as QI ideas and feelings bubbled to the surface, simply drawn out with a few pertinent questions and some very active, active listening. I’d like to thank my triads for these delicious moments of clarity.

I left the programme feeling excited by the power of listening and empowered by the ability to harness a 15 minute time slot. My enthusiasm was echoed amongst the other delegates. “It’s powerful stuff for fostering change,” said one.

I’d love to hear your own thoughts and tips about using coaching to promote and accelerate QI projects. You’ll find me on twitter at @IamKateP or @weahsn.

Using QI methodology to win Euro 2016

Natasha Owen, Quality Improvement Lead at the West of England AHSN, combines her passion for improvement science with her (basic) knowledge of football to get us in the mood for Euro 2016…

This year will see the Quality Improvement (QI) team at the West of England AHSN continue in its aim to increase the capacity and capability of colleagues in our member organisations, through the understanding and use of QI methodology and tools.

What better way to achieve this than by starting with our own teams here at the AHSN office?

Sometimes when using QI tools we have to step outside our own sector, in this case healthcare and the NHS, and develop people’s understanding of the concept using a more relatable topic. Say football for instance. The impending European Football Finals (Euro 2016) felt to us like the perfect opportunity to combine some office fun, in the form of a sweepstake, with an example of how to apply the Model for Improvement.

The QI team set about thinking: how would a football team apply the Model for Improvement to their tactical approach in the competition?

When specialist knowledge and QI skills are combined you can develop what Don Berwick called ‘the knowledge base for continual improvement’, which any team in any industry or field can strive for.

I mean who wants to stand still when you could improve?

As a QI expert or trainer, you are not expected to have the specialist knowledge. The key is allowing specialist teams to apply their knowledge to the Model.

In this case, I had the knowledge of applying the model combined with just enough football knowledge to make this example work!

The Model for Improvement requires a systematic approach to its application. It is a step by step process, which, when applied as described in the correct order, will provide a consistent approach to improving the quality of your performance, or processes, as a team.

Skipping a step, doing step three before step one, or taking steps out completely will not glean the same results. More importantly it is not guaranteed to achieve an improvement every time.

However the ‘test small and quick’ method allows you to rule out bad change ideas as easily as identifying ideas that create an improvement. Both outcomes are essential to promote continuous change.

So back to our football team… How on earth can a methodology created for a healthcare environment help a football team win the Euro 2016 Final?

Picture the scene. It is the month before the finals begin, the football season has ended, and Roy has called up the England boys to play for their country. What an honour!

During the football season all the players play for different teams, where different tactics and skills are used. Bringing them together in the short term is comparable to creating a Quality Improvement team. Roy does not have long to get this team to gel together to be a high quality goal scoring machine: the finals start on 10 June!

Training as a team gets underway. In other words, the planning of the QI project begins. Step One of the Model for Improvement is to establish your aim: what are we trying to accomplish?

For this team the aim is to win the European Football Tournament by 10 July 2016. Aims should be specific. Note that the team want/need to achieve their aim by a certain date.

The next thing they need to do is decide what data they could use to decide whether an improvement has been made. This is Step Two of the Model: how will we know a change is an improvement?

Measurement is key to distinguishing between a change, and a change that makes an improvement. If we don’t know what the data looks like beforehand, the data we collect afterwards will be meaningless.

A football team may have many sources of data they can measure, from the number of goals they score to how fast each player runs during a game. However they need to decide which measures are applicable to their aim. Does running faster contribute to winning? I don’t think it would be a team’s primary concern.

Before you decide what to change, you need to decide if it can be measured. So Roy and the boys have got together and had a discussion in the changing room and came up with the following measures…

Primary measure: number of points scored. Essentially this is how football is governed so that measure is set for the team. This might happen from time to time when undertaking improvement projects where measures are set externally – by CQC or NHS England for example.

Secondary measures

  • Number of goals scored
  • Number of yellow cards given
  • Number of opponent goals saved or avoided.

Your primary measure is the main source of data you will use to establish if your aim has been achieved. Secondary measures can provide further data to indicate to what level a change is driving towards or away from making an improvement.

For example, where the team draws and only scores one point, this could be explained by the number of goals scored being equivalent to the opposing team, but an increase in yellow cards being given might suggest an underlying behavioural issue that led to a poorer performance, ultimately leading to the lack of goals scored or saved.

Now the fun begins! Step Three is all about getting creative: what changes will make an improvement? It’s all about generating ideas, no matter how crazy they might seem as long as they can be conducted within the rules of the game. I am pretty sure EUFA won’t allow players to wear rocket boosters on their shoes!

Finally we move into the testing phase. The team might decide what ideas to test using a prioritisation matrix. Remember, test one idea at a time. Test small, test quickly. This way you will limit the damage a change could cause and create less disruption in a full system which could have a ripple effect in other areas or departments.

This style of testing is called PDSA cycles (Plan-Do-Study-Act).

The team decide their first test of change will be: players will only pass the ball five times before whoever has the ball shoots for the goal during the game against Turkey on 22 May.

Plan: your change. What will you do? What measures will you use? Who will do it? When will you do it? How will you do it?

Action

Lead

Implement by

Measure of success

Install beeper on the ball that will beep after it is passed five times

Manager

16 May

Number of times players shoot after hearing the beep

Number of goals scored

Practice the five pass tactic in training

Players and Coach

16 May

Number of times ball is aimed at the goal after five passes

Use the five pass tactic during the game

Players

22 May

Number of points scored

Number of goals scored

Do: put it into practice. The timescale for the test will be the duration of the next game (around 90 minutes).

Study. Using the measures you set out, has an improvement been made? Run charts are the recommended way to present and analyse your data to indicate improvement.

Act. Did you see an improvement? Yes? Try it again in the next match see if it continues to improve the team performance. No? Reflect on why it did not create an improvement and refine the idea, or scrap it and move on to the next idea.

Now you have this knowledge, you might want to give Roy and the England boys* a call to see if you can help them with their tactics and WIN WIN WIN!

*or any other manager and team in the tournament

Hot off the press! Our guide to Quality Improvement

Our new Guide to Quality Improvement (QI) is a handy, A5 sized handbook, which explains what QI science is all about and how it can be used to deliver safer and better patient care.

It provides a summary of our five-phase Improvement Journey, our methodology for making change happen, and a useful introduction to some basic QI tools.

It is designed to encourage healthcare staff across the West of England to learn more about QI using the resources on our Academy academy web pages, and to get involved with local improvement projects.

Download a PDF version of the handbook here.

Alternatively if you would like a printed copy of the handbook, please email academy@weahsn.net.