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Improving Together: Building Culture Through Collaboration
Improving Together: Building Culture Through Collaboration
Improvement Methods and Resources
Improvement Methods and Resources
The journey of improvement and the key points across the application of an improvement method
In this section
In this section
Institute of Healthcare Improvement model for improvement
Institute of Healthcare Improvement model for improvement
The model for improvement can support you to structure your improvement. You want to know as a team what you are aiming for and how you will know if you have been successful.
Acknowledgement Note: The above image is re-created from the How to Improve: Model for Improvement | Institute for Healthcare Improvement
Engagement
Engagement
Stakeholders are different to project team members. Why is it important to engage them in your project?
What are the 4 steps to the engagement process?
Engaging others: What matters to you?
Engaging others: What matters to you?
Meaning
Meaning
Autonomy
Autonomy
Growth
Growth
Impact
Impact
Connection
Connection
Stakeholder Map
Stakeholder Map
Identifying your stakeholders is one of the first steps you should take in any improvement project to help you decide who needs to be involved and who needs to be informed. Use the template below to identify your stakeholders and map them according to how your project will impact them and what influence they will have on your project.
Click Stakeholder map to download accessible version.
Engaging Children and Families
Engaging Children and Families
Co-Production
Co-Design
Doing With: in an equal and reciprocal partnership
Engagement
Consultation
Informing
Doing For: Engaging and involving people
Educating
Coercion
Doing To: Trying to fix people who are passive recipients of service
Patient Engagement
Patient Engagement
Social Media
What Matters To You (WMTY: a social movement to improve person-centred care)
Interviews
Patient Journey / Shadowing
Liberating Structures
Open Events
Experience-Based Co-Design (EBCD)
Complaints and Friends and Family Test (FFT)
Questionnaires / Surveys
Conversation Cafe
Emotional Mapping
Examples of feedback and stories from staff, children and families
Examples of feedback and stories from staff, children and families
"There was this mother from (an international country), so she had to leave (an international country) and she was worried about her child's feeding, but we were able to reassure her that the child, who was about three or four years of age, was growing very well. But when we dug in deeper, we could see that the child was very anxious that the context was they've just left a war-torn country." - Paediatrician
"5 year old who's constantly... verbalising that he needs to go to the bathroom. Eventually, various referrals were done. (A professional) was able to get him seen in the paediatric day unit almost immediately... the symptoms did improve and then we were following him up in primary care as well." - GP
“At clinic, I think there was possibly a 2-year-old and mum [who] was concerned about autism, and you know, we assessed this child, and we were able to signpost mum to initially further support via the early support services.” - GP
“I think my position within early help, I don't have a medical back like we don't. We don't support families medically. So, there are often instances where you know there might be. Perhaps it's recurring stomach aches or, you know, not wanting to go to school. Those things where I might be able to chip in and say, "actually, have we thought about an anxiety element there?" Have we thought about that, that could be some emotional well-being, what's going on in the home, those sorts of things. So, it's often kind of I'm trying to chip in from a from a kind of more holistic perspective in terms of thinking about the whole family, thinking about any well-being needs, maybe parenting needs. Family support more generally." - Early Years Worker
Benefits of feedback and stories
Benefits of feedback and stories
Feedback can drive continuous improvement and enable teams to understand if the service is meeting need.
Stories can be utilised to demonstrate short-term impact at micro system level.
Encourage a more reflective and reflexive analysis of how health professionals' actions and responses to patients are perceived and experienced.
Enhance staff experience and understand excellence.
Help contextualise what the team are trying to change and improve.
Enabling the voice of the child and family enables professionals to have a co-design approach to improvements.
Patient stories can be positive, negative, or combine elements of both.
Stories appeal to our senses and our emotions, not only drawing our attention more easily but also leaving an impact on us as audiences.
Stories can help preserve and transmit an organisation's or service’s culture and values.
The stories have the power to break down barriers and turn bad situations around. They can capture our imaginations, illustrate our ideas, arouse our passions, and inspire us in a way that cold, hard facts often can't.
Community Networks and Signposting
Community Networks and Signposting
Involving Local Communities
Involving Local Communities
Each of the family hubs has established networks of community groups, the voluntary sector, health and educational establishments. Family Navigators in each Family Hub help families navigate the maze of local services and find the help and support they need.
The plan is to enhance the existing networks and to connect to the Octopus Network in order to ensure a holistic approach to children's support (Family Navigators are already part of this network). There may be a need to upskill the network in order for them to be able to guide families to the support that is required.
The Vibrant and Healthy Communities team is supporting us to explore ways of connecting and integrating further with the voluntary and community sector.
Example 'Crib sheet' to support staff to have conversations about oral health and connect residents to local support
Influencing Change
Influencing Change
The COM-B model provides a simple, evidence-based framework for understanding behaviour and how to influence it. It recognises that three essential components shape the behaviour of an individual or team:
Capability – having the knowledge, skills, and abilities to perform the behaviour
Opportunity – having the external factors, resources, and social support that enable the behaviour
Motivation – having the internal processes, reasons, and habits that drive the behaviour
This model is particularly useful when considering changes in behaviour, whether supporting families to develop positive parenting approaches or helping a team to work in a more integrated, collaborative way.
You can learn more about the COM-B model via Health Education England's resource.
Acknowledgement Note: : COM B model - Further COM-B information | NHS England | Workforce, training and education
Outreach Event
Outreach Event
An important feature of our collaboration with the local communities involved with the pilot sites was the setting up of “Health and Wellbeing fairs” to showcase the professional and voluntary organisations which operated in the hyperlocal areas.
During the pilot period, both Harrow and Brent undertook these fairs and used the opportunity to launch their innovation funds at the same time.
The NWL ICB and Harrow Association of Somali Voluntary Organisations (HASVO) successfully collaborated and hosted the Harrow Babies, Children, and Young People’s Health and Wellbeing Fair in February 2024. The fair hosted over 30 professionals coming together to raise awareness of the support services available to the local community.
Improvement Tools
Improvement Tools
Root Cause Analysis & Fishbone Diagrams
Root Cause Analysis & Fishbone Diagrams
The cause-and-effect diagram is otherwise known as the Fishbone diagram or Ishikawa diagram. It was devised by Professor Kaoru Ishikawa, a pioneer of quality management, in the 1960s. The technique was then published in his 1990 book, Introduction to Quality Control. Simply, the fishbone diagram is a visual representation of the cause and effects of a problem.
It is used to identify, explore and graphically display the variables that “cause” a particular problem or condition to occur.
The “effect” is the problem or undesirable outcome, issue or event being studied. This could be your problem statement, but it could also be your SMART aim, and consider what the barriers are to achieving it.
The branches (i.e., the fishbones) lead to functions or categories of causes that can be broken down further when conducting a root cause analysis (RCA).
Brainstorming or nominal group technique can be used to help the team generate the causes of the problem.
Logic Models/Driver Diagrams
Logic Models/Driver Diagrams
In a nutshell, A Driver Diagram serves as a tool for building a hypothesis that can be tested. It is developed by consensus and summarises what team members feel must change and which ideas may result in an improvement.
A driver diagram illustrates a ‘theory of change’ that can be used to plan improvement project activities. This technique provides a way of systematically laying out aspects of an improvement project so they can be discussed and agreed on collaboratively by the project team.
Process Mapping
Process Mapping
“Every system is perfectly designed to get the results it gets.” - E. Deming
See the ‘whole’ system
Perception to reality – what is actually happening
Bring staff together – conversation and collaboration
Spot waste & duplication
Map out current issues
Confirms the staff needed in making change
Example of a high level process map
Example of a high level process map
Introduction: CYP Services on Offer in Harrow
Introduction: CYP Services on Offer in Harrow
Numerous services exist to support children, young people, parents and carers in Harrow, including 9 early support sites and a youth centre.
Services are provided by schools, the local authority, public health, children’s centres, a youth centre, the acute trust, the community mental health trust, primary care and the voluntary and community sector.
The picture on the right is a visual representation of all the available services in Harrow. This does not include the comprehensive family activities and support offered in the early support sites. Some grant-funded VCS offers are yet to be included.
Identifying waste
Identifying waste
It is the activity that is non-value-adding, not the person
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