Today’s Presentation
 A look back at the development of the MSc
 Why this programme - discuss rationale, approach and
content
 Explore measures of success and impact
 Discuss research into Capability & Capacity
Who am I?
 Child Care Social Work – 1990 to 2000
 Senior Manager NHS Change & Innovation 2000
 Accredited Project Manager 2004
 Tutor/Lecturer University of Edinburgh 2006
 Lean Black Belt – Process & Transformational Change 2008
 Knowledge Exchange Fellow University of Edinburgh 2008
 Institute of Healthcare Management Associate – 2010
 AoEC Associate Executive Coach - 2014
Why this programme?
 Experience and research told us:
 Fragmented and uncoordinated services
 Isolated staff: working hard, but does anybody know?
 How do services fit into a strategic whole?
 The power of information
 To work on the right problem
 to help individual understand and make the case for change
 To make links and build coherence
 Capability & Capacity building in the service
 Service Improvement Competency levels of workforce
 Organisational infastructure – volume
 Roles and responsibilities of people and agencies not clear
leading to delays, confusion and failure or success by stealth.
Right people in the...
Right place with the...
Right skills. =
Right services
Original quotation - Youth Conference Edinburgh, 1999
Later accredited to the MSP ??
Strategic Context
Government Policy and Priorities
 21st Century Social Work Review, 2006
 Better Health Better Care, 2007
 Delivery framework for Adult Rehab in Scotland, 2007
 NHS Healthcare Quality Strategy, 2010
 Efficiency and Productivity Framework, 2010
 Reshaping Older People’s Care, 2011- 2021
 Social Care (Self-directed Support) (Scotland) Act 2013.
 Public Bodies (Joint Working) (Scotland) Act 2014 -
Integration of health and social care.
“Public service providers must be required to work much more
closely in partnership, to integrate service provision and
thus improve outcomes …” (Christie Commission report)
MSc evolution
Programme continuous improvement
 Concept - Collaboration to develop a programme for health
& social care managers – 2006
 Making Integration Work: Initial programme – University
of Edinburgh Post Graduate Certificate – 2006
 Making Integration Work MSc – 2007
 MSc Integrated Service Improvement Health and Social
Care 2009
Core tutor team over time:
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Dr Guro Huby, University of Edinburgh
Kate Bell, Service Improvement
Steve Kendrick, Information Services Division, NHS Scotland
Dr Pam Warner, University of Edinburgh
Ms Marion Duffy, EM People
Dr Francis Watkins, Independent Consultant, Edinburgh
Dr Emma Miller, Joint Improvement Team
Dr. Tony Kinder, Business School, The University of
Edinburgh
Pete Knight, Joint Improvement Team
Dr Ailsa Cook, University of Edinburgh
Dr John Harris, University of Edinburgh
Aim of programme
 Individual development:
 Equip staff with skills to locate, interpret and share
information.
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Evidence
Routinely collected service data
Bespoke information from service mapping, evaluations,
Qualitative and quantitative
Students’ ‘tacit’ knowledge
 Organisational development:
 Target operational and middle managers: link between strategy and
‘coalface’.
 Students apply learning to a project agreed with line manager
 Organisational buy-in and support
 Organisational learning
Making Integration Work Day 1 - 27.09.2007 Guro Huby Programme Director
MSc – programme structure
 Contemporary issues in service improvement –
policy, theory, evidence and application.
 Effective use of information - with particular
focus on application to service improvement.
 Project management – managing people and
processes
 Advanced project planning - leading change and
complexity
 Electives – a range of topics with University
 Structured homework assignments
 Course Web Resource
Programme aspirations and developments
 Reflection / Action
 Understanding the project, its dynamics and particular
challenges: devising strategies to address them
 Student needs / project requirement
 Understanding individual’s role within a project, team
work, subject matter experts, constraints and scope for
action: designing realistic input.
 Leading Change and ‘coping with’ contingency / ensuring
sustainable and strategic service development
 Understanding and managing (in real time) limitations:
keeping projects on track
Evaluation and Improvement
What worked well +
What could be improved ∆
 Tutors and their attitude
 A lot of content crammed in –
 Service Perspective
 Group work and individual time.
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 Lots of learning seems to within
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group(s), good and interactive
participation
Networking Opportunities
Quick turnaround of feed-back
Presentations were good
The variety of examples
Reassurance regarding ‘doability’.
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not enough time to take it in.
Too little time to discuss what
was presented
More groupwork
Cross-over between data and
project management courses
Parallel workshops/tutorials
Tutor ‘critique’ of groups of
projects that are similar
Has the programme delivered
How do we know the success is related to the
programme
Measures of Success
The programme works:
 How many students – 130 + 35 enrolled
 Excellent student/organisational feedback
 Individual career development
 Individual Capability, Competence, Confidence and
Capacity
 Organisational benefit
 ROI
 Efficiencies, savings, projects better managed and
delivered on time
Understanding and Building Capability has never been so
important.....
Integration, Quality, Efficiency, Value, Productivity...... 3R’s
Understanding Quality/Service Improvement
Capability and Capacity
What were we trying to achieve?
Aim of the project
 To understand NHSS QI capability a commissioned project
(structured PM approach, 2 QI ‘experts’ leading the project)
Process of development
 Carry out research on the topic of Capability and Capacity
 Develop a prototype QIC framework (QI Capability
definitions, QI categories,
 Devise a means of engaging the workforce to assess current
state QI Capability
 Devise the content of and further develop a QI survey
framework for assessing quality improvement capability at all
levels in the organisation.
Results: (16 weeks)
QIC 4C’s model – On-line QI Self Assessment tool
Understanding Quality Improvement
Capability Project
Policy Context
 The Scottish Government’s Healthcare Quality
Strategy for NHSScotland (May 2010) identifies the
need to develop capacity and capability in quality
improvement methodologies across the health service.
 The Improvement Service  (IS) works with councils
and their partners to help improve the efficiency,
quality and accountability of local public services
Case for Change
• Significant investment in development of Quality
Improvement Capability (QIC) without
development or execution plan in place
• At present, these practioners/experts are located
in different functional areas and professional
groups in their organisations and have a wide
variety of expectations in terms of their service
improvement role
 Need to understand, develop and build capability
to reduce duplication and accelerate pace of
change.
HPO’s – research - 9 Attributes
1.
2.
3.
4.
5.
6.
7.
8.
9.
Culture
Leadership
Strategy and Policy
Structure
Resources
Information
Communication channels
Skills training
User Involvement (Physicians)
Literature review -2013
 High Performing Orgs 9 attributes for success:
 4. Structure:
 Roles and responsibilities for improvement are clearly articulated.
 Steering/oversight committees provide direction.
 Teams and teamwork are part of structure.
 5. Resources:
 Organisation provides time for staff members to learn skills and participate in
improvement work.
 Financial and material resources and human resources are available for
improvement.
 Quality improvement support/expertise: A core group of improvement experts
is available to help teams and individuals.
 Quality improvement department coordinates and supports initiatives.
 6. Information
 Information is available to support improvement.
 8. Skills training
 Includes training in improvement methods, team and group work, project and
management.
Source: : MacIntosh-Murray et al. (2006). Baker et al, (2008)
Policy, practice and research
 Local Authorities
 Integration papers and policies discuss improving
services through redesign, more robust planning......
 NHSS
 Many strategies and policies over the years talk about
build capability & capacity
 Health Foundation
 Perspectives on Context – March, 2014
 Skills for Improvement – March 2014
When the definitions in the literature are combined,
the following themes can be discerned:
A High Performing Organisation
 achieves sustained growth, over a long period of time,
better than the performance of its peer group;
 has a great ability to adapt to changes;
 is able to react quickly to these changes;
 has a long-term orientation;
 the management processes of a HPO are integrated and the
strategy, structure, processes and people are aligned
throughout the organization;
 focuses on continuously improving and reinventing its core
capabilities;
 spends much effort on improving working conditions and
development opportunities of its workforce.
Understanding Quality Improvement
Capability Project
 Evidence Base:
 Building capacity and capability are essential
components for the establishment of a solid
improvement foundation in the organisation and an
on-going renewal resource for continuous
improvement.
 All too often organisations think that sending staff and
leaders to a one- or two-day “training session” meets
the requirement for building capacity and capability for
improvement.
Institute Healthcare Improvement, 2013
Summary of success factors
Not a one-size fits all... Context!!!
 Involve the right people.
 Improvement projects are turbo-charged by discretionary effort and social
capital.
 They work best when key informants are passionate, they are voluntary,
inclusive (of all disciplines and patients) and in an environment where teams
have senior support to make change.
 Pick the right problem.
 Projects work best on issues where there is consensus on the problem and
solution, and where teams can get traction.
 They are most likely to show results when there is a large gap to be closed
between actual and desired practice, and tight coupling between the
problem/service change and the solutions.
4c Self Assessment formula
Build
competence
•
•
•
•
None
Team member
Project lead
Coach
Develop
confidence
•
•
•
•
Understand
capability
•
•
•
•
Awareness
Foundation
Pratitioner
Lead
A Service
Improvement
workforce
Basic training
Can do with
support
Can do without
support
Can train others
Create
capacity
•
•
•
•
Part of day job
Sessional
Part time
Full time
19 Management Methodologies
Change
Coaching
management
Health
Human
Economics
factors
Communication Evaluation
Improvement
models - BPR
Improvement Improvement
models –
models TQM/CQI
Lean
Improvement Improvement Knowledge
models – IHI models – Six management
Sigma
Leadership
Mentoring
Project
management
Patient
centredness
/experience
Patient focus
public
involvement
Facilitation
Measurement
for
improvement
Service Improvement Self
Assessment - SISA
Respondent Demographics
(All 23 Responses Analysed)
NHSL - Efficiency & Productivity
NHSL - Strategic Planning
NHSL - Modernisation
NHSL - CHCP
NHSL - Nursing Directorate
NHSL - Medical Directorate
NHSL - Facilities
NHSL - Acute Scheduled Care
NHSL - Acute Unscheduled Care
Capability Level (23 Responses analysed)
Change management
2
11
6
6
Communication
1
2
12
4
9
3
13
Facilitation
4
6
13
4
4
Human factors
6
7
3
7
3
8
Improvement models – IHI
2
5
6
5
2
5
2
Measurement for improvement
1
6
3
3
40%
1
5
6
5
5
12
20%
Practitioner
3
7
4
2
3
11
5
0%
Foundation
9
6
6
60%
80%
No Awareness
Awareness
8
9
8
Project management
1
10
6
Patient centredness/experience
Blank
7
Improvement models – Six…
Knowledge management
2
100%
Leader
Competence Chart (23 Responses analysed)
Change management
3
1
5
Communication
2
2
7
3
2
6
Facilitation
2
1
3
3
1
5
Blank
10
5
Human factors
0
3
1
Improvement models – IHI
0
2
1
1
2 0
6
Measurement for improvement
1 1
6
7
6
7
0%
20%
40%
60%
1
2
5
Project management
Project Lead
Teacher
1 1
9
Patient centredness/experience
10
1
01
Knowledge management
Project Manager
2
1
Improvement models – Six Sigma
Team Member
0
3
4
None
3
80%
0
3
0
3
2
100%
Coach
Confidence Level (23 Responses analysed)
Change management
2
14
3
8
Communication
2
3
14
13
Facilitation
5
3
11
5
4
2
7
Improvement models – IHI
3
6
5
1
6
4
1
3
7
Improvement models – Six Sigma
3
5
3
5
Knowledge management
Measurement for improvement
8
5
1
0%
3
7
17
50%
2
8
Can do without
support
Can Train Others
2
13
5
1
1
4
8
Patient centredness/ experience
Can do with support
1
10
12
Received Basic
Training
1
4
6
3
No Training
3
6
Human factors
Blank
4
5
Project management
3
1
4
100%
Length of Experience (23 Responses analysed)
Change management
Blank
Evaluation
No Experience
Human factors
< 1 month experience
Improvement models - Lean
< 1 year experience
Knowledge management
Between 1 and 3 yrs
experience
Mentoring
> 3 years experience
Project management
0%
20%
40%
60%
80%
100%
Service Improvement Capacity
Service
Improvement
Capacity
Numbers
Total
None Sessional PLT
Part- Full
time time
5
5
1
2
22%
22%
4%
9%
10
Total
23
43% 100%
QIC Workforce Assessment Framework
1.
2.
3.
4.
5.
6.
7.
8.
Stakeholder Interviews – diagonal slice
Self Assessment tool
Survey Monkey or other electronic platform – agree the
cohort
Analysis of Self Assessment Survey
Gap Analysis of Survey output
Engage with cohort
Develop Capability Plan
Create a programme of education and development
opportunities to grow and continue to build
Improvement Capability at all levels.
More work required....
 Tailor the Self Assessment tool
 Build a national electronic platform
 Work with NHS Board/Joint Boards to discuss self
assessment, gap analysis and......
 UNDERSTAND Capability, BUILD Confidence and
DEVELOP Competence
 CREATE Capacity............... Increase levels/volume of
Service Improvement posts.... Invest to save.....
 Developing education and development opportunities
Systems Level
Organisational Capability OD Plan
The Improvement Pyramid
Wasted
Skills fall
resource!
short
Health Foundation, Skills for Improvement, 2014
The Improvement Pyramid
Skills Fall
fall short
Skills
Short
Health Foundation, Inspiring Improvement
Next steps
 Roll out Self Assessment tool
 Build educational and development opportunities
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internally
Link up with academia to accredit learning and build
continuous learning process
Service Improvement Infastructure
Deliver success first time and every time
Provide Coaching and mentoring for people leading
improvement
I am developing a model called Coaching for
Improvement