Change is great you go first Tony Martin

Change is great- you go first! Tony Martin Practice Business Manager July 2008 Hebden Bridge Group Practice

Change or Improvement • • • Why? How? What’s my role in it? Why can’t it just go away? • Why can’t you just go away? Hebden Bridge Group Practice

Hebden Bridge Group Practice • • • 19 k patients 9 partners 3 sites 44 staff (33 wte) 10% of Calderdale Hebden Bridge Group Practice

Finance QOF / DES / LES Human Resources Practice Based Commissioning Service Provision Risk “Growing the business” Competition Culture Hebden Bridge Group Practice

Does that sound familiar? • What’s important to the person next to you? • What’s in it for them? • Are they comfortable? • How much do you need them? • How much do they need you? Hebden Bridge Group Practice

So what’s important? Improving health Hebden Bridge Group Practice

So how is what’s important delivered? People Process Hebden Bridge Group Practice

Quality Access Business Plan Finance Hebden Bridge Group Practice

We must…… A. Understand the present B. Understand the desired future Get from A to B Hebden Bridge Group Practice

“Every system is perfectly designed to deliver the results it gets” Don Berwick Institute of Healthcare Improvement Boston Hebden Bridge Group Practice

The KISS Principle…… Keep It Simple Stupid! Hebden Bridge Group Practice

It’s all the same…. . • • • Service Improvement Quality Management Lean Kaizen (but not Kaiaku) Common Sense Hebden Bridge Group Practice

The People • The NHS is unique • Stakeholders (sorry) • Encouragement and support • Patients, patients Hebden Bridge Group Practice

Process is King (or Queen) “. . we achieve excellent results with mediocre people using brilliant processes” Fujio Cho- Chief Executive, Toyota Hebden Bridge Group Practice

Extended Hours Capacity Processes Roles and Resp. Training needs analysis Recruit Nurse Practitioner PBC QOF GP Training

Understanding Processes • What’s the real problem • Bottlenecks, constraints and handoffs • Complexity • Opportunities • The theory is… Hebden Bridge Group Practice

Process Mapping • What’s really going on- no individual knows • Stakeholders- team building! • Understand the problem before you design the solution Hebden Bridge Group Practice

A process map for a blood test GP requests a blood test Patient takes form reception Patient informed of results Patient rings for result Patient makes appt Patient attends appt Result back to GP Blood goes to hospital Patient waits in queue Patient has blood taken Hebden Bridge Group Practice

Act • Decide what changes are to be made • Next cycle Study • Complete the analysis of data • Compare data to predictions • Summarise what was learned Plan • Set objectives • Pose questions & make predictions • Plan to carry out the cycle (who, what, where when) Do • Carry out the plan • Document problems and unexpected observations • Begin analysis of the data Hebden Bridge Group Practice

The effect is… • You understand what the problem is – not what you think it is • The solution is shared and owned • It’s more likely to work • Future problems become “smaller” • Improvement becomes “routine” Hebden Bridge Group Practice

It works……. • Theatres • Outpatients • Pathology • Referral letters • Diabetes • Nursing appointments • Practice Training Hebden Bridge Group Practice

LEARNING LESSONS WITH WINNIE THE POOH: A. A. Milne “Here is Edward Bear, coming downstairs now, bump, bump on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it”. Hebden Bridge Group Practice