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Learning from Excellence & Appreciative Inquiry
Dr Emma Plunkett
@emmaplunkett
Consultant Anaesthetist, Birmingham
What is Learning from Excellence?
Why do we need it?
How does it work?
What is Appreciative Inquiry?
What are the uses for LfE and AI?
Discuss on your tables
Tell me about an episode of excellence you witnessed or were involved in at work?
How did this make you feel?
What factors do you think contributed to this?
Source: Eurocontrol. From Safety 1 to Safety 2. A white paperwww.eurocontrol.int
Understanding negativity bias
Theirs nothing worse than misplaced apostrophe’s
1 + 1 = 2
2 + 2 = 4
3 + 3 = 7
4 + 4 = 8
5 + 5 = 10
Negativity culture:
Adverse events
Error
Risk
IR1 / Datix
SIRI / SUI
Never event
Second victim effectThird victim?Fourth victim?
Source: Eurocontrol. From Safety 1 to Safety 2. A white paperwww.eurocontrol.int
Safety 1 Safety 2
That as few things as possible go wrong. That as many things as possible go right.
Reactive, respond when something
happens or is categorised as an
unacceptable risk.
Proactive, continuously trying to
anticipate developments and events.
Humans are predominantly seen as a
liability or hazard.
Humans are seen as a resource
necessary for system flexibility and
resilience
Accidents are caused by failures and
malfunctions. The purpose of an
investigation is to identify the causes.
Things happen in the same way,
regardless of the outcome.
The purpose of an investigation is to
understand how things usually go
right as a basis for explaining how things
occasionally go wrong.
“Tell me how you measure me and I will tell you how I will behave”E M Goldratt
What do you want to know?
Who (or what) was excellent?
What did they do?
What can we learn?
http://eve/directorates/corporate/cg/Pages/Excellence.aspx
What do people report?
No one has reported themselves
Reports focus on what was DONE
Many themes
“In a 4 bedded bay with frail old women, 2 with delirium and all post hip#. All 4 patients were sat out around a table, she was interacting with them all and they were having tea. This is exemplary care for older people with cognitive impairment with and at risk of delirium.
This is likely to reduce further delirium and is gold standard non pharmacological treatment of delirium. This may well have reduced falls and use of psychotropic medication.
Delirium is a common, serious hospital adverse event that requires whole hospital solutions - this is an excellent example of local practice that does not happen routinely elsewhere.
“Dr X spent a large amount of the beginning of the shift teaching me, and talking me through aspects of setting up emergency theatre for potential cases overnight. Nothing was too much trouble, and I felt well supported, and appreciated, throughout my shift... Fantastic registrar to work with, a real asset to the trust!”
“This surgeon takes the lead in the WHO Checklist in theatre... She sets the tone for the whole theatre team, showing that the process is something to take seriously and needs to be completed thoroughly. Everyone in the team becomes engaged and sharing of information is much improved.”
“Showed incredible patience and flexibility with a patient with crippling anxiety who had had a very traumatic time previously when attempt to anaesthetise her for MRI. They manipulated the scheduling, extended timing, screened off the area where her experience had been so traumatic and were wonderfully compassionate and kind.
“XX showed excellence in communicating to the patient which then enabled patient centred care. They talked to patient about NG feeding /diet - crouched to be at eye level - offered varied options for home, noted end of NG tube not compatible with recent standards, liaised with CNS for patient to have tube end change at patient convenience - patient choice to continue with NG feed which completely met his needs. I felt this interaction / communication could have been recorded to use as an educational tool for excellence.”
Learning from Excellence
Planned output
1 Individual feedback only
2 Anonymous sharing as an example in a staff bulletin
3 To share as an educational tool for training / simulation
4 A mini-AI meeting with person reporting and / or reported
5 Suitable for a roundtable
Video - Sean and Mary
Thoughts
“Won’t people report themselves or each other?”
“Who decides what is excellent?”
“I wasn’t sure if I should fill in a form in about…”
“How do you know this makes a difference?”
“That was unexpected and very nice. Thanks.”
“What a lovely thing to do ...you’ve brought tears to my eyes. Thank you so much.”
“Next to excellence, comes the appreciation of it.” William M Thackery
Appreciative Inquiry
SIRI → IRISImproving resilience, inspiring success
Appreciative Inquiry – the 5D cycle
Define:Topic or example
Discover: The best of
what is
Dream: Imagine
what could be
Design: Plan what
will be
Destiny / Deliver: Create
what will be
Appreciative Inquiry: re-framing
Issue / Concern Re-frame / AI topic
Lack of collaboration Working together for greater good
Waste of resources
No one listening to ideas
Lack of motivation
Delays in treatment
Missed information at handover
Appreciative Inquiry: re-framing
Issue / Concern Re-frame / AI topic
Lack of collaboration Working together for greater good
Waste of resources Making efficient use of resources
No one listening to ideas Everyone open to new possibilities
Lack of motivation Feeling engaged and effective
Delays in treatment Prompt diagnosis and management
Missed information at handover Excellent communication and effective handover
Uses for LfE & AI
Reflective practice
Quality improvement
Learning from incidents
Service development
Safety culture
Appreciation and morale
Uses for LfE & AI
Reflective practice
Quality improvement
Learning from incidents
Service development
Safety culture
Appreciation and morale
Quality improvement
How can we improve quality?
Quality Improvement
Positive deviance & QI
(Safety) Culture
Safety Culture
“How we behave towards each other is the single greatestfactor in how well our teams will perform”
Chris Turner
ED Consultant
https://www.england.nhs.uk/signuptosafety/
Joy in Work
What’s next?
Summary
If we want to keep improving the quality & safety of our work we also need to look at what is working well and find ways to share those lessons
Learning from Excellence and Appreciative Inquiry help us to do this:
Provide balance
Good for morale
Potential to improve culture
Improve organisational and individual resilience
www.learningfromexcellence.com
Summary
“It is both easier and more effective to increase safety by improving the number of things that go right, than by reducing
the number of things that go wrong.”
Eric Hollnagel
“... The two most powerful words in the English language are ‘well done’”
Sir Alex Ferguson
www.learningfromexcellence.com
