Workshop 4 Sustainability Creativity Final For Upload

Quality Education for a Healthier Scotland
Quality Improvement Development for

NHSScotland Organisational Development Leads
Workshop 4
Sustainability for QI
Creativity new ways of thinking

Agenda
Sustainability for QI projects
Creative thinking
Objectives
Understand the key elements of sustainability
Learn process for innovation
Learn some tools for creative thinking

What is sustainability
when new ways of working
and improved outcomes
become the norm
to keep something
going over time and
continuously
maintaining the gains and
evolving as
requireddefinitely not
going back to the old way
Evidence for sustainability
33% of improvement projects had reverted to
their previous way of working after a year
33% had maintained the improvement but it
had not been adopted by others in the
organisation
33% had maintained the gain and there was
evidence of adoption outside of the core
change area
Data from NHSI 2010
Key considerations
Sustainability and project stage
Stage Potential role of sustainability model
1 Start out
2 Define & Scope
To identify and improve areas that require
strengthening right away
3
Measure &
Understand
4 Design and plan
5
Pilot and
implement
For full confidence during implementation phase
6
Monitor and
sustain
To maximise chance for sustainability and
continual improvement
Questions for sustainability
Training and involvement
Are key stakeholders involved in design, trial and implementation of project?
Has a skills analysis been carried out to identify skills and knowledge gaps?
Have key staff been trained in the knowledge and skills required to implement the new project?
Behaviours
Are staff encouraged to express their ideas?
Are staff encouraged to run small scale PDSAs to implement change?
Are staff encouraged to believe that change will result in an improvement?
Leadership
Are senior leaders respected and believable?
Are senior clinical staff respected and believable?
Are clinical staff involved in the initiative?
Goals and Culture
To what extent have you incorporated the "Voice of the Patient" into your project?
Are the goals clear and shared
Is the project contributing to the overall aims of the organisation?
Infrastructure
Do you have the resources to support the new project?
Have new policies and procedures been written?
Is a communication system in place?
Benefits
Are their benefits beyond helping the patient?
Are the benefits credible?
Will staff notice a difference to them (WIFM)?
Monitor progress
Does the change require new monitoring systems?
Is the data readily accessible?
Will the change be easily communicated to a wider audience?
0
20
40
60
80
100
Project A Project B
Training &
Involvement
Benefits beyond
helping patients
Monitoring
progress
Behaviours
Leadership
Infrastructure
Fit with goals &
culture
Sustainability model
Innovation
Effective innovation requires a systematic
process?
Think of a new idea for delivery of healthcare
that will improve the patient experience
in waiting rooms.
IDEO
http://www.youtube.com/watch?v=M66ZU2P
CIcM
Process for innovation
Define the
problem/
situation
Create new
ideas
Act on it
Select best
option(s)
Stretch the
idea
Define the problem
Original
Problem
Broader
Problem
Narrower
Problem
Why do I want to
solve this problem?
What is stopping
me solving this
problem?
Are we solving the right problem?
Define the problem
Why do I want to
solve this problem?
What is stopping
me solving this
problem?
Original problem
Low staff
morale
Broader problem
Need for improved
productivity
Morale affects
productivity
Narrower problem
Find time
Adaptive procedures
Insufficient time
Procedures too rigid
Need for
improved level
service
Broader problem
Need for better
patient care
Narrower problem
Better time management
Overcome cynicism
Too much work
Staff cynicism
Problem hierarchy explorer
10 minutes
Poor communication
-1- True North Innovation Ltd 2006
WHAT IS THE PROBLEM?
Original Problem (start here)
Broader Problem
Narrower Problem

Why do I want to solve this
problem? Why else?
Whats stopping me solving
this problem? What else?
Note that the questions can be repeated to
identify new layers.
De Bonos Mental Valleys
Adapted from HM Government Department for business innovation and skills
Separation in:-
Time
Space
Conditions
Fresh eyes

Ideas funnel
Time
100
ideas
generated
2
ideas
tested
5
ideas
developed
10
ideas
selected
1
Idea
launched

s
s
s
Tools for creativity
1. Reverse brainstorming
2. Fresh eyes
3. SCAMPER
4. 9-windows resources
5. De Bonos 6 hats

Also:
6. Knowbrainer
7. TRIZ contradiction matrix
1. Reverse brainstorming
Clearly identify the problem or challenge
Reverse the problem or challenge by asking:
"How could I possibly cause the problem?", or
"How could I possibly achieve the opposite
effect?".
Brainstorm the reverse problem to generate
reverse solution ideas.
Now reverse these into solution ideas for the
original problem or challenge.
Evaluate these solution ideas. Can you see a
potential solution? Can you see attributes of a
potential solution?

2. Fresh eyes
Age 5, 10? Colleague, spouse?
Airline?
Bank?
Patient?
3. SCAMPER
S Substitute components, materials, people
C Combine mix, combine with other assemblies
or services, integrate
A Adapt alter, change function, use part of
another element
M Modify increase or reduce in scale, change
shape, modify attributes (e.g. colour)
P Put to another use
E Eliminate remove elements, simplify, reduce
to core functionality
R Reverse turn inside out or upside down, or
use Reversal

4. Resources
Substance material (equipment, materials, software,
waste) within the system or systems surrounding
People within and around system
Financial - (budgets, grants, funding)
Information tacit and explicit knowledge, Intellectual
Capital, other sources e.g. books, internet
Energy Resources sources of energy available within
the system or systems surrounding, which are not used
fully
Space Resources any unused space
Time Resources any spare time slots in between,
before or after technological processes
Resources - example
Making use of unused space
Unexpected skills in the team
Making use of what would otherwise be
waste
Allocation of unused time, e.g. patients
waiting

Tangible resources
PAST FUTURE PRESENT
Around system
e.g. External
Within system
e.g. Team
System
e.g. Company
Tangible Resources (people, materials, equipment)
PAST FUTURE PRESENT
Around system
e.g. External
Within system
e.g. Team
System
e.g. Company
Intangible resources
Intangible Resources (information, energy, space, time)
5. De Bonos 6 Hats
From Edward De Bono Six Thinking Hats 1985 / 1999
Exercise
2 minutes big picture (blue hat)
2 minutes positive (yellow hat)
2 minutes negatives (black hat)
2 minutes to expand idea (green hat)
2 minutes feelings (red hat)

Triz contradiction matrix
Knowbrainer Innovation Tool
Investigate needs
Create ideas
Evaluate solutions
Activate plans

From Solutionpeople
Tools for selection
1. By criteria
2. By dot voting
3. By matrix selection
Tools for selection
1. By criteria
2. By dot voting
3. By matrix selection
Easy
Difficult
Low impact
High impact
Tools for stretching idea
Ideal Final Result
Current
Situation
Ideal
Final
Result
Start here
Dont start here
Intermediate
solutions
X
Tools for stretching idea
7 dimensions of performance
1. Safety
Absence of errors
Prevention of harm
Conformance to standards
Reliability
2. Effectiveness
Clinical outcomes
Improved quality of life
Free from complications
3. Timeliness
Waiting time
Time to treatment
Time to complete a task
4. Efficiency
Cost
Use of resources
5. Equity
Cultural sensitivity
Greater access and availability
6. Co-ordination (across all system)
Flow across system/journey
Integration of care plans
Shared information
7. Patient-centredness
Ease of use
Convenience
Portability
Choice
Ease of understanding
Engagement/involvement in care
Self-management
Fit to needs
Experience of care
Process for innovation
Define the
problem/
situation
Create new
ideas
Act on it
Select best
option(s)
Stretch the
idea
Good idea
Testing and
refining systems
Implementing new
procedures & systems
sustaining change
PDSAs for Quality Improvement
Ideal Final
Result
Innovation and project stage
Stage Potential role of creativity
1 Start out
Help generate and stretch ideas for improvement
and transformation
2 Define & Scope
Help generate ideas of how goals and objectives
may be achieved
3
Measure &
Understand
Help discover new ways of gathering information
4 Design and plan Help find solutions to design and planning issues
5
Pilot and
implement
Help identify optimum methods of implementation
6
Monitor and
sustain
Help identify ideas to reignite flagging projects
Resources
Thinking Differently (NHS Institute)
Making a Bigger Difference (NHS Institute)
Creativity, Innovation, and Quality Quality Press
by Paul Plsek
The 7 Levels of Change: Different Thinking for Different
Results by Rolf Smith
www.directedcreativity.com
www.solutionpeople.com

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