Empowering staff to deliver continuous

quality improvement as a routine

Kevin Gibbs
Clinical Pharmacy Manager
Learning outcomes
At the end of the session participants will be able to:
• Recognise the principles behind using transformational
leadership to help organisations achieve change
• Reflect on their leadership style and ability to enact
continuously quality improvement
• Discuss how to empower staff to make quality improvement a
part of their day job
• Identify potential quality improvement tools that can be used:
“EVERYONE IN
HEALTHCARE
SHOULD HAVE TWO
Maureen Bisognano
JOBS: TO DO THE Chief Executive Officer

WORK AND TO Institute for Healthcare

Improvement
IMPROVE HOW THE 2012

WORK IS DONE.”
…the Chief Executive of NHS England
has called for ‘the unleashing of
creative energy and the mobilising of
collective action’ for change… …the Chief Executive
of Monitor advocates ‘turbo-
…commentators warn that the charging’ change in the NHS…
NHS must ‘change or die’…
…the NHS Leadership
…the King’s Fund concludes Academy advocates ‘collective’
that the greatest transformational leadership styles, shifting power
force for change will come from to front line staff and patients…
within the NHS…
<http://www.nhsiq.nhs.uk/resource-search/publications/white-paper.aspx>
Continuous improvement Team
 Can it work? Sky
‘Performance by the aggregation of marginal gains’
– It means taking the 1% from everything you
do; finding a 1% margin for improvement in
everything you do
– If a mechanic sticks a tyre on, and someone
comes along and says it could be done
better, it's not an insult - it's because we are
always striving for improvement
http://www.teamsky.com/article/0,27290,17547_5792058,00.html#FYXpi3JIGadPVtaX.99
http://blog.bufferapp.com/what-would-happen-if-you-improved-everything-by-1-the-
 Top 10 barriers to change

1 Confusing strategies Unclear organisational strategies, too many priorities

2 Over-controlling Perception we do not have the trust / freedom to create change from
leadership the bottom-up

3 One-way Leaders do not communicate with staff

communication Not enough (in)formal ways of connecting creative people

4 Poor workforce Perception of “not enough time”. Is this inappropriate skill mix or a skills
planning deficit from not nurturing our staff

5 Shifting innovation No shortage of idea; a shortage of processes to capture ideas

 Top 10 barriers to change

6 Playing it safe Too difficult to access support for ideas

Fear of doing something new
7 Poor project Tendency to value inputs and action rather than value and outcomes
management We underestimate the complexity in which we are working
8 Undervaluing staff Often do not feel we have a real stake in the organisation’s future – a
cog on the engine rather than a value-adding individual
9 Inhibiting environment Physical environment can stop us meeting people
IT systems that do not help us access knowledge and share information
10 Perverse incentives If better outcomes for patients but lose income then = a disincentive

<http://www.hsj.co.uk/leadership/change-challenge/the-crowd-speaks-top-10-barriers-to-c
hange/5081962.article#.VSQ4l_nF-So
>
 Building blocks for change
1 Inspiring and supportive
leadership
2 Collaborative working
3 Flexibility and adaptability Need flexibility in our formal organisations and I day-to-
4 Smart use of resources
5 Autonomy and trust
Taking forward ideas based on quality
“Distributed leadership” where people are trusted and
talent is nurtured
Peer collaboration nurtures a positive mind-set and desire
to drive bottom-up change
day processes
Deliver change within our current means
Increasing a sense of trust gives people the confidence
and permission to deliver change
Remove the fear associated with failure, foster culture of
reflection and learning on what works/does not work
 Building blocks for change
6 Challenging the status quo Nurture and embrace the creativity of all of your staff
to challenge the status quo and deliver real change
7 A call to action Clear articulation of organisation’s purpose & meaning
Inspire bottom-up contributions to the mission
8 Fostering an open culture Transparency & openness = A more positive
environment
The most open organisations are the most innovative
9 Nurturing our people Prioritise training and development
10 Seeing the bigger picture Give staff space and freedom to develop long term
improvement plans
11 Thought diversity Valuing dissenting opinions gives more effective change
<http://www.hsj.co.uk/leadership/change-challenge/change-challenge-pinpointing-the-building-blocks-for-change/5081960.article#.VSQ40vnF-So>
 Leadership styles

Transactional leadership Transformational leadership

• … is ‘an exchange-based relationship • .. is ‘the ability to motivate and to
where self-interest is dominant.’ encourage intellectual stimulation
• Transactional leaders adhere to set through inspiration.’
rules and regulations, motivating • Transformational leaders aim to lead
employees with specific task-based by example, encouraging employees
to follow a set of values rather than a
rewards
rulebook.
From: <http://switchandshift.com/transactional-or-transformational-which-leadership-style-is-best>
Transformational leadership
• ‘spend time teaching and coaching’
– emphasis on employee training and development
• Transformational leadership focuses instead on building a values-led work culture
– Employees work hard not because they seek reward, but because they believe it’s the right thing to do.
• Show your employees you trust them
– giving them the authority to make decisions
– equip them with the ability to make good decisions, by providing thorough and ongoing training.
• Don’t micro-manage your employees
– Avoid performance-based rewards
– adopt a holistic approach to discipline
– Your workers are intelligent adults – treat them as such
• Give your employees the bigger picture
• Rather than presenting them with a series of small targets, show them where the Trust is heading as a
whole
– Demonstrate how their work is contributing to the business’ success
 Transforming Care

Delivering best Improving Delivering best Renewing our Building Leading in

care patient flow value hospitals capability partnership
• Patient Safety • Productive • Spend on • Improving access, • Leadership • Redesigning care
and Quality theatres medicines signage and development pathways
Improvement • Improving • Non-pay spend environment • Rewards and • Primary care
Programme outpatients • Cost of • Clinical systems recognition engagement
• Improving patient • Better use of diagnostics • New buildings and • Rolling out the • Clinical networks
and public beds • Facilities and improved facilities: values • Pathology
involvement • Clinical process estates • BRI welcome centre • Induction and • Academic Health
• Clinical re-design • Logistics • Specialist appraisal Science Centre
outcomes /best • Urgent care • Records paediatrics • Education and • Whole system
practice improvement
• Trust HQ costs
• S Bristol Community
training working
• Building our • Enhanced recovery Hospital
• Workforce • Flexible • Charitable
research work • 24 hour hospital
productivity workforce partners
 Transforming Pharmacy Care
Delivering best Improving Delivering best Renewing our Building Leading in
care patient flow value hospitals capability partnership
• Safer Care SW / • Discharge team • Spend on • Clinical systems • Leadership • Divisional
AHSN safety • Boots O/P medicines • EPMA / EMR development engagement
• Patient and public • TTA turnaround • Non-pay spend • Centralised • Trust values • Connecting Care
involvement • TTAs completed • Workforce paediatric services • Induction and • Primary care
• Being the Best on wards productivity • Discharge lounge appraisal engagement
• Clinical • Clinical process • EPMA and service • Competency • Clinical networks
outcomes / best re-design delivery redesign frameworks • AHSN
practice • 7 day working • Quality • Education and • Whole system
• Research & • D4D focus improvement training working
publications • Wastage • Flexible • Bath Uni
• Audit reduction workforce
• Meds Opt • Workforce
retention
Useful quality improvement
approaches and tools
Lean
• Process mapping
• Identification & elimination of
waste working
• 5S workplace organisation
• Visualisation / Visual
management
• Standardisation of procedures

http://www.pharmacyqs.com/
Useful quality improvement
approaches and tools
Model for improvement
• Plan - Do - Study - Act
• Measurement for
Improvement

http://www.pharmacyqs.com/
Useful quality improvement
approaches and tools
Failure Modes and
Effects Analysis (FMEA)
an effective way of bringing together a
multidisciplinary team together to
analyse a process to see where there
are areas of concern

http://www.pharmacyqs.com/
Workshop

• How do we transform to ensure CQI is part of

the day job?
• 10 minute discussion: Two things you can do
on Monday to help facilitate improvement
• 10 minutes discussion
 Building blocks for change
1 Inspiring and supportive
leadership
2 Collaborative working
3 Flexibility and adaptability
4 Smart use of resources
5 Autonomy and trust
6 Challenging the status quo
7 A call to action
8 Fostering an open culture
9 Nurturing our people
10 Seeing the bigger picture
11 Thought diversity
Learning outcomes
We have
• Recognised the principles behind using transformational
leadership to help organisations achieve change
• Reflected on our leadership style and ability to enact
continuously quality improvement
• Discussed how to empower staff to make quality
improvement a part of their day job
• Identified potential quality improvement tools that can
be used
 Kevin.Gibbs@UHBristol.nhs.uk
 0117 923 0000 bleep 2268

THANK YOU FOR YOUR TIME

Further information
<
http://ww
w.nhsiq.nh
s.uk/
>

<http://www.pharmacyqs.com/>

<http://www.ihi.
org/Pages/defaul
t.aspx
>
<http://www.changem
odel.nhs.uk/pg/dashbo
ard
>
<http://www.hsj.co.uk/leadership/change-challenge/> <http://www.nhsiq.nhs.uk/9022.aspx>

<http://www.hsj.co.uk/resource-centre/>