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.

Q survey 2016

What is Q and how will it help health care?

Q is a diverse and growing community of people with experience and understanding of improvement who are committed to working collaboratively to improve the quality of health and health care across the UK.

Over time, Q will grow to be a community of thousands of people including front-line staff, managers, researchers, policy makers, patient leaders, and others.

By working together, those who join Q are supported to be more effective in their own improvement work and make more of a difference on shared quality issues.

Q is an initiative, led by the Health Foundation and supported and co-funded by NHS England.

What is the West of England AHSN doing?
We are supporting Q and have committed to help identify potential participants for future cohorts. This complements our own ongoing strategy of identifying improvement expertise and experience across the region.

Your assistance in completing this survey will allow us to begin the exercise of mapping our regional capacity and provide the Health Foundation with basic details of individuals interested in improvement.

In completing this survey you are stating that you give consent for your name, contact details and information about the improvement work you are involved in to be shared with the Health Foundation for the purposes of understanding regional improvement activity and networks and to receive information about being a future participant of Q.

Please be aware that your details will not be shared outside of the West of England Academic Health Science Network or Health Foundation Q Initiative team and you are not committing to being part of any future cohort of the Q Initiative.

For more information visit www.health.org.uk/programmes/about-q-initiative or contact Kevin Hunter kevin.hunter@weahsn.net

The Primary Care Collaborative

In May 2016 we launch our first Primary Care Collaborative. with up to 20 primary care practices from across our seven clinical commissioning groups (CCG) set to join the first cohort. This collaborative will form part of the wider West of England Patient Safety Collaborative.

The initial aim of the Primary Care Collaborative will be to promote a safety culture in the primary care setting through the use of incident reporting, leading to better outcomes for patients. It will also increase awareness amongst practice teams of the patient safety agenda, while promoting an open and honest culture.

Additional benefits for practices will include improving preparation for Care Quality Commission (CQC) inspections and the revalidation and appraisal process for all staff.

Each practice will complete a patient safety culture survey and we will support practices with tools and training in Quality Improvement (QI) methodology, enabling the identification of opportunities to improve patient safety. Practices in the collaborative will come together at four learning and sharing events during 2016/17.

Alison Moon, Transformation & Quality Director for Bristol Clinical Commissioning Group (CCG), says:

“It is really positive working with the AHSN on the primary care programme. There’s a combination of energised joint working, a structured improvement approach and the sharing of best practice and experiences, which gives us a really good chance of achieving our shared objectives on patient safety.”

Contact

For more information on the Primary Care Collaborative, please contact Kevin Hunter at kevin.hunter@weahsn.net.

New Education Pathway launched to improve patient care

The West of England Academy team is pleased to announce the official launch of the Education Pathway, a free training facility open to all staff across our member organisations.

Members of staff from healthcare organisations across the West are now able to access our three-step Education Pathway to develop their quality improvement (QI) knowledge and skills and boost their confidence in using QI tools in order to improve the care provided to patients.

The three steps

Education Pathway graphic

Step One (understanding) provides all staff with access to well-established online training in fundamental QI tools.

Step Two (delivering) offers all staff the unique opportunity to use a BMJ Quality licence free of charge. The licence provides access to a BMJ Quality mentor to provide expert advice on delivering a QI project, and enables participants to publish their projects on the BMJ Quality website.

Step Three (leading) is currently in development. Watch this space for more information on our Improvement Coaches programme and how you can apply for future cohorts.

Flexible training

The Education Pathway is flexible and recognises that you might have already undertaken training or delivered a project that would fulfil either step one or two. If this is the case, staff can have existing training endorsed by their line manager and progress to the step most appropriate to their specific needs on their QI journey.

What’s more, the Academy training is recognised across all our member organisations, which means your QI expertise will be recognised in any cross-organisational working. As you progress through the steps on the Education Pathway, participants can demonstrate their increased QI knowledge by getting your QI Passport stamped as the complete each stage.

Take a look at our Education Pathway pages to get started.

The Academy team appreciates any feedback on the training and resources. You can get in touch with the Academy team at academy@weahsn.net.

The West of England Academy

The Academy underpins all learning and development activities organised and delivered by the West of England AHSN and aims to continually increase the number of healthcare professionals across the region with the skills and knowledge to deliver long-term, sustainable improvements in patient care.

Continuous improvement is a skill requirement for all staff. Our challenge is to develop ways in which staff can use improvement science and tools so they are confident to carry out and sustain changes that enhance patient care. Find out more about the Academy here.

Join us on the Improvement Journey

The West of England Academy aims to increase the number of staff across our member organisations who have the knowledge, skill and confidence to plan and deliver sustainable improvements to patient safety and care.

A key element of our strategy is the introduction of Improvement Coaches; volunteers who are already experienced in the use of basic improvement science who will have the opportunity to develop their coaching skills and enhance their own knowledge of improvement so they can direct, guide and coach colleagues in the use of practical tools and techniques – that will help enhance services in order to drive better patient care.

We were overwhelmed with the number of applicants for our first cohort of Improvement coaches from 19 of our 21 healthcare member organisations, but have had to limit the number to 50 coaches who will start on 1 March 2016. Planning is already underway for a second cohort to start in the autumn.

The interest and enthusiasm shown indicates we will achieve our ambition to expand our community of Improvement fellows across the West – experts who will be at the cutting edge of new developments in improvement science.

But all staff can develop their knowledge and skill for making improvements happen. Our Improvement Journey online toolkit will be launched this spring and available to all.

The Improvement Journey is a five-phase method for planning and delivering a quality improvement project. However complex the improvements you wish to make, our ‘journey’ will take you through a logical approach and provide a suite of tools for you to choose from that will help you to successfully implement changes.

At its heart, the Improvement Journey encourages small-scale tests of change to see whether these will lead to improvements, prior to formal implementation.

For more information on either Improvement Coaches or our Improvement Journey, visit the West of England Academy pages or contact david.evans@weahsn.net.

Anyone for tennis?

Anna Burhouse, Director of Quality at the West of England AHSN, explains a fun way to introduce teams to the basics of quality improvement.

I recently used this technique at one of our workshops with colleagues from across the health and social care sector, and it got such a positive response that I thought I’d share it more widely.

It’s is a great exercise for introducing teams to a number of quality improvement (QI) approaches — including the model for improvement, PDSA (plan do study act) cycles, measurement using a run chart, variation, human factors, thinking differently and distributed leadership.

So what do you need? Not much really!

A group of people – at least 12 and the more the merrier, just add more balls! Each group will need one tennis ball, a recording sheet, a pen, a ruler and a way to record times – most people tend to use their mobile phones. You can download the recording sheet here. You’ll also need one person to act as facilitator.

Find out more about PDSA cycles and the model for improvement in our West of England Academy pages and there’s a great video on PDSA on YouTube.

And how do you do it?

Divide the group into teams of around four or five people.  In each team you’ll need a leader, a time keeper and a measurement recorder.

The facilitator gives each team a tennis ball and sets the task: “The ball needs to pass to each member in turn so that everyone passes it.” Be deliberately vague unless asked for clarification!

Ask the team leaders to start a round of passing the ball. Be explicit that the idea is to pass the ball as naturally as possible in the first round.

Each team times each round and records the turn number on the x axis and the number of seconds taken on the y axis of the chart. Record eight sets of “turns” on the graph. From the eight data points calculate the median and draw a line at of this figure right across the graph parallel to the x axis

Explain that people have now established their baseline and their median.

Ask teams if they think they could improve on the median score. Suggest they identify just one change and note it on the graph and then test it another eight times. This is PDSA 1.

Then run further PDSA cycles until people feel they’ve reached a steady state, where the system is running as smoothly as possible, is maintainable and could be replicated by others.

Then when everyone is feeling confident, go back to each team and explain that the tennis ball was actually modelling how the A&E service was managing flow. Unfortunately it’s now mid-winter and demand has risen sharply. As a result of this the team now has to run another PDSA but this time they cannot use their hands.

End the session. Ask for final times and feedback about the process. Encourage discussion about what has worked.

What will teams learn?

  • Measurement: they have just completed a ‘Run Chart’. Typically a series of seven to eight uninterrupted figures above or below the median is significant and can indicate a deterioration or an improvement.
  • QI Science: they have just completed a quality improvement project using the Institute of Healthcare’s quality improvement theory ‘ Model of Improvement’, using a Plan Do Study Act cycle (PDSA)
  • Variation: they have seen how each group has come up with a different way of approaching the task and there is variation in both the outputs and the way the team works together.
  • Human factors: they have seen human factors in action. For instance, the speed of the person timing will often cause unintentional mistakes and unless this system was automated the system can only ever be as good as the person operating it – the ‘Theory of Constraints’ in quality improvement would also see this as a bottleneck.
  • Thinking differently: often the winter pressures exercise sees people get up and use their feet. Often it improves the time. Just note that necessity is the mother of invention and that by coming up with their own solutions and thinking differently, improvements can often be made. This learning is about the power of distributed leadership where the clinical microsystem can innovate local solutions.
  • Importance of a clear aim: often people ask for greater clarity on the task as the cycle progresses. The learning here is to establish a clear aim of what you are doing and what quality measures are required by the facilitator at the beginning, after all there is no point improving the wrong thing.

Ideally this exercise takes 45 minutes to do really well, but it can be scaled back to 20 minutes if you need to by reducing the number of PDSA cycles or leaving out the winter pressures section.

How can we help you enhance your skills in Patient Safety and Quality Improvement?

The West of England AHSN is conducting a survey amongst health and social care professionals to identify the skills and expertise in our region around Quality Improvement and Patient Safety. And we’re keen to hear from you.

This will help us to better share learning and expertise, and tailor our approach so it meets the healthcare community’s ongoing needs to deliver long-term, sustainable improvements in patient care.

We’re developing our work alongside ‘Q’, an initiative led by the Health Foundation, supported and co-funded by NHS England, and designed to connect people skilled in improvement across the UK.

If you are interested, experienced or trained in Safety or Quality Improvement work, then we would like to invite you to complete this short survey, which should take between five and ten minutes to complete.

This survey is being managed by the West of England AHSN in partnership with The Health Foundation.

For further information, contact:

Kevin Hunter, Patient Safety Programme Manager
kevin.hunter@weahsn.net
0117 900 2413

Putting patients at the heart of Quality Improvement

How can we work collaboratively with patients and carers to co-produce and transform clinical services? This was the focus of our latest West of England Academy masterclass, hosted by our colleagues at Royal United Hospitals Bath.

The 41 participants from our member organisations were joined by three inspirational speakers for a stimulating and interactive workshop in which they got to practice using some of the resources from the Kings Fund’s Experience-based Co-design toolkit.

Our three speakers were:

Annie Laverty, Director of Patient Experience at Northumbria Healthcare NHS Trust

Annie discussed how her organisation has put patient experience at the core of their approach to improving care, with positive results in patient satisfaction and staff morale. Attendees were particularly interested in how patient feedback is collected in the morning and delivered to staff directly that afternoon, in a way that encourages staff members to actively use the feedback to improve the way they and their team mates deliver care.

Suzie Bailey, Head of Development at Monitor

Suzie was able to explain how Quality Improvement approaches are being used by the regulator to increase the range of support they are able to provide to front line care providers. In a previous job, Suzie played an important role in the development of the Sheffield Microsystems Coaching Academy at Sheffield Health and Social Care NHS Foundation Trust, and Sheffield Children’s NHS Foundation Trust, in partnership with the Dartmouth Institute Microsystem Academy from the USA, and was able to offer some practical anecdotes from her work there.

Anna Burhouse, Director of Quality at the West of England AHSN

As well as working for the AHSN, Anna still practices clinically as a Child and Adolescent Psychotherapist.  She also works on a voluntary basis to help develop the Severn & Wye Recovery College in Gloucestershire, which was set up by the 2gether Trust in 2013 to provide a new way to support people living with mental health problems. Anna shared personal stories about some of the people they had helped, including  video clips to emphasise the success of the approach.

In the afternoon, delegates were introduced to the Experience-based Co-design toolkit, working in large groups to consider what observations they might make about their working environment if they were a patient, carer or visitor, with a view to making the environment more attractive for guests. They then worked in small groups to practice interviewing patients in a way that would support their involvement in co-design meetings between clinicians and patients.

Throughout the day there was an extremely positive vibe within the room. The post-event feedback reflected this, with comments on the “inspirational speakers” and being surprised at “how real” the exercises were, as well  “how well organised” the event was.

For more information, contact:

David Evans, QI Programme Manager
0117 900 2249
david.evans@weahsn.net

For details of forthcoming events, check out our Events section. Read the evaluation report here.