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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

Comments

  1. Congratulations on being shortlisted.

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

    Best wishes

     

  2. 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.

  3. 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!

  4. 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. 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.

  5. 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. 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!

  6. Love this, strong team , would be keen to support

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

    Good luck all

    best wishes

    Anna

  8. Be interested in linking up with your project as it complements our bid for Norfolk James Ward can we connect ?

  9. Have a look at https://events.theiet.org/think-big-future-health-life-science-unconference/

  10. 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. 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.

  11. 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. 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!

  12. 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.

  13. 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. 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

  14. 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.

  15. Can you provide a link to the report please?

    1. A link is now on the page above. Thanks, Thomas.

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