Event Blog: Improvement Workshop with Maxine Power


Welcome to Haelo’s live blog from “Demystifying Improvement” with Professor Maxine Power on Wednesday 13 July 2016 at thestudio, Manchester.

Improvement workshop: Demystifying Improvement

The workshop will untangle the web of improvement science, looking to equip delegates with the toolkit to scale up and spread improvement in 2016 and beyond. You can see the agenda for the day here.

The day will be led by Haelo’s Chief Executive, Professor Maxine Power and Senior Improvement Advisor, Kurt Bramfitt. Haelo #Greenshirts will be on hand supporting the event. Please do tweet us @_haelo with #improvementworkshop

About Maxine Power

Maxine is the Chief Executive of Haelo, formally the Associate Director of Innovation and Improvement at Salford Royal where Haelo was founded. Since trading began in April 2013 we have developed a reputation nationally and internationally in the fields of innovation and improvement science.

Maxine had a 20-year clinical career and was one of a small number of non-medical professionals (Speech and Language Therapist) to be awarded a Medical Research Council Clinical Research Training Fellowship.

In 2001, Maxine completed her doctoral training in neurophysiology before in 2006, being awarded a Health Foundation Quality Improvement Fellowship, spending one year at the Institute for Healthcare Improvement in Boston, USA and completed a Masters in Public Health at Harvard University. You can follow Maxine on twitter @powerNHS


Let’s begin…

So today came about after the huge success of recent blog series by Prof Power. You can see the full blog series here on our website, a great selection of resources so support your improvement journey.

You can also access a sample of slides from Demystifying Improvement Prezi.

10am Delegates are welcomed by Kurt Bramfitt, Haelo Senior Improvement Advisor, complete with an introduction to Haelo.

Key learning outcomes are discussed in the room, so we can address and hopefully achieve objectives for all those attending. These range from spreading change, keeping momentum, creating a toolkit to takeaway.

So what is improvement science?

10:20am Maxine takes to the stage to deliver the first session of the day

“One of the things that is important today is not only what you take away from the Haelo team, but from each other. There will be lot of talent and experience in the room, so you may get more from your coffee breaks and not just in the room today.”

The group share their experiences with change in small teams, projects that will hopefully be related to throughout the day as we begin to unravel improvement science.



Put on your armour – You’re going to need it. We’re going into battle” Maxine lays her first lesson that ‘improvement is a contact sport’. The session hopes to look an improvement science through fresh eyes – We’ll take time throughout the day to pause and think “What would I do differently next time that I wouldn’t have done at 9 o clock this morning.”

Step One: Convince people there is a problem. Maxine shares with the room her first improvement programme when trying to reduce C. Difficile in our hospital. You can read the full experience in our: ‘Improvement Aim’ blog.

Delegate question: “What if you become the problem?” – Be prepared, don’t take it personally or let it sap your energy. You can read top tips for an aspiring improver at: Improvement is a contact sport. Appreciate people’s stand point.

Step Two: Set direction and a clear aim, and step back. People need to find the direction of travel that suits them, with the permission and space to fail. Socialise your aim – If you get it right there’s no reason why each member of staff can’t contribute to and engage.

Programme Delivery

“Not enough time is spent considering what already exists.” Pay attention and dig out what has been done in the past – understand complexity of the environment.

WATCH ME: Hear about the ‘dead projects cupboard’ – everyone has one!


Next up, a brief run through on the ‘Driver Diagram’ – a social part of change. At the beginning of any Haelo improvement project, we build a Driver Diagram with an expert group to collate what they think are the important drivers for change, but to also represent the programmes of work and the sub groups.

Things we forget: Not all the drivers have the same impact. It is important to judge which of them will make the greatest impact so you can focus your efforts, and the efforts of you team, in those areas in the first instance.



How will the change happen?

Slide10Psychology: Discussing how Roger’s Innovation Adoption Curve applies to your improvement science project.

InnovationYou need to understand the characteristics of the people in the system. Does it fit with the culture, the prevailing mindset? And if it doesn’t, this doesn’t mean you don’t do it – it will just take you longer.

Rodgers also helped us understand the characteristics of individuals behaviours and responses to change. From laggards to innovators – “this is toolkit we use all the time”.


Systems: Now we move to process mapping. How do you make a cup of tea? A map in a tea cup: Kayleigh Price, Project Manager at Haelo, talks us through the importance of process mapping in a guest blog.

PRocess MapWhen you’re working with teams they need to understand the system they’re working in and how to improve it – they will all have their own view of the system, Just like they will also make a cup of tea differently. Sit down and map out your system.


Variation: We will go into depth with this with Kurt later this afternoon. And finally, also this afternoon, we will look at the Theory of change. We will look at the Model for Improvement.

“When going into an improvement challenge, I will have all four of these.” All four are necessary to effect change – You need to use all interchangeably. Getting to know and using the ones you aren’t familiar with will be like using your left hand, but it’s necessary.




Excited about data?

Self confessed data enthusiast and measurement lead at Haelo, Kurt Bramfitt, is up after lunch to lead the next session: Measurement for Improvement.

If you look at the Model of Improvement, developed by the IHI, in this session we’re going focus on the second question.

Improvement is not just about measurement but it plays an important role. In the next hour we’re going to explore data, specific measures and balancing measures.

We use specific measures to generate learning, during PDSA cycles. Balancing measures are needed to assess whether the system as a whole is bring improved. Data from the system can be used to focus improvement and refine changes.

Kurt tells the group what reactions to expect when presenting data:

What can measurement show?

  • How well we are currently performing
  • Have we reached our aim
  • How much variation occurs
  • Effects of tests of change
  • Have we improved? And has this been sustained?

Kurt shares his real life experience using data to track weight lose before his honeymoon!



Tools to understand variations “is what gets me out of bed in the morning” Kurt Bramfitt

Why do we need a chart? Bringing data in a table to life, we can spot trends and variation we otherwise may not have been able to visualise. Kurt uses an example bar chart to understand why to display over time. You can read more about this in a haelo blog.

Common cause of a system is system operating in its common state.The output of a system that is designed to get those results. To bring this to life, Kurt hires 6 willing workers in his business to produce high cards in a deck of cards.

Special cause variation looks at inputs/change that have been added to the system. Then we need to identify if those changes are effecting the results

Run charts vs Shewhart (SPC) charts

Run charts can be used to present data over time, allows you to see variation in your data and assess common cause variation. Should be used when you have 12 points or less and  a median average is used to create it’s center line.

For more on run charts, see our recommended resources list: ‘The run chart: a simple analytical tool for learning from variation in healthcare processes’. Read more

Shewhart control charts are a statistical tool used to distinguish between variation in a measure due to common cause or special causes. A tool that measures the impact of change. A mean line is used for it’s center line.

So, to summarise our data session…


Developing & testing ideas and theories

In the next session, Kurt explores how to text change ideas with PDSA – Plan, do, study, act – cycles.

For more on PDSA, use our recommended resources list which includes: Opening the “black box” of Plan-Do-Study-Act cycles: Achieving a scientific yet pragmatic approach to improving patient care. Read more



Groups are tasked with reducing the time taken for every person to touch the tennis ball in a particular sequence. Groups are asked to carry out four tests to achieve the quickest time.


Kurt uses ‘Building knowledge, asking questions’ which can be accessed in our recommended resources section. Read more

Appreciation of a system

In our final session from Kurt today we’re understanding and visualising systems. “Every system is perfectly designed to get the results it gets”

Follow our quiz – what do you get?



How did you get on? Grey elephant from Denmark? An example of how: Every system is perfectly designed to get the results it gets.

Closing remarks from Professor Maxine Power where together we review the live blog and feedback from the day via text poll.

Tackling one of the NHS’s biggest issues: GP access Access to GPs is one of the key issues the NHS faces today. See the story of how one surgery in Salford used innovation in service delivery to improve:

Clarendon Surgery, Salford – Improving patient access to GPs from Haelo on Vimeo.

Your feedback in three (or more!):

Aim, armour, measure
Equipping, energising, enlightening
“Great insight into data. Enjoyed the interactive aspects. Can’t wait to start a project!
Informative, motivational, friendly
Informative, eye opening, fascinating
Data making change possible
Inspired to improve

Recommended resources


Also in our network:

A map in a tea cup: Kayleigh Price, Project Manager at Haelo, talks us through the importance of process mapping in a guest blog.

Haelo’s Data Coordinator, Nick John, from the Measurement team tells us why we need for data over time, and his ‘top tips’ when presenting data.

What do you think?

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