Spreading Good Practice: Sarah Fraser

2012-02-10T08:05:00.000Z

There's a new paper out (see below) which comes to a conclusion similar to ones found a few years ago - namely, in Quality Improvement Collaboratives, teams where the members have low knowledge of the topic or improvement science, are the ones which come out best. It also demonstrates that good leadership trumps the teaching of theory.

I've always thought that the more we push theory under the guise of "Improvement Science" at these short term interventions, the more we may confuse participants and in fact create a type of "performance anxiety" where they become afraid of doing what comes naturally, because it has been turned into what appears to them as a right-wrong application.

Implement Sci. 2012 Jan 9;7(1):1. [Epub ahead of print]
Factors associated with the impact of quality improvement collaboratives in mental healthcare: an exploratory study.
Versteeg MH, Laurant MG, Franx GC, Jacobs AJ, Wensing MJ.

ABSTRACT:
BACKGROUND:
Quality improvement collaboratives (QICs) bring together groups of healthcare professionals to work in a structured manner to improve the quality of healthcare delivery within particular domains. We explored which characteristics of the composition, participation, functioning and organization of these collaboratives related to changes in the healthcare for patients with anxiety disorders, dual diagnosis, or schizophrenia.

METHODS:
We studied three QICs involving 29 quality improvement (QI) teams representing a number of mental healthcare organizations in the Netherlands. The aims of the three QICs were the implementation of multidisciplinary practice guidelines in the domains of anxiety disorders, dual diagnosis, and schizophrenia, respectively. We used eight performance indicators to assess the impact of the QI teams on self-reported patient outcomes and a number of process of care outcomes for 1.346 patients. The QI team members completed a questionnaire on the characteristics of the composition, participation in a national program, functioning and organizational context for their teams. It was expected that an association would be found between these team characteristics and the quality of care for patients with anxiety disorders, dual diagnosis, and schizophrenia.

RESULTS:
No consistent patterns of association emerged. Theory-based factors did not perform better than practice-based factors. However, QI teams that received support from their management and both active and inspirational team leadership showed better results. Rather surprisingly, a lower average level of education among the team members was associated with better results although less consistently than the management and leadership characteristics. Team views with regard to the QI goals of the team and attitudes towards multidisciplinary practice guidelines did not correlate with team success.

CONCLUSIONS:
No general conclusions about the impact of the characteristics of QI teams on the quality of healthcare can be drawn, but support of the management and active, inspirational team leadership appear to be important. Not only patient outcomes but also the performance indicators of monitoring and screening/assessment showed improvement in many but not all of the QI teams with such characteristics. More studies are needed to identify factors associated with the impact of multidisciplinary practice guidelines in mental healthcare.

Systematic Review of Communities of Practice in Healthcare

2011-11-22T10:54:00.000Z

I love systematic reviews. They are hard work, major undertakings and make life much easier for the rest of us. Compliments to the authors of this new paper which can be accessed online.

How and why are communities of practice established in the healthcare sector?
A systematic review of the literature.

Geetha Ranmuthugala, Jennifer J Plumb, Frances C Cunningham, Andrew
Georgiou, Johanna I Westbrook, Jeffrey Braithwaite

Australian Institute of Health Innovation, University of New South Wales, Sydney,
NSW 2052, Australia.

Does opinion leadership change over time? New Research

2011-11-14T10:35:00.001Z

I'm pleased to see useful research is being done to clarify further what we mean by opinion leadership. Too often I hear people reducing what is a very complex topic to a simple slide of Roger's characteristics. Roger's initial work on the Diffusion of Innovations was researched and published before the age fo the Internet and before many staff were born. We need updates and we need to grasp a deeper understanding of the complexities.

There's a new paper out.
Implement Sci. 2011 Oct 11;6(1):117. [Epub ahead of print]
Opinion leaders and changes over time: a survey.
Doumit G, Wright FC, Graham ID, Smith A, Grimshaw J.

I've posted the conclusions to this paper below - and recommend you read the original.

"CONCLUSIONS:
Opinion leaders identified in this study were not stable over a two-year time period and generally appear to be monomorphic with clearly demarcated areas of expertise and limited spheres of influence. These findings may limit the practicability of routinely using opinion leaders to influence practice."

Meeting Agenda Good Practice

2011-11-09T11:42:00.000Z

I've been on a mission for some years to get agendas for meetings organised and prepared in a way that supports an efficient and effective process. here are many ways to do this and a recent post from Radcliffe Learning [this link is no longer working but I'm leaving this live while I try to find another way to get to the info as it is really useful. It comes from Radcliffe Publishing and you can view earlier editions of their newsletter here)] has some excellent advice. I particularly like the way they suggest the agenda items are to be divided into:

· Part 1: Items requiring a decision today

· Part 2: Items requiring discussion today

· Part 3: Items for information only today

What's your favourite tip for great meetings?

Overcoming resistance to change

2011-11-06T13:33:00.000Z

Resistance to change is on that "Top Five" list of topcis I get aksed about.

I think the video below is a great answer to the question on how to overcome resistance to change:

Where are the negative studies?

2011-11-04T13:27:00.000Z

I've written about his before, but I am still concerned about the lack of will to share what doesn't work in quality improvement initiatives. I worry that improvement leaders are so concerned about telling their sponsors that the work is doing very well, that they can't face the less than successful projects. We all know we learn from mistakes - in fact one of the basic tents of quality improvement is the importance of testing and learning (from the good and the bad).

I keep threatening to start the Journal for Quality and Safety Initiative Learning/Mistakes/Failures/Messes. When I figure the title I'll get it going. Any suggestions?

Predicting implementation success from organisational readiness

2011-11-01T13:21:00.000Z

I've wondered for a while whether there is any evidence that we can predict the success of a change based on the organisation's readiness for the change - else why would we bother with worrying about readiness? As always, loads of researchers have not only been worrying about this issue, they have also been investigating it. I found numerous papers, however, one captured my interest - probably because of the rational and detailed way in which the research was conducted. The conclusion as I figure it, is that it all depends on the biases (or not) in the readiness instrument.

You can read this paper here.

The meaning of Implementation Climate

2011-10-30T13:15:00.000Z

I've just read a new paper about implementation climate and how it differs from organisational climate - all part of the "readiness for change" strategies than many of us use. You can read the whole paper at Implementation Science (online - open access). I've pasted the abstract here, though I recommend you read the whole paper.

The meaning and measurement of implementation climate.

WeinerBJ, BeldenCM, BergmireDM, JohnstonM.

Abstract

BACKGROUND:

Climate has a long history in organizational studies,but few theoretical models integrate the complex effects of climate duringinnovation implementation. In 1996, a theoretical model was proposedthat organizations could develop a positive climate for implementationby making use of various policies and practices that promote organizationalmembers' means, motives, and opportunities for innovation use. The modelproposes that implementation climate--or the extent to whichorganizational members perceive that innovation use is expected, supported, andrewarded--is positively associated with implementation effectiveness.The implementation climate construct holds significant promise foradvancing scientific knowledge about the organizational determinants ofinnovation implementation. However, the construct has not receivedsufficient scholarly attention, despite numerous citations in the scientificliterature. In this article, we clarify the meaning of implementationclimate, discuss several measurement issues, and propose guidelines forempirical study.

DISCUSSION:

Implementation climate differs from constructs like organizational climate, culture,or context in two important respects: first, it has a strategic focus (implementation),and second, it is innovation-specific. Measuring implementation climateis challenging because the construct operates at the organizational-level, butrequires the collection of multi-dimensional perceptual data from many expectedinnovation users within an organization. In order to avoid problems withconstruct validity, assessments of within-group agreement of implementationclimate measures must be carefully considered. Implementation climateimplies a high degree of within-group agreement in climate perceptions.However, researchers might find it useful to distinguish implementationclimate level (the average of implementation climate perceptions) from implementationclimate strength (the variability of implementation climateperceptions). It is important to recognize that the implementationclimate construct applies most readily to innovations that require collective,coordinated behavior change by many organizational members both for successful implementationand for realization of anticipated benefits. For innovations that do notpossess these attributes, individual level theories of behavior change could bemore useful in explaining implementation effectiveness.

SUMMARY:

This construct has considerable value in implementationscience, however, further debate and development is necessary to refine anddistinguish the construct for empirical use.

Sustainability - how about 52 years?

2011-10-29T09:08:00.000+01:00

After 52 years, the Marshall and Fraser Racing MAY be letting down the tyres and packing away their tools. I say MAY, because, if I know them, they might just, possibly, pop out for a few more races next year...

Many of you will have met this team virtually as I have used them as an example of sustainability. I'll leave you with the question I always leave an audience - how will you sustain the results of your work for 50+ years? I mean results of course. The car looks very different than it did 50 years ago, but their focus is on the outcome.

Congratulations to the team, who, 52 years later, are still on top.

Class Winners of the Championship in 2011.

Improvement Leaders - role modelling

2011-10-25T09:01:00.000+01:00

Improvement leaders know a great deal of theory. One aspect of leading that I am constantly aware of, is the need to role model - practice what you preach. It's no good me pushes for the Lean 5S of a hospital ward if my own office is a complete mess. There's a dissonance here.

I recently attended a workshop at NHS Improvement in the UK. This is a smallish group who are dedicated to working with healthcare professionals to improve care. They are all very practical, work in clinically specific teams, and have good results from their projects. They don't get huge press coverage for their work, largely I think because they are humble - and too busy to do PR and marketing! I joined the session at dinner and was inspired by the way they were holding a raffle to raise funds for a need close to their own values. Not only did they raise money, but there was a lot of fun in doing it.

I left the session the next day quite inspired - and know they will be inspiring others in their day to day work.

Altering mental content - 3: Changing Minds

2011-10-22T08:51:00.000+01:00

I come across clients who are sp captivated by the notion of spreading good ideas by stories that they forget that they also need to provide the theoretical base for the change, as well as the need to identify the key concepts - and - if required, support the development of skills to enable others to change.

I drew the above chart as my way of showign how all these topics need to come together. Next time I am involved in helping someone draw up a spread plan, I'll spend time working through what we need to do to provide the mental content to help others adopt new practices.

6 different types of change by scale - 2: Changing Minds

2011-10-19T08:47:00.000+01:00

Large Scale Change means different things to different people. In his book, Gardner suggests six different types of scale. I found these different levels useful in thinking through the strategies I might use to effect proposed changes.

Large scale changes involving diverse populations on a national or regional basis
Large scale change involving an homogeneous group (e.g. peer group such as theatre nurses)
Changes brought about by technology, science or art (e.g. a whole generation has been influenced by Harry Potter)
Changes within formal settings (I think of bounded organisations here).
Small gatherings and the more intimate shifts in perspective (e.g. group of friends who decide to change their exercise habits and support each each)
Changing one's own mind (which, of course, we never admit is probably the most difficult!)

Seven Key Factors in how minds change - 1: Changing Minds

2011-10-16T08:40:00.000+01:00

Notes from the book "Changing Minds" by Howard Gardner (2004)

What I learnt was that if we want to help someone change their mind about what constitutes good practice (and thereby figure their practice is not the best so they need to decide to adopt a better practice), then it helps if we can:

Demonstrate what has to be changed in a way that someone can figure out for themselves what the reason is for them to change. Some people do this analytically and others deduce or infer from what they learn that a change is necessary. I think it's important to understand it's the adopter who needs to reason, not the person pushing the change.
Research, evidence, statistical analysis etc is crucial when working with healthcare professionals for whom this is the base of their practice. The onus of evidence is on the person pushing the change.
The proposed change needs to connect at the emotional and intuitive level with the potential adopter. The really good proponents of change can combine the emotive, rational and evidence content in their rhetoric.
The concept of redesciption intrigued me. I can see now that the person who can describe the proposed change in many different ways, whilst remaining true to the core concepts and values, is more likely to be able to convince others to change. Not least, being able to redescribe means you know your stuff and this enhances the credibility of the proposal.
Rewards are obvious - pay someone and they are more likely to do it. But this doesn't always lead to the mind changing. The most basic reward is praise and confirmation of the new behaviour.
Real World Events - means tagging your proposals to outside influences. As a friend pointed out to me recently, a great time to raise the profile of pancreatic cancer would have been in the days after Steve Jobs died. To make the most fo these (not always sad) events, is to be prepared.
Resistance... it takes two to create resistance. The best way I know to deal with it is to stop pushing and to see things form the other's perspective - then, find a way to break through the debate.

Changing Minds by Howard Gardner

2011-10-14T08:23:00.000+01:00

A book with the subtitle "The Art and Science of Changing our Own and Other Peoples' Minds" intrigued me. So much of the change process and scaling up better practice across larger systems involves helping others change their minds. I've made a few notes from the book which I will post here in a series over the coming days. I recommend you get hold of a copy and have a read for yourself.

Back to Writing

2011-10-13T08:18:00.000+01:00

Today is the end of my 4 month experiment... From mi July to mid-October 2011 I reduced my writing significantly. For years I have written blogs, papers, articles, short stories etc on an almost daily basis. I often wondered what it would be like if I stopped. Would I forget how to write? Would my creativity go away? Would I forget about all those interesting things I'd like to write about?

No.

I've learnt a few things:

creativity doesn't always need to be captured and I think I've got better at remembering because I have made less notes. However, there have been some things I'd wish I'd written down - but I knwo they will come back to me
the break has allowed me to mull over some ideas in more depth. I've performed some "what if's" in my head and thought through scenarios, ideas, theories, plots and characters
I love to write. Boy, am I desperate to get back to writing!

So here we go again...

How safe are clinical systems - report on the evidence by The Health Foundation

2011-06-16T10:20:00.000+01:00

This report for The Health Foundation is excellent. I like the way it is based on research and whilst it doesn't cover any specifically new ground, it does provide insight for anyone wishing to improve the safety of patients in hospital.

"While the knowledge that poor systems can cause harm is not new, this report provides groundbreaking evidence of the extent to which important clinical systems and processes fail, and the potential these failings have to harm patients.

The results of this study, covering seven NHS organisations, identify the variation in the reliability of five key healthcare systems and processes:

availability of information when making clinical decisions
prescribing
handover
availability of equipment in operating theatres
availability of equipment for inserting intravenous lines.

The research, led by Professor Bryony Dean-Franklin, was conducted by The Centre for Patient Safety and Service Quality (CPSSQ) at Imperial College, and Warwick Clinical Systems Improvement (CSI), University of Warwick."

Fully-funded leadership programme open for application - Health Foundation, UK

2011-06-13T09:18:00.000+01:00

Fully-funded leadership programme open for application

The Health Foundation is seeking people who are passionate about transforming healthcare to join GenerationQ, its fully-funded, masters-level programme creating leaders for improvement.

GenerationQ is open to senior leaders in healthcare or the voluntary sector who are in a position to influence improvements to care quality.

Fellows will learn about the evidence base underpinning leadership for quality improvement and how to apply improvement science, leadership and change theories in practice.

Fellows will also deliver a substantial improvement project in their place of work, benefiting their organisation through addressing real-time quality challenges, based on organisational priorities.

This part-time programme takes between 18 months and two years to complete, and leads to a postgraduate certificate, diploma or Masters in Leadership (Quality Improvement), accredited by Ashridge.

The Health Foundation is an independent charity working to continuously improve the quality of healthcare in the UK.

If you are interested in applying, please visit the Health Foundation’s website to find out more and download the application form: www.health.org.uk/generationq Please pass on this information to anyone who may be interested.

The deadline for submitting an application form is 9am on Monday 18 July 2011.

Guide to facial expressions and emotions

2011-06-12T09:48:00.000+01:00

I think http://www.cedarseed.com/fire/emotut.jpg should be in every meeting room - if only as a reminder for us all that we say more with our expressions than with what comes out of our mouths...

Get your long documents summarised - Topicmarks

2011-06-12T09:15:00.000+01:00

I'm a quick reader but never shy of a short cut I checked out Topicmarks. It promises to summarise the document you load into short easy sentences. I tried it on a complex Dept of Health document and I love the result! The 15 page document of tightly packed text was summarised into a single page of mostly bullet pointed sentences. I quickly got the gist of what the document was about. And yes, I did then check whether the system produced a good result, by reading the whole thing, and it did.

A great system, though of course, the originator of documents could also provide a short summary list in the first place! I think this will be good for the quick review of academic papers.

It is free (in beta) and I don't get anything for recommending it...

Why do we forget good practice?

2011-06-08T09:49:00.000+01:00

I spent a lovely English Spring day visiting the Roman Villa of Chedworth. I came away marvelled by the way in which they had underfloor heating and an hygienic toilet system fifteen hundred (and more) years ago. When the Romans left our small island, those who remained ignored / forgot about (not sure which) these and many other useful inventions. Why did they do this?

And what other well evidenced business related techniques and products have we forgotten about and are ignoring?

Implementing social media is more than dabbing in a few fun technologies

2011-06-04T08:48:00.000+01:00

Technology is really exciting - for those who get excited about it. But technology is useless unless it connects with those who use it. There's the obvious stuff about it needing to be easy to use. But there's also the need to any technology that puts "social" in its marketing blurb - to be just that - social. And then there's the need for the organisations that want to jump onto the social media bandwagon to make sure they are doing so with thought and concern rather than a random set of activities they can tell everyone they are "into social media".

Here are five sets of questions to ask yourself if you're wanting to involve social media in your business:

Why social media and not any other strategy or technique we and our customers are used to?
What do we expect to happen? What is our intention?
How will we, and our customers, keep moving with the times as new technologies become available?
To what extend are we building on what works? Does this matter?
What policies and legal concerns do we need to take into account?

Oh, and I'll add one more, just in case:

(i) How do we define social media?

Three Collaborative Models for Scaling Up Evidence-Based Practices

2011-06-01T08:48:00.000+01:00

A new paper is out is Adm Policy Mental Health (See abstract below). Two of the models are those I've presented on and published about - the rolling cohort and the cascading dissemination model. There are also subsets of these methods - see my book 101 ways to improve your collaborative.

Three Collaborative Models for Scaling Up Evidence-Based Practices

Chamberlain P, Roberts R, Jones H, Marsenich L, Sosna T, Price JM.

Source

Abstract

The current paper describes three models of research-practice collaboration to scale-up evidence-based practices (EBP): (1) the Rolling Cohort model in England, (2) the Cascading Dissemination model in San Diego County, and (3) the Community Development Team model in 53 California and Ohio counties. Multidimensional Treatment Foster Care (MTFC) and KEEP are the focal evidence-based practices that are designed to improve outcomes for children and families in the child welfare, juvenile justice, and mental health systems. The three scale-up models each originated from collaboration between community partners and researchers with the shared goal of wide-spread implementation and sustainability of MTFC/KEEP. The three models were implemented in a variety of contexts; Rolling Cohort was implemented nationally, Cascading Dissemination was implemented within one county, and Community Development Team was targeted at the state level. The current paper presents an overview of the development of each model, the policy frameworks in which they are embedded, system challenges encountered during scale-up, and lessons learned. Common elements of successful scale-up efforts, barriers to success, factors relating to enduring practice relationships, and future research directions are discussed.

Difficult Conversations 5: The Art of Listening

2011-05-15T09:45:00.000+01:00

Conversation requires a talking AND listening, and these actions need to be shared by everyone involved. Some people may need help expressing themselves and other may need help in listening to others. Usually, it is the listening that is more difficult.

The Art Of Listening

View more webinars from Phil Wylie

Difficult Conversations 4: Fierce Conversations - practical tips

2011-05-10T09:39:00.000+01:00

The practical advice in this slideshow is very helpful. I particularly like the "Sixty second" technique for starting off the conversation.

Fierce Conversations

View more presentations from Evan Wood

Difficult Conversations 3: Tips from the psychology viewpoint

2011-05-05T09:33:00.000+01:00

There's no one way to approach a difficult conversation. The short slideshow below covers some useful hints and tips - if the psychological viewpoint is interesting and useful to you.

Making Difficult Conversations Less Difficult

View more presentations from John Deely

Difficult Conversations 2: Remembering Body Language

2011-05-02T09:15:00.000+01:00

There's research (though controversial) that suggests more than half of our communication with an other comes through body language. We instinctively know this, however, when dealing with difficult situations and conversations we can easily forget this.

Body language is just that - a language. Complete with a syntax and grammar. It is not enough to think that someone who crosses their arms is being defensive. We need to understand the whole "paragraph" they are speaking with their body. They may in fact be cold or they may just be leaning back and relaxing. We need to look at the whole body and its cue.

Secrets of Body Language

View more presentations from Arif Anis

Canadian Best Practices Portal - Healthcare

2011-04-28T10:05:00.000+01:00

The Public Health Agency of Canada has a very interesting website: Canadian Best Practices Portal. I think it is an excellent example of helping to spread good practice.

It describes interventions (best practices) without overly classifying them. The reader can make their own judgements of value and worth. I also like the way these are summarised as they are written for the reader and not as corporate sales pitches which is a temptation other organisations fall foul of.
The resources have a great at-glance feature which show how they relate to define, search, appraise, synthesise, adapt, implement, evaluate.
Their list of systematic review sites is extensive and pitches these best practices as being based on evidence which is both appropriate and welcome for healthcare interventions.

Difficult Conversations 1: The DED Technique

2011-04-28T09:14:00.000+01:00

Dealing with the difficult situation is difficult - usually because emotions are running high and emtoional responses tend to send all good planning straight out the window. One technique I've found useful is simple enough to remember when the flak hits the fan and tends to work well - the DED technique.

D = Describe

E = Example

D - Discussion

Describe the behaviour you're finding difficult, how it makes you feel and explain the wider impacts of the behaviour. Without any description the other person probably has no idea why you are upset.

Then provide an example of what it is you've just described. Without an example the other person may think you're making it up and may not be able to ground the descriptions in reality.

Discussion - or I prefer the term dialogue as that presumes it is a two-way thing - is the obvious important and final step. If the first D and the E have gone well then the discussion should be fairly straightforward - though posisbly still emotive.

Do you have a favourite technique you'd like to share?

Hans Rosling's 200 Countries, 200 Years, 4 Minutes - The Joy of Stats - BBC Four

2011-04-24T20:25:00.000+01:00

This video is pure genius. For anyone who doubts the importance of visualisation for bringing insight to data, then take a few minutes to view this video:

Design a 50 minutes lecture that works

2011-04-21T10:19:00.001+01:00

Tired of the person who stands up and delivers a repeat of their presentation (they are as bored as you)? Tired to the point of not being able to concentrate for more than the first few minutes of a presentation? Tired of making it through to someone's lecture to discover afterwards you have no idea what you learnt?

John Medina is a scientist who researches ways to avoid problems like these. He also has some very practical advice. I like his Brain Rules website, with videos (nice to see him practising what he preaches), tips and links to a new book. Each of his 12 rules are available with illustrations and videos.

Advice for a 50 minute presentation? Break it down into 10 minute segments. At the end of every segment add a hook / statement that will generate an emotional response in the listener. I'll be trying that for my next presentation.

Leadership models and theories - some links

2011-04-18T09:18:00.000+01:00

I'm often asked what leadership theory I espouse. I'm never sure how to answer because I think leadership is a practice and not a theory. However - as we know, all models and theories can be useful (though remember none are right!).

Here is a collection of a few of the places where I go for leadership theory information

Academic online library - this is always my first choice (keep those fingers of the Google Search button!). Here is can find properly thought out, detailed, reviewed and practised theories. It is also here that I learn about the latest research and practice. For me, these papers are more useful that books as they are not subject to marketing bias.
Google Scholar Search - bridges the academic library with the wider Google Search
Current books - either buy, download or go to the physical library to borrow
The Web...

Some useful web links:

Nice summary and overview for those of us who often don't have time to read a whole book or figure out the complexities of a paper
A review of leadership theories and competency frameworks - ok, this is a paper, but a useful one...
http://www.12manage.com/i_l.html has a page full of ideas and concepts to keep you thinking

Post your favourites in the comments section.

Leadership means putting personal differences aside

2011-04-15T09:02:00.000+01:00

Mike Golding is an International Yachtsman. He is also the man who gave up a winning position in a round the world yacht race to pick up a distressed competitor - someone with whom he'd not had the best of relationships.

Enough said.

How far out of your way will you go to help someone you may not like, but who is struggling?

Leadership notes from a pilot who saved the passengers

2011-04-12T08:54:00.000+01:00

Staying with the leadership theme of the previous posts, Capt Peter Burchil has some interesting reflection of the incident where the BA777 from China, in January 2008, landed short of the runway, due to a technical issue. There was no warning and it was skill, maybe a bit of luck, and a cool head that resulted in no loss of life.

One of his taglines was "plan for the expected and prepare for the unexpected" which I think is an excellent mantra for anyone at work - especially during times of great change.

He summed up his talk by explaining how he was taught in the controlled environment of the simulator to "Aviate, Navigate, Communicate". What an excellent three words those are for any manager or director! For "aviate", substitute the verb that best describes what your job requires you to do (the tick here is to remember to keep doing what you're supposed to be doing and not get distracted.). Navigate - similar to aviate, though I think all Executives should keep navigate in their list of three words. Communicate is obvious.

What are your three words that ensure you remain leading in a crisis?

Leadership thoughts from an astronaut

2011-04-09T08:48:00.000+01:00

When I heard Tom Henricks speak at a conference, I was inspired in many ways. A few of the notes I captured all seemed to relate to leadership on the very edge of what is important; there is room for mistakes on a Shuttle.

He spent time talking about how leadership is also about teamwork; how you cannot be a leader unless you have a team. But this also means the leader needs to be an excellent team player. You cannot separate leadership from teamwork. I don't think this has been so clearly set out for me before. It is obvious when you think about it, but less obvious in action in the workplace.

He didn't equate leadership with a consensus, soft approach. He quite clearly explained how the buck did stop with him. On launch, he was the person who said the word"Go". His was the final decision. (mmm, now that is taking responsibility!)

Leadership lessons from rugby

2011-04-06T08:44:00.001+01:00

A few more wise words from Brendan Venter than I picked up:

When it comes to leaderships, he believes:

walk the talk
never be neutral (learn to have a point of view)
be able to build relationships (learn to like each other)
stay in the core
communicate effectively with colleagues

Again, standard stuff, but so hard to do, consistently and predictably.

Most popular posts on the Spread Good Practice blog

2011-04-04T16:56:00.000+01:00

Here is the list of the most popular posts on this blog for the last 6 months. If I'd had to guess I'd not have guessed these - nothing like a good bit of measurement to separate fact from opinion!

Model 2: data, information, knowledge, wisdom

22 Dec 2010, 1 comment

640 Pageviews

The quickest way to spread scale up change

21 Jul 2010

484 Pageviews

Model 1: data, information, knowledge, wisdom

20 Dec 2010

339 Pageviews

Using Twitter in the Classroom or Organisation

2 Sep 2010

320 Pageviews

Productivity 1: Operational Efficiencies are not e...

24 Oct 2010, 1 comment

284 Pageviews

Research into Implementation and Spread: Methods, Findings and Future Agendas by John Ovretveit.

2011-04-03T12:22:00.000+01:00

If you were unable to attend John vretveits March 24th VA Cyber Seminar, you can now view the archived video (link below).

QUERI Implementation Research Seminar

Thursday, March 24 1:00pm-2:00pm ET

Research into Implementation and Spread: Methods, Findings and Future Agendas by John vretveit, Ph.D.

Here is the link to the flash video of the presentation:

http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/qir-032411.cfm

Staying motivated

2011-04-03T08:43:00.000+01:00

Brendan Venter, coach of an English rubgy team, explained at conference I attended, how important it is to keep motivated, especially in difficult times. This sounds a bit trite but I was interested in the way he explained for a team that is losing, when you get together at half time, the pep talk is important., However, what really matters is the culture of the team that will support their ability to survive the difficulty and to work through it so they engineer some from of success.

Will healthcare systems all over the world going through significant change, I was left wondering how important past and current culture is - so often the word on the organisational street is "we must develop a new culture" - but it may be too late. It is the existing culture that will determine much of the success of tomorrow.

Brendan also mentioned that people on the team need to know what the purpose is of it all. They need to know this for themselves. It is not something that can be issued in a memo. What is it that keeps people coming back to work? Ultimately, he suggests, it is friendship. There is nothing else.

Never events: what's on your list of ensuring patient safety?

2011-03-23T12:16:00.000Z

I was talking about Never Events at a dinner party, trying to explain what they are, and two friends were horrified - at the concept that in healthcare we need to draw up a list of things that should never happen. I agree, as a patient the list below does feel scary - not because they might happen, but because we need to talk about them not happening...

The NHS in England has just expanded the list to 26 from 8 (details are in this policy document); I'm still not sure whether this is a good thing or not.I have heard that some countries and regions don't bother with Never events lists. I'd be interested in finding out whether they do this for a reason.

There are 25 "never events" on the expanded list. This includes the original eight events from previous years, some of which have been modified, and builds on the draft list published in October 2010. The list is as follows:

Wrong site surgery (existing)
Wrong implant/prosthesis (new)
Retained foreign object post-operation (existing)
Wrongly prepared high-risk injectable medication (new)
Maladministration of potassium-containing solutions (modified)
Wrong route administration of chemotherapy (existing)
Wrong route administration of oral/enteral treatment (new)
Intravenous administration of epidural medication (new)
Maladministration of Insulin (new)
Overdose of midazolam during conscious sedation (new)
Opioid overdose of an opioid-naïve patient (new)
Inappropriate administration of daily oral methotrexate (new)
Suicide using non-collapsible rails (existing)
Escape of a transferred prisoner (existing)
Falls from unrestricted windows (new)
Entrapment in bedrails (new)
Transfusion of ABO-incompatible blood components (new)
Transplantation of ABO or HLA-incompatible Organs (new)
Misplaced naso- or oro-gastric tubes (modified)
Wrong gas administered (new)
Failure to monitor and respond to oxygen saturation (new)
Air embolism (new)
Misidentification of patients (new)
Severe scalding of patients (new)
Maternal death due to post partum haemorrhage after elective Caesarean section (modified)

Publishing negative studies is good for learning

2011-03-11T10:53:00.000Z

Humans learn by making mistakes. When the mistakes of others are hidden then we all have to go over the same ground to discover the errors - a waste of time, in many cases. The issue of publishing negative studies is a bit one. When I was researching my book "Why good practice doesn't spread" I could find no-one who was prepared to share, publicly, their experience of a large scale change project that did not achieve what it set out to do. They would talk in private and anonymously - but not openly.

One of my ambitions is to start the online Journal of Quality Improvement and Patient Safety Program Failures. I would love to be able to read about projects that went pear-shaped. I think I would learn more from them than from the ones which advertise greatness.

If you have ideas on what should be included in this Journal then please leave a comment on this blogpost or email me directly.

In the meantime if you want to read a few articiples and papers about the issue check out:
Increased calls for publishing negative clinical trial data
Publish or perish culture distorting research results
The importance of publishing negative results

Is there evidence for your quality improvement intervention?

2011-03-08T10:30:00.001Z

Is there evidence for the interventions we're using to improve quality of services and to reduce costs? I suspect in many cases there isn't. Sometimes just doing something is better than nothing, though I do find it surprising that some organisations are strong at pushing a particular intervention, even though there are few (unpaid for) independent evaluations. And on the other hand, there are some well evidenced interventions that organisations don't want to use because they are appear old fashioned. Hmmm - we demand of healthcare professionals that they use the best evidenced methods - should we be demanding that of ourselves?

There's an excellent visualisation for the scientific evidence of dietary supplements. When I looked at this I wondered whether we could do something similar for the quality improvement interventions that are being used around the world?

In the meantime, using the SQUIRE Guidelines to write up your projects will go a long way to building up an evidence base of what works - and what doesn't.

The Innovator's DNA - book by Dyer, Gregerson, Christensen

2011-03-05T10:18:00.000Z

The Innovator's DNA; Mastering the five skills of disruptive innovators is a book that we really need - right now - as we try to rearrange public services so we reduce costs and improve quality. I hear many people talk innovation but few actually doing it. I also think there are many innovators hidden away in organisations; just because they aren't smart at advertising themselves doesn't mean their abilities shouldn't be harnessed. So be on the look out for the following:

Associating; innovators connect the dots and see patterns between seemingly unrelated topics, tasks and issues
Observing: innovators spot emerging trends long before the formal reviews because they are intense observers of the small details.
Experimenting; innovators try things out - they don't necessarily talk about it or spend their time encouraging others to do it - they test things out themselves
Questioning; innovators can be a pain in the rear because they are curious and because they like discovering new stuff
Networking; it's difficult to spot patterns, notice details and test things out unless you have buddies. Innovators are terrific networkers and often link with others outside what may appear to be "normal" interests. They are also involved with groups outside their employment.

How would you rate yourself on these five categories?

Social Media Policy: The simplest way forward

2011-03-02T10:17:00.001Z

So many public sector organisations are still banning the use of social media. This seems a bit like being unwilling to give up your horse when the cars are all whizzing past you. Anyway, the root of this short-sighted vision is often fear. Apart from fear of the unknown (when senior managers have no idea about social media they are more prone to ban it or poo-poo it) there is also the fear of lack of control. In the public sector we're good at writing rules and regulations so when management does get to grips with social media it tends to be via a tortuous and complicated social media policy.

I particularly liked Mike Brown's take on social media policies. He recommends the following (please go to his blogpost to read the whole article:

“Will what you’re about to share online offend, surprise, or shock your

Spouse
Mother
Employer (current or future)
Clients (current or future)
Business partners (current or future)
Coworkers
Children

in a way which critically jeopardizes your relationship? If you answer even one “Yes” for this short list of people, think long and hard before publishing your content.”

Literature review for the use of Web 2.0 tools in Education

2011-01-24T11:16:00.002Z

Whilst education is different from both healthcare and private organisations, there is a lot in this literature review to get you thinking. I was wowed by the comprehensive coverage of the technologies and the analysis of what might best be used when and where and by whom. I started reading from the back - with the Appendices!

Introduction
Methodology
Changing  technologies
The  emergence  of  Web 2.0  tools
A  typology  of  Web 2.0  tools
Changing  learning  and  learners
Theories  of  learning
New  forms  of  learning
Patterns  of  technology  use and  the  characteristics  o f learners
The  changing  role  of  teaching  and  teachers
Strategies  for  supporting  the  use  of  technologies
Barriers  to  uptake  and  lack  of  impact
Digital,  networked  and  multiliteracies
Success  factors  and  strategies  for  change
Contextual  examples
Blogs,  wikis  and  social  tagging
Twitter.
Social  networking.
Immersive  environments  and  virtual  worlds.
Summing  up.
Conclusions
Appendices

Gagne's nine levels of learning

2011-01-19T11:09:00.002Z

It;s a while since I visited the theory about learning in a way that fundmaentally changed the way I delivered a workshop or series of lectures. Gagne's work is not new but it is, I think, forgotten by many.

gain attention
inform the learners of the objective (expectancy)
stimulate recall of prior learning (retrieval)
present the stimulus for current learning
provide learning guidance
elicit performance
provide feedback
assess performance
enhance retention and transfer

to read more about this you can Google "Gagne" or read the short summary at Mindtools.

Video: Christakis on Social Networks, Spread

2011-01-17T10:50:00.002Z

Nicholas Christakis is my hero - his research is moving us on from the staid, static and way out of date work of Rogers (Diffusion of Innovations). I recommend spending 18 minutes to watch the video below if you're part of or planning any large scale change, social movement (not that I believe they can be planned), spread of project results.

The shift to norms being spread and not behaviours is significant. What are you doing in your own project work to build on this?

Review of mobile and wireless technology: free book

2011-01-14T10:43:00.001Z

Whether you are knew to the concepts of mobile and wireless technology or an old hand, a new online book on this topic is worth a read (if nothing else other than to experience some very nice online reading technology!). The models, frameworks and use of evidence means it is an excellent resource for teams and organisations figuring out how best to use current technology to further learning, development and quality improvement work.

Getting started with mobile learning

2011-01-12T10:38:00.001Z

While some organisations are struggling to make the move to video conferencing and webinars, others have moved on even further and are using mobile technology as a key part of their learning and development plans for employees. A recent article in ASTD covered this topic and it is a short and easy read for anyone who is wondering what is meant by mobile learning.

Model 7: data, information, knowledge, wisdom

2011-01-10T10:19:00.001Z

I thought I would stop at 7 models on the data, information, knowledge and wisdom theme - afterall, the brain is supposed to be able to hold a maximum of seven thoughts at any one time. I've left my favourite to last. I particularly like the examples given at each stage. You can read more about this model on this blogsite.

Model 6: data, information, knowledge, wisdom

2011-01-06T10:11:00.001Z

The Liebowitz (1999) model of DIKW is helpful if you are looking for something with details to give you ideas on what you might do in your own work. I can see how this can be used to evaluate large scale programs. The value aspects are useful reminders of the underlying purpose in moving to each stage, and therefore gives an idea of what might need to be planned for in a large scale program to achieve each step.

Model 5: data, information, knowledge, wisdom

2011-01-03T10:00:00.002Z

So let's start 2011 by continuing the data-information-knowledge-wisdom series of posts with something creative from Topicscape's Mindmap directory:
.

I like the zone of potential - zone of possibility continuum as well as half the "effort" being below the surface which can only really be explained by doing a drawing like this.

Model 4: data, information, knowledge, wisdom

2010-12-30T09:50:00.000Z

The Model from Infovis below shows just what I always struggle in explaining to tohers as to why the results of one project cannot just be pushed onto other, adopting, groups.

The producers, the pilot projects, create the basic data and some information (patterns) about it. The consumers (the adopters) need to retest this in their own environment. Any pilot project that can be written up in a way that helps the consumer to bridge the gap from information to knowledge will likely be more successful at spread than others. This can include things like: you can adapt this in the following way, we did the following and it didn't work but it may work in xyz circumstances etc.

Model 3: data, information, knowledge, wisdom

2010-12-28T09:38:00.001Z

One of the QI refrains is "increase the capability and capacity of employees". While this is a great concept, easy to declare and impossible not to support, for me it lacks any concrete applicability. What exactly is meant by this? There is another one of our data-information-knowledge-wisdom models which may help pin down what might be meant. Next time you hear somebody say the capacity/capability thing then whip this model out and ask them to explain their intentions and expectations along the data to wisdom curve.

The challenge here is to produce learning experiences that enable someone to move up the curve. In my experience, much of healthcare improvement work is focused on developing data based skills - how to measure change. Some people get to the information stage where they learn to look for patterns, say by using SPC charts. Can they port this knowledge to other projects in a predictable way? Can they make intelligent choices? To what extent do the participants on a QI project become "wise"?

The above curve comes from Designing Knowledge Eco-Systems for Communities of Practice. The web resources are excellent - especially if you are developing CoP's as part of your QI strategy.

Model 2: data, information, knowledge, wisdom

2010-12-22T09:30:00.002Z

There is an excellent post about wisdom on one of my favourite sites - Big Dog and Little Dog's Performance Juxtaposition (yes, really!). It's a place I recommend you spend some time checking out.

I like the way this model gets me thinking about how we learn - there are connections here to the Honey & Mumford Learning styles. The fact that there is a continuum for context is also thought-provoking. This model has left me wondering whether in many of our quality improvement projects we focus too much on the bottom left hand corner and assume the progression to wisdom will be automatic. What would happen if we thought more and designed more of the journey to wisdom into our improvement interventions (and by extension, into our evaluations of projects)?.

Model 1: data, information, knowledge, wisdom

2010-12-20T09:20:00.005Z

The old adage goes along the lines that knowledge can be defined as knowing a tomato is a fruit, and that wisdom is therefore knowing that you don't add a tomato to a fruit salad... There are a number of models and frameworks that investigate the data-information-knowledge-wisdom continuum and in the this series of posts I cover a few of these.

For the theorist a good place to start is with an online paper A Primer:, Enterprise Wisdom Management and the Flow of Understanding by ScottCarpenter@CognitiveCybernetics.com

I like the way environment and context have come into play as important factors in understanding that knowledge and wisdom have a contextual perspective.

New Paper: What is the experience of national quality campaigns?

2010-12-17T08:58:00.001Z

I liked the conclusion in this paper - "..may depend on.." as it summarised my experience of national quality campaigns - the results depend on a multitude of factors - and I would add depends on the perspective/s of the stakeholders involved.

Health Serv Res. 2010 Dec;45(6 Pt 1):1651-69.

What is the experience of national quality campaigns? Views from the field.

Bradley EH, Nembhard IM, Yuan CT, Stern AF, Curtis JP, Nallamothu BK, Brush JE Jr, Krumholz HM.

OBJECTIVE: To identify key characteristics of a national quality campaign that participants viewed as effective, to understand mechanisms by which the campaign influenced hospital practices, and to elucidate contextual factors that modified the perceived influence of the campaign on hospital improvements.

CONCLUSIONS: The impact of national quality campaigns may depend on both campaign design features and on the internal environment of participating hospitals.

New Paper: Short and long term effects of a QI collaborative on diabetes mgt

2010-12-15T08:53:00.001Z

I'm always on the look out for evidence of the sustainability of QI projects. A new paper in Implementation Science has some thoughts on this though I am not convinced 1 year classes as "long term".

Implement Sci. 2010 Nov 28;5(1):94. [Epub ahead of print]

Short- and long-term effects of a quality improvement collaborative on diabetes management.

Schouten LM, Hulscher ME, Van Everdingen JJ, Huijsman R, Niessen LW, Grol RP.

ABSTRACT:

INTRODUCTION: This study examined the short- and long-term effects of a quality improvement collaborative on patient outcomes, professional performance, and structural aspects of chronic care management of type 2 diabetes in an integrated care setting.

CONCLUSIONS: At a time of heightened national attention toward diabetes care, our results demonstrate a modest benefit of participation in a multi-institutional quality improvement collaborative focusing on integrated, patient-centered care. The effects persisted for at least 12 months after the intervention was completed.

New Paper: How to use an article about quality improvement (JAMA Nov 2010)

2010-12-13T08:51:00.000Z

One of the difficulties in spread and adoption is, on the one hand avoiding the temptation to take the results from one project and then do a back of the envelope calculation and announce if the results were spread then there would be x billion savings etc; and on the other hand, if you're a project lead, how do you read a piece of evidence and work out its relevance for your own work? There is a new paper out which touches on this subject.

JAMA. 2010 Nov 24;304(20):2279-87.

How to use an article about quality improvement.

Fan E, Laupacis A, Pronovost PJ, Guyatt GH, Needham DM.

Abstract

Quality improvement (QI) attempts to change clinician behavior and, through those changes, lead to improved patient outcomes. The methodological quality of studies evaluating the effectiveness of QI interventions is frequently low. Clinicians and others evaluating QI studies should be aware of the risk of bias, should consider whether the investigators measured appropriate outcomes, should be concerned if there has been no replication of the findings, and should consider the likelihood of success of the QI intervention in their practice setting and the costs and possibility of unintended effects of its implementation. This article complements and enhances existing Users' Guides that address the effects of interventions--Therapy, Harm, Clinical Decision Support Systems, and Summarizing the Evidence guides--with an emphasis on issues specific to QI studies. Given the potential for widespread implementation of QI interventions, there is a need for robust study methods in QI research.

Testing the transferability of ideas and practises

2010-12-03T09:07:00.001Z

We are not short of good ideas on how to improve healthcare. Nor are we short of good examples and case studies. What we are short of is evidence that good examples are transferable form one place to another.

I really like the way in which NHS Improvement has reviewed their own work with the aim of testing out how transferability their work is. The organisation works in an unpretentious way, in that their work is organised by healthcare pathways rather than improvement techniques. In their Cancer stream they have reviewed how good examples are transferred from one team or organisation to another and made notes about the issues and difficulties. These reports are easy to read and full of the lessons of the spread and adoption process.

Web 2.0 not role modelled is inauthentic

2010-12-01T08:59:00.000Z

Anyone or any organisation that flies the flag of change management and improvement always has the difficult task of acting what they say, namely being a role model for what they espouse. It is difficult to get right all the time and I certainly don't.

One positive example I have experienced is the Institute for Healthcare Improvement who, a while back, took on the challenge of improving their invoicing and payment system on the basis they couldn't teach others to do it unless they (a) were a good role model and (b) learnt from their own experience.

The worst of management consultancy is when concepts and theories from books are copied onto PowerPoint slides and then used to train others. Where the trainers have no experience of the content their audience will soon figure out the dissonance and leave the session - either physically or mentally.

In England we have a rash of NHS Improvement related organisations trying to get onto the social media bandwagon. I am all for it as I believe it is an essential tool for communicating and engaging with others. However, when the organisations involved have no official and monitored Facebook page, do not use blogs (as in few is any of their Executive Teams or Senior Staff use them), have never used a wiki, do not use RSS feeds themselves as part of their own learning, or never used a discussion forum in-house etc - then the exhortations and training comes across as inauthentic.

There are one or two NHS Improvement groups, like NHS Improvement, who are using Web 2.0 techniques to their advantage and I like the way they are starting with themselves and learning how to use them in-house, before going outside. I am sure they will be excellent role models for the future.

Public Value in the Public Sector: Literature review and toolkit

2010-11-30T07:16:00.002Z

The University of Birmingham Health Services Management Centre and the NHS Institute have completed some research on public value in the context of public services. The literature review and associated "toolkit" is available on the NHS Institute Website.

Hoorah! It is now recognised that the technical tools of change (like redesign, scenarios etc need to be combined with the more non-technical aspects such as the media, local pressure groups, politics etc.

As always, turning theory into practise is the difficult bit and I look forward to these concepts and new ideas being used.

Influencers: How trends become Contagious

2010-11-26T11:00:00.001Z

The DigitalBuzz blog is one of my great sources. They found a high video (a film, really) Influencers: How trends become Contagious from R+I Creative that documents the importance of Influencers in setting new trends that move to mainstream. No theory, models or management gobbledegook in it!

Helping leaders understand variation

2010-11-24T12:27:00.001Z

What does your leader do when you put a control chart or run chart in front of them? There is an excellent paper available from the Institute for Healthcare Improvement on the topic of helping leaders understand variation.

Lloyd R. Helping leaders blink correctly: Split-second decisions have patient safety implications (Part 1). Healthcare Executive. 2010 May/June;25(3):88-91.

This article describes two of four necessary skills health care leaders need to develop in order to "blink" appropriately (i.e., make decisions based on robust analysis and interpretation of data): understanding the messiness of improving health care, and determining why you are measuring.

Download part 1 here

Download part 2 here

eLearning Perspectives: Free eBook

2010-11-22T10:48:00.000Z

The Masie Center has released a comprehensive ebook with contributions from 40 Global Leaders. A must read for anyone who is interested in the topic of eLearning.

Download it here

Contents
Part I: New Learning Frameworks

Learning National Park, Needs Rangers! Getting to Know Bob
- Allison Anderson, Intel Corporation...............................................................10
What Problem Are We Really Trying to Solve? - Julie Clow, Google..................15
An Idea Whose Time has Come - Deb Tees, Lockheed Martin .........................21
The Power of Deep Expertise! Developing Expertise in a Corporate Environment
THE POWER OF DEEP EXPERTISE! - Raj Ramachandran, Accenture .................27
LEARNING ORGANIZATIONS: PEOPLE POWER?
- Nigel Paine, The Learning Consortium ..........................................................35

Part II: Under30 Perspectives
Learning: Converting the Crash Dieters to Lifelong Healthy Eaters
- Liz Scott, ZS Associates ...................................................................................39
Inspiration and eLearning - Linda Backo, PPL .................................................40
Access and Opportunities - Ben Betts, HT2 Ltd..................................................41
It’s Curtains for the LMS - Joe Beaudry, Verizon Wireless ..................................43
Engaging Learners Through Gaming - Lacey Grande, Ogilvy & Mather...........45
Learning Together To Change the World - Elizabeth Musar, InsideNGO.........46
Underemployed or Unprepared? - Kaylea Howarth, Alliance Pipeline .............47
Conscious Incompetence - Doug Livas, Moss Adams, LLP ................................49
Exciting the Learner - Aviva Leebow, Pacesetter Steel Service, Inc. ....................51
“Question? Try Twitter!” My Take on Social Networking
- Rachel Donley, BGSU Student ........................................................................53
Learning by Falling - Jen Vetter, TorranceLearning ...........................................55
What Happened to OJT? - Michelle Thompson, Poole and Associates .............56
Get Out of Your Comfort Zone: Developing Training for the Learner
- Emily Fearnside, General Mills .......................................................................57
Just Ask! - Katie Mack, Westinghouse Electric Company ..................................58
Passion for Learning - Sarah Carr, Google.......................................................59
4
Gamifying Learning with Social Gaming Mechanics
- Enzo Silva, Oracle Corporation......................................................................61
Incorporating the Human Touch in Online Education
- Jessica Sanderson, Cleveland Clinic ...............................................................63
The changing expectations of learners and the LMS
- Connor Gormley, FM Global .........................................................................64
Getting Beyond the Formal Classroom - Grant Velie, Farmers Insurance .........65
Establishing a Training Culture – Moving from Data Deluge to Learning
- Jennifer Wright, Alstom Power........................................................................68
“Y” not Mentor? - Danielle Sagstetter, Capella University / PACT .....................70
Common Constraints - Meg Hunter, CFA Institute ............................................72
Students have a say too! - Joshua Smith, Department of Veterans Affairs..........74
Learning That Makes a Difference - Julie Thompson, Xcel Energy .....................75
Part III: Learning in Action
The Impact of Knowledge Management on the Workplace Learning Organization
- Patty Glines & Eric Zenor, CUNA Mutual Group.............................................78
The New Ground Rules: A Collision of Knowledge at the Speed of Light
- Lisa Pedrogo, Turner Broadcasting/CNN BEST University...............................84
The Blended Future of Learning - MaryJo Swenson, Novell...............................92
Learning to Meet the Mission - John Guyant, CIA University ............................ 98
Blending AVON’s 125 year Old “Social Network” into Our Learning Approach
- Stephen Barankewicz, Avon .........................................................................107
Is Learning & Development Being Lost in the Age of Talent Management?
- Sean Dineen, Luxottica.................................................................................111
Part IV: Learning Changes
Combining “Cool” with “Core” in Learning
- Elliott Masie, The Learning Consortium .......................................................117
What Shapes the Future of Learning? The Third Industrial Revolution
- Wayne Hodgins, MASIE Fellow aboard the Learnativity ................................119
Trends in Learning Technology: The View from Late 2010
- Rick Darby, Rollins’ University .......................................................................132
The Times They May be a’Changing: From Sizzle to Fizzle in Learning Technologies
- Larry Israelite, Liberty Mutual Group ............................................................139

Social Marketing Podcasts from the Open University

2010-11-20T12:15:00.003Z

I had a proud moment when listening to Michaela Firth via iTunes talking about Social Marketing. She is really a leader in this field and I'm glad we've shared coffee and brownies over the last ten years. The Open University has a series of podcasts that I recommend to anyone working in the field of trying to spread behaviourally related good ideas to a wider audience.

Social marketing - Audio

by The Open University

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Description

Have you ever wondered how marketing techniques have been used to promote positive social change? In a series of lively interviews, Professor Gerard Hastings of the Institute of Social Marketing, faces questions from members of ISM-Open (the Institute of Social Marketing at the Open University Business School) on issues such as the ethics of social marketing, branding and advertising, and the morality of shocking or scaring people into changing their behaviour for the better. This material forms part of the Open University course B324 Marketing and society.


Social marketing	View In iTunes
What is social marketing?	View In iTunes
Critical marketing	View In iTunes
Ethics and advertising	View In iTunes
Evaluating social marketing programmes	View In iTunes
Ethical brands	View In iTunes
Ethics and social marketing	View In iTunes

eLearning 3: 5 Resources for effective online conferences

2010-11-18T09:29:00.004Z

With the bans of travel and other cost reductions in place, eConferencing is on the up. Unfortunatley, this is iften paralled with a signficiant reduction in value for the participants. eConferencing is more than ticking the box that you've "run an event".

Let's look at what not to do in a video conference:

Other resources

19 tips for effective online conferences; from eLearning Technology
http://onlinelibrary.wiley.com/doi/10.1002/stvr.411/pdf (I liked the lessons learned and tips for the future) PDF
Guidelines for running online seminars
Online conference - a participant's perspective

eLearning 2: 5 Resources for learning about Teaching Online

2010-11-16T09:04:00.002Z

Teaching online is quite a difference from teaching face-to-face. If done properly it can be an inspiring and motivating process for both teacher and learner. If not, it can be awful, especially for the learner. In my experience there is not much mediocrity - just brilliance or horror.

Try a book or two:

Check out a video or two:

eLearning 1: 5 Resources for supporting online discussions

2010-11-13T09:01:00.001Z

Creating and moderating an online discussion group requires more than sending out an email inviting people to join. In some cases it is not the cheap, quick fix you may be after. It's work. Treat it like a project - from strategy, planning, resource allocation through to evaluation.

Here are a few of my favourite resources on the topic:

Designing and Managing online discussions from Oxford Brookes University (PDF paper, with references - my favourite)
Teaching with online discussion forums - good introduction
Online discussions: Tips for Instructors from the Centre of Teaching Excellence at the University of Waterloo. Web page with bullet hints
Using discussion boards to engage students
How to avoid problems with online discussions - student guide. Short web page with more links on it. USeful because it is from the student/user perspective

Productivity 8: Where to find ideas for improving productivity in the NHS

2010-11-04T19:24:00.001Z

This is the 8th in a series of Productivity notes by Sarah Fraser. So where do we find the "no-brainer" ideas for improving productivity in healthcare.

There is no need to start from scratch if you're looking to improve productivity in your organisation, team, ward or practice. Many have gone before you and many have spent time writing up their experiences so you can learn from their efforts.

This is where I start looking:

NHS Library (or any other academic library). DO some proper searches. I do feel that starting on productivity initiatives without doing a couple of hours research is shortsighted. Google is not enough..
NHS Institute for Innovation and Improvement; for NHS England there is a lot of information available. Scotland and Wales I know have similar organisations who gather and share productivity and improvement information. The same is true for most countries which have a public sector health system
The Institute for Healthcare Improvement has a great deal of case studies and resources freely available

If I find nothing in the above then I will find another topic to work on. There is so much to learn from what others are doing that can make the productivity process easier that it doesn't feel worth being the one person who decides to design a research project instead of getting on with the change process.

If you have any favourite place to look for productivity ideas then please add a comment to this post.

Productivity 7: How replicable is productivity?

2010-11-02T09:01:00.000Z

This is the seventh in a series of productivity notes by Sarah Fraser. If one organisation or region is classified as productive, can we make generalised statements that the rest of the organisation or nation can implement the same and be as productive?

A new report by York University is making big claims.

"The NHS could cut expenditure by £3.2billion without reducing the number of patients treated if all parts of the country were as productive as the South West, according to a report published today by the Centre for Health Economics at the University of York."

The report has many maybe's and possibly's as to whether the rest of the NHS could see the same cost savings if they performed like the South West Region. I have no doubt the SW is producing excellent care. My concern is headlines like this paper produces sets unrealistic expectations on others. The delivery of healthcare is significantly contextual in its nature. Services all over the country reflect the complex make up of the areas they serve. The report summary on their website states:

"South West may also benefit from a more stable workforce, vacancy rates for non-medical staff being well below the national average. Lower productivity in the hospital and community sectors may be because more work is undertaken in primary care."

I believe this is enough uncertainty to warrant being very cautious about ratcheting up national numbers. Additionally, there is significant use of the "average" in this report. I am not convinced that averaging data and using the average as a measure is a good one for healthcare. As I pointed out in my earlier Productivity note, there is a big difference between accuracy and precision; basically, it is possible for there to be little variation across the regions (precision) but they are all delivering the wrong solution (accuracy).

Like all theories, this research is helpful to a degree (mostly in applying judgement) and like all theories, needs to be treated with a pinch of salt. If you are going to quote the headline £32billion on the stage then make sure you've read and understand the limitations of the report.

(To those who read the previous Productivity note about definitions - productivity is defined in this research report as output / input - how much output you get for the inputs...)

Productive 6: Are Patients Productive?

2010-11-01T08:48:00.001Z

This is the sixth note in the the Productivity series by Sarah Fraser. You can find the earlier notes here.

Mark Russell commented on the first in this series and he got me thinking. Healthcare is different from being a consumer of say a car dealership. We know that. We can learn from techniques used in industry and we can apply them to our services to gain some benefits. But I wonder whether we are too focused on programs such as Lean, or too focused on seeing the patient as someone with whom we need to engage?

The car dealership or company with be thinking about their customers constantly. It feels to me they spend time in empathy mode, figuring out how to make things easier for the customer. This ease translates into more sales (yes, I know I am reducing an entire academic discipline into two sentences.) They may even run focus groups.

When it comes to patients and productivity I am thinking the relationship is more than one of engagement. As a patient I am not seeking to be engaged with my local healthcare providers. I am expecting the provision to help me be a productive member of society. This means, for example, I don't' want to take an entire day off work so I can have an 8 minute blood test. Equally, I am prepared to to help the providers be productive by being an efficient and responsible patient - but I may need help to do so. If I have a chronic disease, then help me learn how best to manage it so everyone benefits from this productivity.

When the patient's interface with the provider is not productive for either party, then we have work to do.

Productivity 5: What do we mean by "Productive"?

2010-10-29T08:34:00.001+01:00

This is the fifth in the Productivity Series by Sarah Fraser. If you want to sign up to receive updates in your email inbox or your Reader (your choice) then go to the Blog and click on the Subscribe button.

So what do we mean when we say we want to be productive or we want our services to be productive? This is something we think we know but until we articulate exactly what we mean, the term is uncertain and ambiguous. What one person understands as productivity may not be the same meaning that another has.

The online dictionary provides a number of definitions and I liked the way it provides similar, related and dissimilar words.

ThesaurusLegend: Synonyms Related Words Antonyms

Adj.	1.	productive - producing or capable of producing (especially abundantly); "productive farmland"; "his productive years"; "a productive collaboration" creative, originative - having the ability or power to create; "a creative imagination" fertile - capable of reproducing fruitful - productive or conducive to producing in abundance; "be fruitful and multiply" profitable - yielding material gain or profit; "profitable speculation on the stock market" successful - having succeeded or being marked by a favorable outcome; "a successful architect"; "a successful business venture" unproductive - not producing or capable of producing; "elimination of high-cost or unproductive industries"
	2.	productive - having the ability to produce or originate; "generative power"; "generative forces" generative
	3.	productive - yielding positive results successful - having succeeded or being marked by a favorable outcome; "a successful architect"; "a successful business venture"
	4.	productive - marked by great fruitfulness; "fertile farmland"; "a fat land"; "a productive vineyard"; "rich soil" fertile, rich, fat fruitful - productive or conducive to producing in abundance; "be fruitful and multiply"

Using the above I came up with a number of questions to ask myself and others who claim to be working on increasing productivity:

If being productive can be defined as the capability to reproduce I wonder what productive spread is? I think it is about how efficiently we adopt and implement best practises, but that may not be the all of it.
If being productive is about abundance, how can we shift our mindset to one where we aim to use and create abundance rather than to streamline, cut and destroy services? How much impact can a mindset shift make?
If being productive is about yielding positive results, I wonder for whom these results are? How do we manage the differing expectations of different stakeholders?

How do you define "productive"?

Productivity 4: Leaders need to be productive

2010-10-28T14:33:00.002+01:00

This is the fourth in the Productivity series by Sarah Fraser. Is is possible to have a productive organisation if the leader is not productive?

This short video by Patrick Collins focuses on how leaders can use the 80:20 rule to ensure they focus on what matters and what provides the value you provide as a leader.

If you think you know the 80:20 rule, then I challenge you to watch this video and test whether you put it into action.

Productivity 3: Productivity is more than a process

2010-10-26T14:17:00.002+01:00

This the the third in a series of Productivity notes by Sarah Fraser. Productivity is more than a process.

New and improved policies can impact the design and implementation of efficiencies. For example, new recruitment, pension, appraisal and similar policy changes can impact processes not only in the short term but also long term. I do think that policy improvements are a necessary condition for many other efficiencies to be put into place.

Clinical productivity is often conceived as as "how hard are we sweating out clinical assets". Another way of looking at this is to see clinical productivity as the most up to date and best practice clinical methods being used. For example, continuing to carry our surgical procedures that are no longer proven to be effective is not productive.

Process productivity is the most familiar aspect of efficiency chasing in healthcare. Largely based on the principles of Lean (or reduced and less focused use of Lean) it is helpful but not enough to meet the healthcare challenges for the next 2 - 5 years.

Productivity 2: Reduced variation is not enough

2010-10-25T14:00:00.002+01:00

This is the second in a series of productivity notes. Reducing variation is only part of the productivity process.

Reorganising processes so they are precise and prediction is helpful but not enough. In the diagram, the red dots are hitting the target in a predictable way. However, while they may be precise, they are not accurate. The green dots, with less precision, are more accurately placed around the bulls eye.

What I learn from this is the need to

know the definition and position of the bullseye (what is the purpose of the process being improved)
measure for accuracy as well as measuring variation
fix accuracy first, then go for reduced variation

Productivity 1: Operational Efficiencies are not enough

2010-10-24T14:00:00.000+01:00

This is a the first in a series of Productivity notes from Sarah Fraser. Are your productivity projects innovative enough?

Organisations, like the NHS, will need to do more than streamline some processes as part of their cost saving initiatives. Many projects underway are badged as productivity improvement yet mostly they are about basic good management. For example, reducing DNAs (Did Not Attends), improving the Discharge Process, holding less meetings, carrying less stock etc. These are important and help to provide a good base form which to develop more innovative approaches, however, I am concerned few organisations considering gains in productivity through redesign and reconception of processes.

Many managers may feel like they are standing in the equivalent of the Victorian cotton mill with a clipboard in one hand and a stop watch in the other. Yes, it is possible to gain more efficiency from a process. I argue, however, that the leaps in efficiency come from reconceptualising what is being delivered. For example, in many countries for at least a decade, group appointments are available for patients with long term conditions. This is one small example of how rethinking a process can create both an efficiency and an improved patient experience.

Gartner's Hype Cycle is more useful than the Rogers' Diffusion of Innovation Curve

2010-10-15T09:17:00.000+01:00

The classic Diffusion of Innovation curve was created by Everett Rogers back in the 60's, before many improvement facilitators were born.The terms, early adopter, majority, laggard etc have survived because they provide an explanation for something that is often difficult to fathom - how different groups of people respond differently to the same innovation. I have written at length (see previous posts and books) about the limitations of this theory and it inability to predict or provide guidance about what to do next.

Gartner introduced a theory in 1995 designed to explain what happens when a product or innovation is hyped, and then goes through various stages to acceptance. I like this theory because it steps away from the position of blaming people for not doing something and focuses more on the intrinsic value of the innovation or product.

Image from Wikipedia: Hype Cycle

The Trigger is the first breakthrough event that starts the interest in the product/innovation. This is followed by the peak of inflated expectations where the optimism for application outweighs the difficulties. The focus is on the possibility of the product/innovation. The trough of disillusionment comes when the failures start stacking up, expectations are not met, or something new comes along and this idea is no longer fashionable. The slope of enlightenment may turn up years later when the original idea is tweaked and adapted and made more applicable. The plateau of productivity is reached when the product/innovation becomes mainstream due to its stability and usefulness.

Obviously, this curve will have different shapes for different products. Here are a couple of exercises:

Take one product/innovation which you believe to be at the Plateau of Productivity, and track back, seeing how the curve shapes with regards time and visibility (visibility = talked about, in the press, on agendas etc)
Map your current products, innovations and ideas on the cycle and see what you learn. Are they grouped in one area? What might you need to do to manage the transition to the next phase?

Let me know how you do by filling in the comments section below.

Scheming Virtuously; A Handbook for Public Servants

2010-10-09T16:35:00.001+01:00

Nick Charney (Canada) has written a brief e-guide on how to get things done in the Public Sector, perhaps innovatively, whilst keeping our sanity, job and relationships.

Highly commended and you can download Scheming Virtuously; A Handbook for Public Servants as a pdf from the davepress blog (which is worth subscribing to davepress.net).

4 resources why PowerPoint is not a good format for influencing others

2010-10-05T16:21:00.000+01:00

PowerPoint has its place. As a method of influence it is limited, however, it has become pervasive in corporate life to the extent it is used beyond its purpose.

1. Life after death by PowerPoint 2010
This video by Comedian Don Mcquillan says it all.

2. Do my slides suck? test
This "Stop your presentation before it kills again" blogpost provides a compelling arguement to ditch your slides, or at least do some self analysis to discover the reason why you are using PowerPoint.

3. 11 ways to images poorly in slides
This blogpost covers 11 ways in how using images in PowerPoint can detract from your message. It is a compelling argument to beware the selftrained designer...

4. Dodging bullets in presentations
An excellent slideset which not only highlights the problems with using bullet points but also shows how to move to something better and more effective

Oh dear, I see I wrote this blog in bullet points. Deary me.

When stories and Powerpoint clash

2010-10-04T16:13:00.000+01:00

A mantra I keep hearing is "we need to tell stories to influence change." I agree with this, however, I do have a few provisio's

if the story has no relevance to your message then why are you telling it?
if you provide a personal story to illustrate your values then please make sure it connects with the audience at the time (please update and avoid repeating)
when you use PowerPoint to tell your story there seems to be a dissonance - the method is not matching the intent

As a method of influence, especially for large scale change, stories work well because they contain the emotive meme that a PowerPoint presentation usually lacks. So let's use stories, but let's use them advisedly and with care.

7 Resources about Social Enterprise

2010-10-02T16:59:00.000+01:00

With the decimation of the quangos in the NHS in England there will no doubt be a rush to create a variety of social enterprises to fill the gaps and maintain employment. I have been on a mission to try and understand a bit more about social enterprises and here are a number of links and resources that I found useful.

Social Enterprise Coalition (UK) is a good place to start. It is fairly comprehensive and I learnt a lot about what is going on, right now, with regards social enterprise. There is a Health & Social Care forum.
If your interest in Social Enterprise is beyond the shores of the UK then Wikipedia has an overview of what it means in different countries.
Business Link (UK) has the how to steps if you want to set up a Social Enterprise in the UK
Social Enterprise Live is a useful magazine, giving news, resources, blogs and comments on the topic. There is a recent post on how the organisational from will suit the NHS.
The Department of Health has a fairly comprehensive guide on social enterprises and health
If you are up and running as a Social Enterprise and need support and resources then an excellent place to start is with Social Enterprise Works.
The most inspiring, for me, website on Social Enterprise is SE London. Lots of resources, videos and success stories.

Overcoming resistance to change - isn't it obvious

2010-10-02T16:30:00.000+01:00

How to overcome resistance to change is one of the most common questions I am asked. The dominant mindset I encounter is that the person who does not want to change (aka doesn't want to do what they are told to do) is resistant and therefore wrong. There is as many answers to this issue as there are management consultants. An interesting approach is the animated video with a script by Eliyahu Goldratt of "The Goal" fame. Despite the video being largely a promotion for his new book, it does have some useful content and ideas.

Different types of practice; good, best, novel, emergent

2010-10-01T07:53:00.000+01:00

The definition of good practice has always been contested and maybe the use of the phrase "spread good practice" is part of the problem as to why adoption of existing practice is so difficult. The Synefin model provides us with four categories of practice:

Best Practice (simple systems where the idea is obvious to all and obvious to adopt)
Good Practice (complicated systems where the relationship between cause and effect is less obvious, some investigation is needed and usually adaptation in order to solve the problem
Emergent practice (this occurs in complex systems where you only figure out in hindsight how something happened, how the results occurred - and this analysis is not necessarily predictive.
Novel Practice from chaordic systems where there is no relationship between cause and effect

If the goal of a large scale program is to spread the use of methods or techniques that deliver improvement then I think it is important to be able to diagnose what type of practice is being touted. Often novel or emergent practices are praised as the solutions to problems, putting the pressure on other individuals, teams and organisations to do something similar - and when they don't they are castigated for not trying.

The devil in the diagnosis of type of practice. Do you have any examples of the different types of practice?

(If you are reading this in an email or on your smartphone, to get automatic updates on this blog go to http://spreadgoodpractice.blogspot.com/ and click on the Subscribe Button)

New Tools Wiki - a stunning set of resources

2010-09-30T15:57:00.000+01:00

The newtools workshop wiki is the most amazing set of resources I have come across for months - and those of you who know me well know that I don't use "most amazing" very often. I'm at a loss for words on how to describe it so you need to go and have a look for yourself.

Be prepared to spend some time exploring it...

How to implement 7-30-90 Day projects

2010-09-30T07:51:00.000+01:00

“Being busy does not always mean real work. The object of all work is production or accomplishment and to either of these ends there must be forethought, system, planning, intelligence, and honest purpose, as well as perspiration. Seeming to do is not doing. “ - Thomas A. Edison

The purpose of this blog is to set out some ideas on the how of a 90-day improvement project within the context of healthcare. This project process is evolving so please add comments to this post so everyone can learn from your experience.

Principles:

Having more time doesn’t mean getting more done
Manage the tasks not the time
Deliver incremental value
Deliver results within a defined timeframe
Honour the concept of organisational learning and continuous improvement
Discover a rhythm of change and implementation that balances risk with results
Use these ideas as ingredients and make your own recipe
Ensure a focused, targeted and committed action process

“Absorb what is useful, reject what is useless, add what is specifically your own.“ –Bruce Lee

There are a variety of approaches. The choice of your approach will depend on your strategic aim, the timing that best suits you as well as the nature of your improvement process.

STEP 1: Create your format based on your timescale

“Once you have mastered time, you will understand how true it is that most people overestimate what they can accomplish in a year - and underestimate what they can achieve in a decade!” - Tony Robbins

It is possible to deliver changes in 3 days (see Kaizen methods for further information).

Consider your desired results, the amount of people who need to be involved in the process, the team and organisational culture as well as the nature of the problem to be solved / the solution to be implemented. With this in mind, look at the options below and see which most closely matches your needs. Where possible make your task

smaller and the timing shorter.

All of the timescales contain a basic strategic rhythm of

a) diagnostic steps

b) implementation focus

c) review and next steps

It is possible to design a 90 project so the phases are sequential, or it can be built up from a series of smaller 30 day cycles. The choice depends on your strategy for change:

“Hell, there are no rules here - we’re trying to accomplish something.” - Thomas A. Edison

Why 90 days?

Scope is more complex though is manageable within the timescale
Sufficient interdependencies that will need to be followed through with conversation and negotiation
Good if have high energy people working on the project who can also maintain their focus

Why 30 days?

May be easier to commit to than 90 days or 18 months
Deal with the now; plans remain relevant
Long enough to see an improvement (or not, so can then change the strategy)
Scope is such that one individual or a small team can make the changes with no further resource to committees or individuals for permissions

Why 1 week?

Good for those who are too time / task pressured to commit to improvement
Able to test an improvement-through-learning process
If used as part of a longer project the 1 week cycle can provide a mechanism for involvement (different people different weeks)
Good for working with those with a low energy

	Diagnostic	Implementation	Review
12 week (90 day)	4 weeks	6 weeks	2 weeks
8 week (60 day)	2 weeks	5 weeks	1 week
4 week (30 day)	1 week	2 weeks	1 week
1 week (5 day)	1 day	3 days	1 day

A diagnostic phase includes, to varying degrees, some of the following (remembering that diagnosis is part of the change process as individuals discuss and assess their own situation):

R What is the current situation, including baseline measures; this needs to be localised to the context of those making the changes. Process and value mapping, relationship mapping and other techniques are useful here.

R Creating ideas for change and improvement; being creative rather than just implementing known tasks (otherwise we end up with low energy projects)

R Understanding any interdependencies and carrying out appropriate negotiation

R Planning, designing, getting in the resources that may be need (like equipment) etc.

An implementation phase includes, to varying degrees, some of the following

R Action, with measureable results

R Learning, from personal and team reviews

“Words may show a man’s wit but actions his meaning.” - Benjamin Franklin

A review phase includes, to varying degrees, some of the following

R Working out what is going well, and why

R Figuring our and being honest about the problems, and then working through some ideas to resolve these

R Capturing personal learning as well as team and organisational learning, specifically noting those things you would like to do / feel more of

A project of any length can be constructed from a weekly pattern of activities.

“If we did all the things we are capable of, we would literally astound ourselves. “ - Thomas A. Edison

Misusing numbers to sell project results

2010-09-29T15:49:00.000+01:00

The more I know about statistics, the less confident I am about my own use of numbers and the more suspicious I am of any publicised data. The oracle on this topic is Dr Ben Goldacre , author of Bad Science, one of my favourite reads. A new book out by Charles Seife called Proofiness; the dark art of mathematical deception is along similar lines.

When it comes to scaling up the results of improvement work across a wider population, the danger of inflating the opportunity is significant. These are some of the numerical problems that have come my way in the past few week:

Hospital a got a 30% improvement, therefore if we multiply this across the whole county, this 30% improvement will give us a £1.3 billion saving. Humpf? So I need to know how representative of the national picture was Hospital A. I need to know the numbers and not the percentages behind this statement. I need to know how generalisable the improvement process is. And that is before we get to understanding how the savings are calculated.
Pathway b is delivering 212.3 more patients in a shorter time of 8 days. Humpf? More than what and shorter than what? The 212.3 gives me the wobbles because I've never seen 0.3 of a patient. Seife discusses the art and deceptiveness of the specific number in his book - see a relevant excerpt.
87% of hospitals have adopted the use product y. 87% of what population - national, region, the city? What counts as use - have they used it once or are they using it all the time. Did they try it out or have they made it part of their regular routine? Did just one ward test it once or have more (all?) wards tested it and are using it all the time? These questions are important in understanding the true nature of what has, or has not, been spread throughout a system.

Are there any headlines of numbers that make you wonder?

Connection is key for innovation

2010-09-26T15:32:00.000+01:00

A little luck and a lot of perspiration is no longer the prerequisite for innovation. Nowadays connections, relationships and networks are key.

Steven Johnson's next book is about Where Good Ideas Come From. You can watch him in action on this TED video (which starts with a picture and talk about the Grand Cafe in Oxford).

A couple of key points include:

Innovation is the result of the brain making new connections and these connections mirror workplace connectivity. The better the networks and more complex the relationships then the more likely it will be that good ideas arise. His premise is that innovation is an interactive process.
The architecture of space is important if ideas are to be generated and spread - he has looked into what environments have contributed to innovation. If we want innovation we need to design spaces that enable connections.
Great ideas that appear to spark from nowhere are most likely the result of a long period of incubation which may not be obvious and are most likely cobbled together from a variety of existing ideas.. He argues that ideas are networks and the way of thinking about them as sparks, illumination etc is no longer relevant.

Patient Experience; report to help Boards build patient and public experience into quality fo care

2010-09-24T07:54:00.001+01:00

If you are steeped in the healthcare quality improvement methods you will know how important it is to understand the patient experience. Scaling up project results to a wider audience does not mean the patient's views are no longer important. While the theory is obvious the practice is not. It can be difficult to engage non-executives and Board members with the patient experience and a new report on the Patient Experience issued by Dr Foster in the UK covers the following:

Foreword
Key messages
The scope of this report
What is patient experience?
Good intelligence guide: The basics
Good intelligence guide: Measuring what matters
Good intelligence guide: Building an intelligent report
Good intelligence guide: Advice from the sharp end
Board briefing: Intelligence types and uses
Board briefing: 2010 policy directions
Board briefing: Glossary
Board briefing: The current state of play
References
Acknowledgements

It provides advice on how Boards can produce a meaningful intelligence report on the patient experience. I particularly like the checklists and the brevity with which it is written. They have nicely avoided the temptation to burst into theoretical concepts.

I found this report via Jocelyn Cornwall's blog at the Kings Fund - another good source of information.

Learning networks or social movements? Which is best for large scale change?

2010-09-23T08:35:00.000+01:00

I'm not sure there is a specific answer as to whether learning networks or social movements are best for large scale change. However, my personal preference is for learning networks and these are my reasons:

learning networks connect the people who are interested in solving the problem, and they do so in an interactive, participative and empowered way. In comparison social movements have the image of someone wanting to make something happen and in manipulating the joining in process and to an agenda they have set.
learning networks are about the exchange of information, discussion and both personal and group learning. Personal behaviour may change as a result of learning about something new from within a peer group. When a group discovers new knowledge and feel the creative process of doing so, they may become quite committed to then implementing changes.
learning networks can be direct and specific. They can be topic based or professional grouping based.
there is a sense of an output with learning networks. Social movements are useful in that they are purpose driven, however, learning networks to me are more concrete, pragmatic and easier to associate with outcomes and results.
we know learning networks work in healthcare while social movement theory is in its infancy. I am a proponent of using the existing knowledge we have to best effect.

This doesn't mean social movements are not useful, rather that I am sceptical about their ability to deliver results, especially when we know learning network can have an impact.

There is an excellent paper on Learning networks for sustainable, large scale change which is worth a read.

Options for large scale spread; excellent new report by WHO, IHI, Harvard

2010-09-22T08:27:00.000+01:00

A new report about large scale change and spread of simple, high impact interventions is available now. And it is a really good summary of methods old and new. I highly recommend it for anyone planning simple large scale spread, especially if you think you know the answers. This report summarises a variety of methods and is very pragmatic in it's use of examples.

The World Health Organization Patient Safety Programme and the Harvard School of Public Health commissioned the United States Agency for International Development’s Health Care Improvement Project (HCI), managed by University Research Co., LLC (URC), to present its understanding of and experience with the effective adoption of simple, high-impact interventions, such as the Surgical Safety Checklist. URC is joined in this effort by the Institute for Healthcare Improvement, which also has decades of experience in this field.

Readers should note this report and advice covers the spread of simple, high impact changes - namely it does not cover complex, system related changes.

The report covers:

III. Spreading Evidence-based Interventions
IV. The Scientific Basis for Spread
A. Framework for Spread
B. Individual Adoption and Behavior Change
C. Positive Deviance
D. Factors that Influence the Rate of Spread
E. Understanding the Social System
F. Integrating Content into Process Design
G. Testing and Implementing Change
H. Executing for System-level Results
V. Approaches for Large-scale Spread
A. Natural Diffusion Approach
B. Executive Mandates
C. Extension Agents Approach
D. Emergency Mobilization Approach
E. Affinity Group Approach
F. Collaborative Approach
G. Virtual Collaborative
H. Wave Sequence Approach
I. Campaign Approach
J. Hybrid Approaches
K. Lessons Learned from Large-scale Spread
VI. Which Approach Should Be Used to Disseminate Checklists?

(And thank you to the authors of the report for referencing my book on how good practice doesn't spread)

5 checks to test whether your conference call is productive

2010-09-18T07:12:00.001+01:00

Conference calling is often touted as the more productive way to have a meeting. In many cases it is, however, some calls are so badly organised, chaired and processed, that it may have been better to meet face to face - or not meet at all.

1. Don't start on time.
"We'll wait another couple of minutes for Dean and Tam."
silence
"Is Mike on the line?"
silence
"Janet can you call Mike on his mobile to check he is dialling in"
Silence

If 20 people wait 3 minutes past the start time for the people who have not joined the meeting it means 1 hour has been wasted. If 100 people wait 3 minutes it is the equivalent of 5 hours wasted by the organisation.

A good way round this problem is to predictably open the line 5 minutes before the session starts and then predictably start on time - every time. You wouldn't keep the meeting room door locked until the advertised start of the meeting.

2. Use slides
"For those of you with Internet connections, you'll see the agenda. What? Oh Mary, yes, I'm sorry, the agenda is so up to date it couldn't be circulated beforehand."
...
"Can everyone see the slides?"
"Next slide please. No, go back one. Yes, that's it."
...

Slides are used mostly as personal notes for the person speaking. As some people don't have access to the computers when they dial in, any necessary slides should be circulated before the call (rather than afterwards). Some learning styles work better when they have had time to read and then contribute.

3. Rely only on audio
Meetings of any sort work best when there is trust. Unless the session is an online seminar when your role is to push out information via some slides to a large group, then video is essential. Even in the seminar option, the speaker needs to use video. The more participants who use video, the more everyone will pay attention and not do their email at the same time. Multitasking is proven not to be productive. A 90 minute conference call with everyone doing two tasks at once is unproductive. It could be replaced by a 30 minutes, focused, video-face-to-face committed time discussing what matters.

When presenters refuse to use the video option they lack the ability to influence using body language. The same goes for listeners. This makes the call ineffective and unproductive as messages have to be repeated.

4. Don't use names
'Thanks for that..um.. sorry, who was that who agreed to review the budget?"
...

Audio, especially without visual, is anonymous - which may account for why some groups enjoy using it - it feels like they are having meetings yet no much happens to move the work forward. Anonymity is not a good name as it means listeners have to work hard to keep connected.

Each time you speak, say your name: '"Sarah here, I like what you're proposing Simon, however, I am not sure about item 3." Try and say the other person's name as often as possible to let them know you are connecting with what they are saying.

5. Have a call when an email would have done
Holding a meeting is an act of power and control, and one to be used with care. If the intent of the call is to share information then consider first whether an email or discussion group would be a better and more productive option. If group discussion is required - then a call is good. If information needs to be shared and not much discussion is expected or required, then another method is far more productive. Many calls can be replaced by the use of efficient and productive discussion groups and document storage systems. Huddle is a great one, though Google groups/documents is a good start. The real issue here is about power and control; relinquishing the weekly conference call and replacing it with an online discussion group means someone has lose control of the process.

Measuring large scale change

2010-09-17T08:36:00.001+01:00

Many complex programs are designed to deliver large scale change. A key concept is knowing when a change is being made, and whether it is in the right direction. Large system change is different to process change in that it seldom has a clear beginning and end, has multiple causal factors (some of which we will never know), and the result is often separated from the action in time and space.

Differentiating the types of measures from each other helps, as well as estimating and checking connecting between them. The following categories may be useful to you in deciding how to measure what.

Inputs: a bit like a baseline measure though perhaps a bit more active. It could be the number of patients not attending their appointments or the % of staff committed to a new organisational vision.

Activities: this counts how much is done of something designed to engender change. IN the case of large scale change there may be a variety of activities underway at the same time. This could be the % increase in number of people attending a workshop, the number of patients

Outputs: the results of the specific activities. So if the number of employees attending a patient experience workshop increased, and the workshop had an aim of improving staff satisfaction, then an output would be the amount of increase in staff satisfaction (and perhaps compared to areas where employees had not attended the workshop.

The above three measures often look alike. What is key is to understand what large scale change is being measured and to think through, and perhaps map, the links between the identified measures.

Outcomes: this differs from outputs in that it moves up a higher level - more long term, bigger impact. For example, if patient satisfaction increases then an outcome may be more patients returning, more income etc.

Impacts: this is the final level of measure. Perhaps the organisation reaches a new public grading, patients in the local area experience better health as a result of the improved services etc. Reduced health inequalities is another example.

Identifying the measures is only half of the learning from measuring for large scale change.A key step is to find a way to map out the linkages between the measures. To do this at the start of a program is helpful as learning from the actual measures can be replotted. This will help identify whether movement to the large scale change is underway as a result of the current activities - or not.

Choosing the right chart to show your project progress and performance

2010-09-15T16:45:00.001+01:00

Essential to any improvement project and spread / adoption campaign is a system to measure progress. An Excel produced bar or line chart on the regulation maroon and blue is suggestive of either a lazy monitoring process or one which is not turning data into useful information.

In large programs fundholders often like to see comparisons between one sub-project or site and another. Or maybe you are interested in how the results are stacking up as a whole; for example, are all the sites adopting all the elements of the new project? Do you know the best way to show a trend of your data? What about relationships between different data?

A favourite place to download Excel templates for your charting needs can be found at the Chart Chooser. Best of all, you can work out which template best suits your needs using their diagnostic process.

Do you have any templates for charts used to monitor the spread / adoption process or project improvement that you would like to share? Leave your comments below.

The Intelligence of crowds

2010-09-15T15:15:00.000+01:00

It is difficult to subvert the ego of the individual and go with the average of the crowd - yet when the crowd's results outperform those of individuals it may be time to do some creative thinking about how we make chnages in healthcare - or anywhere else. A classic example of the wisdom of the crowds is the "how many marbles in a bottle" challenge. With a decent sample, the average of the crowd is usually very close to the actual number. In comparison, individual's results are varied, the range is big and there are few that are close to the target.

NPR has interviewed the author of a book on the subject.

In his book The Perfect Swarm, Len Fisher talks about swarm intelligence -- where the collective ideas of a group add up to better solutions than any individual could have dreamed up, including an example of how UPS reorganized its driving routes using the logic of an ant colony.

You can listen to the interview (17 mins) or read a transcript.

Listen out for the way in which UPS redesigned their routes using swarm logic. Do you think the same is possible for the redesign of patient pathways?

6 resources for Patient Centred experience and Design (EBD)

2010-09-14T08:51:00.000+01:00

Ensuring "involving patients" is more than rhetoric is a challenge. For any healthcare project, be it an innovation or an attempt to spread good practice and adapt evidence to work locally, engaging with patients and service users is a challenge. This post suggest five resources to help you.

1. The Picker Institute Europe is a world leader in working with patients on a large scale and covering public, private and the voluntary sector. Their remit is to work with healthcare providers and commissioners to:

measure patient experience
gather patient feedback
analyse the findings
develop action plans
engage patients in service improvement
evaluate improvements and
communicate developments back to your Board and stakeholders.

Available from their website is a comprehensive toolkit for Using Patient Experience. It is free.

2. The USA based Institute for Patient Centred Design is unique in that it provides resources on design not only for healthcare professionals but also to patients; excellent way of practising what they preach! They have a number of documents and surveys (free) available online.

3. The Centre for Health Design has an evidence based focus. They have a number of evidence based design resources on their website and their Healthcare Leadership portal has excellent PDFs for download and access to a variety of multimedia resources. This includes an excellent review on the literature of evidence based design These are free.

4. The NHS Institute which covers the NHS in England, has a toolkit on Evidence Based Design which is available to NHS England staff (max 20 copies) for free, and £30 for copies for others. They also have a facilitator's pack available for purchase.

5. The UK Department of Health has published a toolkit on understanding detailed patient experience data. Although this does not cover design and involvement in depth it is a useful kit to help you understand what to do with the data you are presented with.

6. The Design Council in the UK is running a project about Designing for Patient Dignity. While most of this covers the physical aspects of patient care, the case studies and design process make for interesting reading. They have published a 25 page booklet which is free to download.

If you have any favourites I've not covered here then please leave your notes and a link in the comments on this blog.

Productive Partnering self assessment tool

2010-09-13T08:49:00.000+01:00

The NHS Institute, working with PriceWaterhouseCoopers, developed a self assessment tool to help English Primary Care Trusts to figure out how best to create and maintain multi-sector partnerships.

The self assessment is the result of a program that aimed to reduce health inequalities which involved multiple different stakeholders coming together for the purpose of the project. The tool is aimed at groups who need to work together to deliver complex health orientated outcomes.

Getting evidence into practice is difficult enough. Doing this when there are multiple stakeholders is even more complex, risky and prone to non-delivery. This tool goes some way to helping groups figure out how best to work with each other, with a health outcome in mind.

5 tools for understanding and assessing organisational learning

2010-09-09T14:38:00.001+01:00

Organisational learning is a vast discipline full of theories, models and frameworks. The ability for an individual, team or organisation to learn is a key factor in determining whether the results of a project will be sustainable beyond the duration of the project.

The Society for Organisational Learning is the home of the topic and the first port of call for information. There is an excellent overview of OL for beginners and the timeline is interesting for anyone who feels they have heard something similar before but not sure when.
SCSI (Social care institute for excellence) has a resource pack that works well for health and social care public sector programs. This pack is designed to allow organisations to assess whether they are a learning organisation, that is, an organisation that uses evidence-based practice and informed decision-making. The resource pack will be beneficial to chief executives, senior managers, frontline staff, service users and carers. The pack has been developed by SCIE Practice Development staff, in collaboration with service users, carers and staff in social care. We would like to thank all those who contributed to the production of this resource pack.
Harvard Business Review have an online version of an OL survey for personal use. It links to the article, "Is Yours a Learning Organization?"
The Learning Needs Analysis Toolkit is a useful source not only for the survey but also a variety of links to underpinning theories.
European Consortium for Learning Organisations has resources for download with a knowledge management bias.

The above links comprise only a small selection of a vast quantity of resources available. Feel free to add your favourite link in the comments below.

Mobile learning may be more significant than web learning for healthcare

2010-09-09T08:14:00.000+01:00

Educational methods have long been one of the key strategies to encourage the adoption of existing good practice and evidence in healthcare. The predominant method is face-to-face sessions though over the last three or four years this has started to be replaced by virtual sessions. The Web has been the technology used ofr the virtual learning, however, the advent of smart phones suggests learning via the mobile may be overtake the web portion of learning and may dig deeper into the face-to-face session.

The chart above comes from Ambient Insight Research who have an excellent article on this topic.

Are your spread plans including the use of mobile learning and technology?.

What are 30, 60 and 90 day projects?

2010-09-08T19:25:00.000+01:00

We all want results as quickly as possible from any project team. In fact, we want the results now! Quality improvement projects are by nature a cyclical process where a few steps are taken, then tested, evaluated and then a few more.In complex organisations and systems such as healthcare, the cycles of change can take a long time It can be challenging to keep staff motivated after the initial months of the project.

The concept of the 90 day project comes from research where the aim has been to shorten the cycle of learning from the often 3 or 5 year project horizon. Projects like these accelerate some of the learning, but not all. In healthcare improvement programs, accelerated timescales can be useful at the start, in the middle or the end of a formal program. At each stage they will have a different focus.

At the start of a project, short timescales can be used to get some momentum going. A 7 day sub-project is an excellent way to focus on commitment and action right up front. Half way through a project a series of say 3 x 30 day projects can be run in parallel with different teams all focusing on the same result. Or they could be run in series. At the end, a series of rapid projects can help cover all the loose ends and ensure comprehensive results.

So what is a short project? We know what it isn't:

not a replacement for the overall project
an easy option; all short projects need planning
not for everyone

If you want to run a short timescale project then consider the following:

for the same topic, different teams will choose different lengths of project. This is because the specific context for change is one of the the biggest factor in the speed of implementing change.
be practical, pragmatic and realistic
focus on the outcome to be delivered rather than traditional project planning
remember this is one technique that may work for some people and may not work for others

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Online Clustered Networks Spread Behavior Change Faster

2010-09-05T09:31:00.000+01:00

Online communities have different dynamics to face-to-face communities of practice. New research suggests that for online communities, behaviour spreads more quickly when the community is grouped into networks with overlapping connections than when left to develop more random and distant links.

If you are managing online communities then the research is worth a closer look as it may provide hints on how to design and support it so behaviour and influence can spread amongst the participants.

For communities of practice not online this clustering effect is not new. Research has been around since the 1970's which show the importance of bringing groups together geographically, thematically and/or by profession or person type. As humans we like to be with people similar to ourselves and are most influenced by those the same as us - if Joe can make the change then I will probably be able to as well.

There is a lot of buzz about social movements, mobilising and organising for change in healthcare. One of the success criteria for this work will be the depth to which those doing the organising as well as those participating understand network dynamics, and design accordingly. Random networks are less influential.