Improvement Science for Beginners: demystifying improvement

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Our Senior Digital Communication Manager, Lauren Heaton reviews Improvement Science for Beginners: demystifying improvement.

It’s a sunny day here at Haelo HQ and we’re all set up and waiting for today’s attendees. The workshop, lead by Kurt Bramfitt, Senior Improvement Advisor and Nick John, Lead Analyst, will fly through the world of Improvement Science. Giving our beginners all they need to take the first step into the world of improvement. I soon realised I’ve been using this methodology all along, I just didn’t know it!

And so we begin, with willing improvers from Haelo, Medway Council, GM Neuro Rehab Network, Cumbria NHS Foundation Trust, Barnet, Enfield & Haringey NHS FT and Salford Royal NHS FT. We’ve got one attendee who left London at 4:50am this morning, so it’s a good job we’ve got exhilarating content…and strong coffee!

Overview

Kurt sets the scene of what promises to be an intense, introduction session and we kick things off with a quick icebreaker – who knew we had someone in the room who can eat nine Jaffa Cakes in one minute!? (and who has been using small tests of change to perfect this technique without even knowing!)

Throughout the day we cover content from both The Healthcare Data Guide (Lloyd P. Provost, Sandra Murray) and The Improvement Guide (Clifford L. Norman, Lloyd P. Provost, Thomas W. Nolan). Kurt begins with an overview of the pioneers of Improvement Science – Deming, Shewart and Juran. First up it’s the Lens of Profound Knowledge and a tour of: appreciation for a system, knowledge of variation, theory of knowledge and the psychology. We’re shown some great examples and told how Deming travelled the world learning from others – something we as an organisation should definitely do more of!

Digging deeper

After a quick break, we’re back with Nick and an overview of the Model for Improvement, a framework guide to improvement work. We spend some really useful time on aim setting. The room agreed this is one of the hardest parts of any improvement programme and equally the most important, we all need to work towards one aim and we all need to believe that aim.

Group exercises now on aim setting. Kurt and Nick have both spent time choosing the right exercises and participation tools (we know how tedious these can sometimes be) and so it was great to hear at the end of the day how useful these activities were “I normally hate participation games and I found all really useful today”.

Onto driver diagrams, with Nick describing these as a map to change. My own learning style is to relate examples to every day life and I think of aim setting like a road map – you wouldn’t set off to a new location without knowing where you are going! Another great example from the room; one attendee explains how driver diagrams helped with a recent business plan, turning potentially meaningless content into a viable and understandable aim.

The afternoon

After a hearty lunch we’re back in the room with Nick and it’s measurement and data time!

A great review of measurement types – judgement, research and improvement and it’s a real eye opener for some “A lot of what we’re doing is driven by target but no discussion around the aim – the why this matters“. Again, we’re shown real life examples – a light bulb moment for me. Working in groups, we’re given an aim and an exercise using a tennis ball to demonstrate the use of PDSA to test ideas and theories.

Ready for the real world

After a quick break we continue with Nick going into more detail on understanding variation. Having two data points, before and after a test of change, just doesn’t give you enough information to ascertain if an improvement has been made. We need to see more regular data over time to truly start to answer the question ‘Have we made a difference?’. Once we have this, we can start to question and investigate the data using various techniques to differentiate between the natural normal variation inherent in the data and variation caused by an external influence.

Kurt took to the floor to facilitate a discussion on the psychology importance in improvement. Understanding people and their behaviours can be difficult, however it is often vital to the success of an improvement project. We also discussed common challenges faced and the theory of diffusion of innovation, before moving onto motivators and top tips for engaging people in improvement.

Back with a new face, Haelo’s Senior Improvement Advisor, Bob Diepeveen. Bob wows attendees with how to develop an appreciation of a system. The key to understanding a system is looking deeper than a single event, such as a fall. Delegates are urged to look into the trends and patterns that have occurred, from your quantitative and qualitative data. But this can only tell you so much. The next and final step to truly understand your system is to look further down into the structure to really improve.

More participation exercises to show how every system is perfectly designed to get the results it gets and if you don’t make any changes, it won’t result in any improvements.

Another key element of Improvement Science is the Process Map, a graphic representation showing all steps, actions and decision points to receive an outcome. Process Maps can generate ideas to test changes in your project. They identify waste (duplication, inefficiencies) and are a powerful tool to understand problems, customer perspective and variation (everyone’s different understanding of the system).

A completed map gives you idea of what the current process looks like, shows the relationship between steps and departments and serves as process documentation and standardisation.Understanding a System Triangle

Next time you start a process map, take a look at Bob’s Top Tips:

  1. Define a clear start and end point for the process
  2. Have at least one representative per role, don’t forget to include a patient/customer representative
  3. Start high level and gradually add detail. Don’t get stuck in the detail too early
  4. Use post it notes to build the chart – this allows steps to be moved as additional detail is added
  5. Draw the arrows last
  6. You can use different colours as you go along – such as, red for waste, green for improvements etc

And that’s a wrap. Today’s session has really improved my appreciation of the system of profound knowledge and will definitely impact how I view systems and problems in the future.

I’ll be back to continue my learning with “Improvement Science for Intermediates: the improvement toolkit” in September.

If you’re interested in improvement science for beginners, Haelo are hosting two more workshops this year in July and September.

We suggest learners attend:

  1. Improvement Science for Beginners: demystifying improvement
  2. Intermediate Improvement Science: the improvement toolkit
  3. Improvement Science Academy: scale up and spread
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