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A Method to our madness: Our theory of how improvement happens Ninon Lewis and David Williams

Early Years Collaborative: Learning Session 4. A Method to our madness: Our theory of how improvement happens Ninon Lewis and David Williams Institute for Healthcare Improvement. Components of a learning system. System level measures Explicit theory or rationale for system changes

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A Method to our madness: Our theory of how improvement happens Ninon Lewis and David Williams

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  1. Early Years Collaborative: Learning Session 4 A Method to our madness: Our theory of how improvement happensNinon Lewis and David Williams Institute for Healthcare Improvement

  2. Components of a learning system • System level measures • Explicit theory or rationale for system changes • Segmentation of the population • Learn by testing changes sequentially • Use informative cases: “Act for the individual learn for the population” • Learning during scale-up and spread with a production plan to go to scale • Periodic review • People to manage and oversee the learning system Source: Tom Nolan PhD, Associates in Process in Improvement

  3. Session objectives • Explore Stephen Covey’s “Big Rocks Theory” as a guide to understanding how we can prioritize our work • Connect the Big Rocks theory to the seven Early Years Collaborative key change areas • Explore a four-part execution strategy for EYC improvement efforts within key changes

  4. Place the big rocks first… Video Credit: The Seven Big Rocks Productivity System

  5. Key Changes

  6. A framework for execution

  7. CPP Execution Strategy • Setting Breakthrough Performance Goals • Developing a Portfolio of Projects to Support the Goals • Deploying Resources to the Projects That Are Appropriate for the Aim • Establishing an Oversight and Learning System to Increase the Chance of Producing the Intended Results

  8. Setting Breakthrough Performance Goals Breakthrough Performance Goal #3 Percent 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 weeks

  9. Portfolio of Measures

  10. Developing a portfolio of projects to support the goals • A portfolio is a collection of projects that will together move our stretch aims. • Your portfolio will be informed by a broad view of what you and other partners can do. • There’s a lot in your portfolio already.

  11. Developing a Portfolio of Projects to Support the Goals

  12. Developing a Portfolio of Projects to Support the Goals Big Aim

  13. Developing a Portfolio of Projects to Support the Goals Big Rocks

  14. Developing a Portfolio of Projects to Support the Goals CPP Portfolio of Projects

  15. WORKSTREAM 2 (1 year to 30 months) R Theory of what actions will ensure developmental milestones are reached Theory of what drives developmental milestones Where project ideas come from! Improved teamwork, communication, skills and collaboration 2⁰ Aim 1⁰ Poverty Improved money management Quality Of Home Environment Domestic Abuse & Violence Improved child’s dental health Societal Issues Workforce Issues Improving child nutrition Transport, Community Capacity & Cultures Improving brain development and physical play Children have all the developmental skills and abilities expected of a 27-30 month old Access To Services Improved family centred response Employment Health Improved stability / permanence for LAC Child’s physical & mental health and emotional development Attachment Improved early identification Early Learning & Play Additional Support Improved joint working Detailed Aim: 85% of all children within each CPP have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review by end-2016 Level of education Improved sharing of information Misuse of alcohol & drugs Improved management, planning and quality of services Carer’s physical & mental health and skills Nutrition Improved leadership, culture and planning Disabilities & Mental health Parenting skills & knowledge Identification & reasons for current resilience Version: 06/03/2013

  16. Developing a portfolio of projects to support the goals • A portfolio is a collection of projects that will together move our stretch aims. • Your portfolio will be informed by a broad view of what you and other partners can do. • There’s a lot in your portfolio already. • Use a driver diagram or logic model to show how the portfolio hangs together • You can annotate with system and project measures

  17. Every project wants a charter Aim Statement: Improve what? By how much? By When Measure(s) Percent 100% 90% Change Ideas 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 weeks

  18. Sample project charter (located on EYC Extranet)

  19. At your tables… • What’s in your CPP’s Portfolio of Projects? • What key changes do they belong to? • Are there any key changes without project activity?

  20. CPP Staffing • Deploying Resources to the Projects That Are Appropriate for the Aim • Establishing an Oversight and Learning System to Increase the Chance of Producing the Intended Results

  21. Sample CPP Staffing model

  22. Sample CPP Staffing model

  23. Sample CPP Staffing model Percent 100% 90% 80% 70% 6 60% 5 50% 4 40% 30% 3 20% 2 10% 1 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 weeks

  24. Sample CPP Staffing model

  25. Sample CPP Staffing model

  26. At your tables… • Considering this model… • How are your resources deployed? • What are the gaps? • What does your CPP need to develop going forward?

  27. 1) What are we trying to accomplish? 2) How will we know that a change is an improvement? 3) What change can we make that will result in improvement? A P S D D S P A A P S D A P S D Repeated Use of the PDSA Cycle Changes That Result in Improvement DATA Implementation of Change Wide-Scale Tests of Change Percent Hunches Theories Ideas 100% 90% Sequential building of knowledge under a wide range of conditions Follow-up Tests 80% 70% Very Small Scale Test 6 60% 5 50% 40% 4 30% 3 20% 2 10% 1 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 weeks

  28. P P P P P A A A A A D D D D D S S S S S S S S S S D D D D D A A A A A P P P P P A A A A A P P P P P S S S S S D D D D D P P P P P A A A A A D D D D D S S S S S Aim: Big Dot Early Years Developing parents' skills Project(s) Early Intervention in Maternity Services Project(s) Attachment and Child Development beyond maternity services Project(s) Continuity of care in transitions between services Project(s) 27 - 30 month Child Health review Project(s)

  29. Multiple Key Changes for a Single Aim Continuity of care in transitions between services 27 - 30 month Child Health review Attachment and Child Development beyond maternity services Early Intervention in Maternity Services Change Concepts, Theories, Ideas

  30. Thank You!

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