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Scottish Improvement Skills Improvement Principles

Scottish Improvement Skills Improvement Principles. Improvement principles. By the end of this session you will be able to: e xplain Deming’s System of Profound Knowledge a pply the System of Profound Knowledge to assist an understanding of complexity in your local context.

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Scottish Improvement Skills Improvement Principles

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  1. Scottish Improvement Skills Improvement Principles

  2. Improvement principles • By the end of this session you will be able to: • explain Deming’s System of Profound Knowledge • apply the System of Profound Knowledge to assist an understanding of complexity in your local context.

  3. Quality Improvement is defined as the application of: “a systematic approach that uses specific techniques to improve quality.” What is Quality Improvement? Health Foundation 2013

  4. All approaches have the following in common

  5. System of Profound Knowledge Deming 2000

  6. System of Profound Knowledge • https://www.youtube.com/watch?v=xKv--YA8XJE

  7. System of Profound Knowledge Deming 2000

  8. Appreciation for a system • A common purpose • What’s in a system: structures, processes, culture • Interdependence, interactions • Whole is greater than the sum of its parts

  9. Appreciation of a System • “Dividing an elephant in half does not produce two small elephants.” Senge 1992

  10. What is a system? • “A system is a set of interrelated parts that work together to achieve a common aim” • Deming 2000 • “A group of items, people or processes working together toward a common purpose” • Improvement Guide p77-79

  11. Characteristics of a System • Has aim or purpose • Series of factors leading to outcomes that have value to stakeholders • Structures, processes, people, cultures • It is dynamic • To improve outcomes need to understand system dynamics

  12. Characteristics of a System • Structure + Process = Outcome • Donabedian (1966)

  13. Complexity Simple Complicated Complex

  14. Appreciation for a system: a personal example • Structures • Processes • People • Culture • Interdependencies

  15. Theory of Knowledge • Current knowledge is expressed as theory • Change involves prediction • We learn by testing theory and finding our if our prediction succeeds or fails

  16. The typical approach Conference Room APPROVE DESIGN DESIGN DESIGN DESIGN Real World IMPLEMENT

  17. The Quality Improvement approach Conference Room APPROVE IF NECESSARY DESIGN Real World START TO IMPLEMENT TEST & MODIFY TEST & MODIFY TEST & MODIFY

  18. Model for Improvement The Improvement Guide Langley J et al 2009

  19. Theory of Knowledge • What do we think we know? • What do we think stops us getting the outcomes we want? • What could we do differently, and what do we predict would be the result of that change?

  20. Understanding variation • Random variation – affects everyone all outcomes and overtime • Non-random variation – arises because of specific circumstances does not affect everyone or all parts of the system all the time

  21. Variation: Random or Non-random?

  22. Variation: Random or Non-random?

  23. Displaying variation in data (1)

  24. Displaying variation in data (2)

  25. Understanding variation: a personal example • What measures might be useful? • For each measure, Is variation in the data collected random or non-random? • If non-random, what is the cause of the variation?

  26. Psychology • Interactions between people • Motivation (intrinsic, extrinsic) • Beliefs • Assumptions • Will to engage with and adopt a change.

  27. Psychology: soft or hard?

  28. Psychology

  29. System of Profound Knowledge • Interactions between people • Motivation (intrinsic, extrinsic) • Beliefs • Assumptions • Will to engage with and adopt a change.

  30. System of Profound Knowledge Deming 2000

  31. References and further resources Deming W Edwards, 2000, The New Economics 2nd ed. Cambridge MA: MIT Press Donabedian A, 1966, Evaluating the quality of medical care. Milbank Memorial Fund Quarterly 44:166-206 (Republished 2005) Health Foundation, 2013 Quality Improvement made simple 2nd ed Langley Gerald J et al, 2009, The Improvement Guide: A Practical Approach to Enhancing Organizational Performance 2nd ed Wiley Senge Peter M, 1992, The Fifth Discipline: The Art and Practice of the Learning Organization Random House

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