Q Exchange

Improving improvement

Co-designing a systems approach to managing complexity in Healthcare Improvement - building on the landmark report, Engineering Better Care, together we can develop the power to tame wicked problems.

Read comments 27 Project updates 2

Winning idea
2019

Meet the team

What is the challenge your project is going to address and how does it connect to your chosen theme?

“The UK’s health and social care system is, appropriately, one of our most treasured national assets. However, the sheer size and complexity of the system, as well as the pressures it faces from an ageing population and finite resources, mean that making improvements to health and care can be a significant challenge. Successful transformation must take into account the needs of all patients, carers, healthcare professionals and other staff. It requires consistent consideration of every element of the system, the way each element interacts, and the implications of these interactions for the system as a whole – that is, it requires a ‘systems’ approach.” This comment from the foreword of Engineering Better Care echoes a number of key global reports and advocates the need to describe a systems approach to design and continuous improvement, to build on current practice and bring renewed focus onpeople, systems, designand riskas vital perspectives in the improvement of complex systems.

What does your project aim to achieve?

Engineering Better Care sought to co-design a systems approach to health and care design and continuous improvement by bringing together improvers, healthcare providers and systems engineers in a series of workshops to define a common language for improvement. The resulting approach, based on a series of simple questions, formed the basis of a landmark report from the Royal Academy of Engineering, Royal College of Physicians and the Academy of Medical Sciences. This project aims to take this work further, co-designing a systems approach toolkit with health and care improvers, based on a prototype developed by the University of Cambridge. The main objective is to create a toolkit, owned by the improvement community, that shares ideas and good practice in taking a systems approach to improvement. This will be achieved by building an active, self-sustaining forum for discussion, learning and sharing where success is measured by interaction with the toolkit and stories of its use.

How will the project be delivered?

The core team will run a series of face-to-face workshops, site visits, online debates and forums to encourage improvers to share experiences of improvement. Particular attention will be paid to the improvement frameworks and approaches used and their accompanying activities and tools, the choices made in their deployment and the top tips for achieving success or avoiding failure. Q members will be asked to describe new tools, add references to existing tools, provide rationale for their tool choices and examples of their use. Stories will provide the basis of members’ narratives and a culture for sharing stories will be actively supported and encouraged as the primary mechanism for improving improvement. The core team have significant experience of facilitating improvement and working with Q members and the improvement community. The risk of poor engagement will be mitigated by identifying members from the early Engineering Better Care workshops to assist in building the community.

What and how is your project going to share learning throughout?

The project will deliver a toolkit, based on the Engineering Better Care prototype that provides guidance on a systems approach to improvement. This will be a dynamic resource ‘owned’ by the Q members, updated and choreographed by the core team. The project will also deliver a forum and events to encourage such ownership and a culture of storytelling to sustain the development of case studies which will add insight as to the use of systems tools and the value of using a systems approach. The toolkit and its associated guidance and resources will be made freely available to a Q members.

How you can contribute

Ideas for resources to include in a systems toolkit
Identification of existing improvement toolkits that work
Discussion on the best means to encourage toolkit ownership in a busy world
Identification of core team members

Plan timeline

14 Jan 2020	Initial workshop to roadtest toolkit
10 Feb 2020	Ongoing curation of toolkit content
11 Feb 2020	Online discussion session
25 Mar 2020	First site visit to those using the approach
29 Apr 2020	Second online discussion session
13 May 2020	Second workshop to test content (incorporating feedback)
17 Jun 2020	Second site visit to those using the approach
23 Jul 2020	Final online discussion session
9 Sep 2020	Final site visit

Project updates

29 May 2020

Hi Everyone,

As promised, this is our update following the second workshop which took place on the 19th of May. Overall, the session was a success, with participants scoring the session just under 8 out of 10. However, we faced two significant challenges. Firstly, whilst there was a good level of attendance, there were a number of people who attended the second workshop who could not attend the first. To mitigate this, we made the recording of the first session available. We’re sure for those people, whilst the recording helped, it wasn’t the same as going through the experiences (all the exercises and discussions). So now we are reflecting on the wisdom of splitting the day-long session into these two workshops. The second challenge was around using virtual on-line documents. We set people an individual task, based on their own work project. In doing this, we couldn’t see well enough how people were using the online documents, and any challenges they were having. This meant that, for some individuals, the technology got in the way of some of the learning. We’ve learnt lessons from this, about how we remove technical challenges, either avoiding these in the design of the documents, or taking that challenge outside of the learning environment.

Despite these challenges, we now have a core group of people who are eager to apply the Improving Improvement approach so that we can continue to refine the online toolkit, which is available to everyone at: http://www.iitoolkit.com

There are platforms we’d like to re-iterate the importance of as we work more and more virtually: Zoom, the backbone of the workshop, iCloud.com, to create and share collaborative documents, and WhatsApp so that workshop facilitators can communicate during the session.

We are now finalising plans with the core cadre of people mentioned above regarding how we can support them and how they can support each other, and are in the process of putting the message out (for instance in the Special Interest Group) for people to contact us if they would like to be part of this core group, should people have both the capacity and the energy to get involved.

Thank you for your interest; we will keep updating you as we progress. If you would like to contact us, please message myself, Peter Dudgeon, via the Q community website.
21 Apr 2020

Hi Everyone,

As with so many other cases, Improving Improvement has moved on-line for the foreseeable future. We planned our initial day-long workshop on the 2nd of April. Given this moved on-line, it was split into two virtual sessions, one on the 2nd, and the follow up to be help on the 19th of May. We were all surprised by how well the first session went – we used Zoom, as well as Apple’s online iCloud documents (like Google docs) to facilitate this. Of course, many people had to cancel because of COVID 19. Out of the 20 people initially booked, only 7 could join. However, we were able to record the session and make it available to those who were unwilling to attend. Our attendees gave helpful feedback (using google forms); the event scored a solid 8/10, with attendees looking forward to the second session, where we’ll get into the details of the toolkit. We are currently in the design process for the 19th of May, and will contract with people at that session, how we will mentor them through their project delivery going forward.

Any questions, please don’t hesitate to contact me via the Q members website or by email at: peterdudgeon@icloud.com

I’ll post another update after the 19th of May. All the best, Pete Dudgeon.

Comments

Mark Fenton 15 May 2020

Hi, I've just joined the Q Community and this looks like a really interesting piece of work. My background is from outside of Healthcare as a systems engineer. I have lots of experience in applying systems thinking to solving complex problems, facilitation of co-creation workshops, and continual improvement. I'd love to contribute to this activity if there is the opportunity to do so.

Kind Regards,

Mark
1. Peter Dudgeon 15 May 2020
  
  Hi Mark,
  
  Thank you very much for your interest. Do you happen to be free next Tuesday morning? If so I wondered if this event would be of interest to you?
  
  https://www.eventbrite.co.uk/e/improving-improvement-training-part-2-tickets-102661479248
  
  If signing up, the password is Improving Improvement
  
  Best wishes,
  
  Pete
  
  Health Transformation Partnership
  peterdudgeon@icloud.com
  07507 819168
Tim Bryson 27 Feb 2020

Hi John and James,

I am looking forward to hear more about the Improving Improvement toolkit at our seminar on 26 March for the London 'safety in Mental Health Settings' project and insights we can bring to bear on the challenges and complexities of the acute mental health care system. Thank you for your input.
Susan Went 20 Oct 2019

Congratulations on being shortlisted.

great idea and I would be delighted to contribute and offer support

Best wishes
Ruth O’Dowd 20 Oct 2019

Really like this idea, and would be keen to get involved. we have introduced systems based approach to learn and improve from incidents in North Cumbria, and keen to build on this thinking.
1. Peter Dudgeon 21 Apr 2020
  
  Hi Ruth,
  
  I hope you are well. I know a lot has changed since you posted this comment, expressing your interest. However, if you are still interested in getting involved, there are resources/ virtual training opportunities coming up. If you'd like to know more, please don't hesitate to contact me at peterdudgeon@icloud.com.
  
  All the best,
  
  Pete
Mary Salama 17 Oct 2019

Dear team

i really like this idea. My team have been working on how to improve care for children with medical complexity across health, social care and housing and immigration boundaries. Happy to share the learning.

i would suggest involving the CIEHF group of chartered ergonomists as stakeholders. As you probably know they have written a white paper in 2018 and are increasing their visibility and support within our sector.

Good luck!
Isabel Ho 10 Oct 2019

Hi Emma. We are doing a piece of work to promote system thinking in radiotherapy. Our digital material has been adopted by International Atomic Energy Agency and will be launch Q1 next year. I think your project would also compliment very well with psychology 4 improvement which is what I m keen to get involved in both. Does your group use STAMP model by Prof Nancy Leveson at MIT?
1. Alexander Komashie 11 Oct 2019
  
  Hello Isabel, thanks for your interest in this work. I am a member of the Engineering Better Care team in the University of Cambridge hence my interest in your question. Great to hear about your work in radiotherapy and with the IAEA. We will love to learn more about your approach. Will also be great to explore the link with P4I. STAMP is not our main approach to improvement but some of my colleagues have used it for risk analysis in a number of situation. You can see an example comparing STAMP and Bow-Tie approaches here https://onlinelibrary.wiley.com/doi/epdf/10.1111/risa.12897. We have our own approach to risk management called the System Safety Assessment (SSA) toolkit. You can find more info on the SSA toolkit here http://www.ssatoolkit.com/ssatoolkit/. Most importantly, the Engineering Better Care approach to improvement was designed to be complementary to existing approaches and so will not be against the use of STAMP. I hope this helps.
Thomas John Rose 9 Oct 2019

A good starting point for a toolkit is 'The Productive Series: Releasing time to care, a programme developed by the NHS institute for Innovation and Improvement'. I have hard copies of this series and I use them extensively in my research. The nitty gritty of a systems engineered 'system' is standard work. The Productive Series hints at this but in my view did not go far enough. The Viginia Mason book 'Transforming Health Care' has an interesting piece on this. As a Systems Engineer (IET and CQI member) I'd like to help with this most important project in any way that I can.
1. James Ward 14 Oct 2019
  
  Thanks again for your helpful observations, Thomas. I have the entire Productive series on my bookshelf, and many other materials from when the NHSIII closed down!
Helen Crimlisk 8 Oct 2019

Love this, strong team , would be keen to support
1. Peter Dudgeon 21 Apr 2020
  
  Hi Helen,
  
  I hope you are well :)
  
  I'm not sure if you've seen my posts on the Improving Improvement special interest group, but there are opportunities coming up to get involved with this project virtually, particularly with a training workshop on the morning of the 19th. If you'd like to know more, feel free to drop me a line at peterdudgeon@icloud.com
  
  All the best!
  
  Pete
Anna Burhouse 29 Jul 2019

Love this idea and having seen the early work would happily get involved to help the next stage.

Good luck all

best wishes

Anna
1. Peter Dudgeon 21 Apr 2020
  
  Hi Anna,
  
  I hope you are well. How the world has changed since you posted this comment!!! If you are still interested in getting involved, there are resources/ virtual training opportunities coming up - a key one on the 19th of May. If you'd like to know more, please don't hesitate to reach me at peterdudgeon@icloud.com.
  
  All the best,
  
  Pete
Barbara Hercliffe 28 Jul 2019

Be interested in linking up with your project as it complements our bid for Norfolk James Ward can we connect ?
Thomas John Rose 25 Jul 2019

Have a look at https://events.theiet.org/think-big-future-health-life-science-unconference/
Wendy Lewis 22 Jul 2019

this was a great piece of work to be involved with previously. There is so much potential for this shared approach to improvement from engineering and health expertise and the combination of the 2 developed an energy and passion of its own which is what this project would capitalise on for the benefit of our patients, staff and systems.

there are other Q Exchange projects posted that connect to this one - is there a plan to combine efforts and avoid duplication?

I'd very much like to stay connected to this work and offer any support.

Good luck!
1. Emma Adams 25 Jul 2019
  
  We're really keen to take the work forward and have made some connections with other projects proposed to combine our efforts. There's a lot of interest in engineering and healthcare but we now need to "test" some of the approaches with real health systems and with real improvers to develop suitable resources and an applicable toolkit.
Seema Srivastava 18 Jul 2019

Really great idea. Having spent a day with John, John and James at the RCP last summer looking at an early stage of the toolkit and having commented on the development of the interactive online report, I am really interested to see how this proposal develops. Let me know if you need any further help. Seema
1. Peter Dudgeon 22 Jul 2019
  
  Thanks for your interest and support Seema. Having now seen a physical prototype of the guide and toolkit which supports the approach, we're hugely excited about working with other improvers to turn it into a powerful, helpful guide for improvers in complex Health and Care systems. I'm sure we'll be coming to you for more feedback and input!
James Ward 17 Jul 2019

Thanks Thomas. I believe my colleagues, who are writing the application, are planning to get in touch with you separately. I'll leave it up to them, and thanks for your interest.
Gareth Evans 17 Jul 2019

Hi all,

Happy to be involved in this and share my experience using Human Systems Dynamics and other applied (anthro) complexity approaches (Cynefin, Adaptive Space) if that's at all helpful...

All the best, Gareth
1. Emma Adams 25 Jul 2019
  
  Hi Gareth. Thanks for your offer of support. There are some great linkages with other approaches to systems thinking and being able to explore the possibilities Human Systems Dynamics could bring to this would be great. We've had some other comments on the Complexity SIG pages which also suggest that this is an area of growing interest for Q members.
  
  Best wishes
  
  Emma
Thomas John Rose 12 Jul 2019

Thanks James. I recognise the document now. Please have a look at my idea https://q.health.org.uk/idea/2019/process-management-how-to-make-qi-outcomes-more-sustainable-and-scal/ I think that it may fit well with your idea and we may be able to share knowledge. Certainly standard work, if designed correctly, fits with a systems engineering approach.
Thomas John Rose 1 Jul 2019

Can you provide a link to the report please?
1. James Ward 4 Jul 2019
  
  A link is now on the page above. Thanks, Thomas.