What changes do we think will result in improvement?

EYC is one!

Mothercare Award for Maternity Service of the YearNHS Forth Valley

Philips AVENT Award for Innovation in Midwifery

Maternity telehealthSheona Brown and Dorothy FinlayNHS Greater Glasgow and Clyde

Pregnacare Award for Excellence in Maternity CareVulnerable Families Maternity TeamElaine Moore and Mary GarvenNHS Ayrshire and Arran

The RCM Award for Partnership Working Early Years Assessment TeamRebecca Wade and Linda DavidsonNHS Borders and Scottish Borders Council

The President’s Award for Supervisors of Midwives Supervisor of Midwives TeamNHS Lanarkshire and University of the West of Scotland

NMSF Award for Bereavement CareBereavement care: maintaining a gold standardFamily room organisation and updateEmma CampbellNHS Lothian

Pregnacare Award for Excellence in Maternity CareVulnerable Families Maternity TeamElaine Moore and Mary GarvenNHS Ayrshire and Arran

Scotland Johnson's Baby Mums' Midwife of the Year winner Laura Main NHS Grampian

Early Years Collaborative

Stretch Aims 1. Positive pregnancies which result in the birth of more healthy

babies by end 2015• 15% in the rates of stillbirths and infant mortality

2. 85% of all children reached all of the expected developmental milestones at the time of the child’s 27‐30 month child health review, by end‐2016

3. 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end‐2017

4. 90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021

1. Positive pregnancies which result in the birth of more healthy babies by end 2015

• 15% in the rates of stillbirths and infant mortality

2. 85% of all children reached all of the expected developmental milestones at the time of the child’s 27‐30 month child health review, by end‐2016

3. 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end‐2017

4. 90% of all children in each Community Planning Partnership area will have reached all of the expected developmental milestones and learning outcomes by the end of Primary 4, by end-2021

Stretch Aims

• One year in…

• ‘Superior results in certain locations do not spread to other sites’ WHO/IHI

• Key Changes

Learning Session 4 January 2014

Key changes

• Develop and package interventions for optimal adoption across the EYC

• In alignment with the EYTF expectations and the agreed Single Outcome Agreements.

• Describe the relative advantage over current practice

• ‘Trialability’ and ‘Observability’  

• Small pockets of activity (islands of excellence)

• Make it compelling!

Key changes

Focus

Breakthrough items

Big tickets

Concentrated effort

But don’t stop other stuff!

Activity to dateKey Changes event

Engage those not in the room

Develop a menu of key changes by work stream

Paper to EYTF December 2013

Learning session 4 – ‘Key Changes’

Activity todayYour work today – develop and refine the proposed Key Changes

Consider the evidence base

Consider your population

Apply your improvement science learning

Consider your ‘Pioneer’ sites

Share your data…

BECOMING A “PIONEER SITE” IN THIS AREA• A Pioneer Site is an area (specific geographical location,

nursery, clinic, school, community centre etc.) that has:1. The local will and interest to work on this important issue with

their community.2. Leadership support to be the CPP’s Pioneer Site for this issue. 3. Adequate resourcing to do the work required for testing in this

area.4. Some existing work in this area.5. Willingness to share their data and learning with the

Collaborative, warts and all!

Key changes

Cross cutting

Workstream 1

Workstream 2

Workstream 3

Workstream 4

Workstream 5

In 1601, James Lancaster successfully conducted an experiment to illustrate the effectiveness of lemon juice to prevent scurvy. When did the British Fleet

adopt this treatment?

1. 16022. 16893. 17574. 17965. 1865

264 years....264 years....

19

Controlling ScurvyControlling Scurvy

1601 Captain James Lancaster experimented with lemon juice to prevent scurvy

1747 James Lind, another experiment on HMS Salisbury

1795 British Navy adopts innovative prevention on all ships

1865 prevention was adopted across the British Merchant Marine

“Strong evidence for an innovation is necessary but not

sufficient to result in its adoption”

Mark Freeman, 2012, The International Journal of Management Education

Source: Based on Ryan and Gross (1943)

The “Diffusion Curve”:Reaching the Tipping Point

Number of Adopters of Hybrid Seed Corn in Two Iowa Communities

Tipping Point

Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.

Roger’s Adopter Categories

Jason’s preferences…

Roger’s Adoption Attributes

““Up to 70% of improvement Up to 70% of improvement projects never spread”projects never spread”

Eccles R, Miller Perkins K, Serafeim G. How to Become a Sustainable Company. MIT Sloan Management Review 2012;

53(4): 43-50.

With thanks to Carol Haraden

1. Start with a large pilot

2. Find one person to do it all

3. Be assured…vigilance and hard work will solve the problems

4. Do one small test and then spread everywhere

????

????

5. Get the pilot team to spread the improvement system-wide

6. Only look at the process/quality measures on a quarterly basis (or less frequently)

7. Expect marked improvement in outcomes early on without attention

to process reliability

Memo issued to all staffMust do this!

Memo clearly worked – job done!

Testing and Implementing a Change Idea

What factors What factors influence the influence the

decision?decision?

BELIEF

Low degree of belief

that change idea will lead

to improvement

High degree High degree of beliefof belief

that change idea will lead

to improvement

Current commitment commitment within organisationNoNo

commitmentcommitmentSome Some

commitmentcommitmentStrong Strong

commitmentcommitment

COST OF FAILURE

Cost of failure largelarge

Cost of failure smallsmall

Cost of failure largelarge

Cost of failure smallsmall

Very small scale Very small scale testtest

Very small scale Very small scale testtest

Small scale testSmall scale test

Very small scale Very small scale testtest

Very small scale Very small scale testtest

Very small scale Very small scale testtest

Small scale testSmall scale test

Large scale testLarge scale testSmall scale testSmall scale test

Very small scale Very small scale testtest

ImplementImplementLarge scale testLarge scale test

Testing and Implementing a Change Idea

@jasonleitch