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Improving Together: Building Culture Through Collaboration
Improving Together: Building Culture Through Collaboration
The Team, People & Creating an Improvement Culture
The Team, People & Creating an Improvement Culture
Improvement as a team-based approach, access individuals who can support, participate, provide insights and test changes
In this section
In this section
Team Building
Team Building
Vision: Smart aim ¦ What's in it for me?
Expectations: Personal objective setting ¦ Delegation ¦ Communications plan
Capability: PDR conversation ¦ Competency framework
Inclusion: Relational meeting ¦ Ideas generation ¦ Recognise and celebrate difference
Capacity: Huddle ¦ Sponsorship
Organisational Values: Behaviour framework reflection ¦ Make a difference
How do I make a start?
How do I make a start?
We brought together the three sites and teams from the NW London Early Years Pilots, so that lessons learned could be shared more widely and to foster relationships as the projects progress. We wanted to understand how innovative ideas could be spread across the sector as well as being able to capture the learning. The following are some top tips to help you get started with your own early years work in your locality.
The Double Diamond Framework
The Double Diamond Framework
As a team, you can use the Double Diamond framework to structure your thinking when tackling challenges or developing new ideas. This simple, four-stage model helps teams explore the problem fully before moving on to create, test, and deliver solutions that meet the real needs of children, families, and practitioners.
Defining the key steps in developing early years project work - "Start with the stuff you know”
Defining the key steps in developing early years project work - "Start with the stuff you know”
Getting the “energy people” around the table
Find people with the right energy who share a similar vision. This might only be two or three individuals to begin with who share the desire to make a change. They, in turn, will decide who should be the critical partners in developing such a piece of work. Initial meetings are likely to focus on the gathering of evidence, both from existing public health data, clinical experience and public opinion.
Delivery Team
There is a need to identify individuals who will make up the core delivery team. A "structure–process–outcome" approach can be applied to each element, such as meetings, engagement of the community, impact and case finding, i.e what or who is needed, what are the processes required and the impact expected. It is important to understand how the system works and how this work can be fitted into existing “system rhythms”. Groups should ask where people already connect and try and influence others. It may be easier/ more acceptable to add an early years agenda item onto an existing meeting than to set up new meetings where people have limited time to contribute. Providing food and refreshments is a very supportive glue mechanism to bring people together. Consider the concept of liminal space; a place to “invite people to dance”.
Outcomes and mechanisms
Define a set of shared outcomes which would be desirable for a particular pilot site. The importance of having a logic model and developing this in each site is emphasised. A template which could be adapted was agreed to be a useful component of such a toolkit.
Logic Model Example:
Logic Model Example:
Click image to see more information about Logic Models
Asset mapping of existing help out there
Agree upon how to harness the existing resources that are present in a particular area in order to support early years work. This sort of asset mapping is invaluable, especially if it includes both statutory and non-statutory resources. The voluntary sector and community organisations often have an umbrella organisation in each borough and can help with this asset mapping approach.
Highly effective improvement teams
Institute of Healthcare Improvement (IHI) identifies four essential types of individual(s) to include:
System Leadership
Clinical Leadership
Clinical Expertise
Day-to-Day Leadership
Patients, family involvement and co-design
There may be one or more individuals on the team with each expertise, or one individual may have expertise in more than one area.
Other key skills to consider are:
Data and analytics
Communication
Risk management and escalation
6 tips for leading an effective team:
Create a cohesive and complementary team
Define and communicate in a clear direction.
Establish a functional structure
Provide contextual support to the team
Having an experienced improvement team coach
Invest in team diversity
The Team
The Team
The following is a list of recommended team roles:
Project Sponsors – champion the project at your organisation's executive level. This individual should have the authority to communicate effectively with the Chief Executive Officer and other key executive stakeholders, provide the resources necessary to implement the QI Action Plan, and approve or reject activities recommended by the improvement team.
Team leader – fully understands the targets for improvement and the vision of the improvement plan in order to effectively lead team meetings. This individual is equivalent to a Day-to-Day Leader as described above.
Team facilitator – ensures the improvement team stays on task. This may include meeting facilitation and ensuring that all members participate and engage in their roles. Some areas/services may combine this position with the Team Leader, which may be an efficient strategy if you have limited staffing resources.
Team champion – members of the team who have a good working relationship with the project Sponsor and team leader. This role has a vested interest in the success of the improvement project and has expertise to contribute.
Service / Area champion – a member of the clinical team who is interested in driving change and has a good working relationship with the MDT, who can help achieve buy-in among the team. An individual who is an opinion leader in the service makes an effective Provider Champion. Provider Champions are specifically necessary when working on clinical improvement initiatives.
Team Members – additional stakeholders who are not the team leader or team facilitator. These individuals have multidisciplinary knowledge and skills that inform the decisions and activities of the improvement Plan.
Acknowledgement: NHS Improving Quality - First steps towards quality improvement: A simple guide to improving services, 2014 service improvement guide.
Acknowledgement: NHS Improving Quality - First steps towards quality improvement: A simple guide to improving services, 2014 service improvement guide.
Team Building
Team Building
Tuckman's Team Development Model
Forming
Forming
High dependence on leader
Little agreement on team aims
Individual roles and responsibilities unclear
Processes are often ignored
Members test system and leader
Storming
Storming
Leader coaches
Clarification of team aims
Individuals view for power
Focus on goals needed
Norming
Norming
Leader facilitates and enables
Roles and responsibilities are clear
Big decisions are made by the team
Delegation of small tasks possible
Performing
Performing
Leader delegates and oversees
Team has shared vision
Focus on over-achieving goals
Disagreements are handled politely and within the team
Adjourning
Adjourning
Celebration at team sucess
Sadness can occur as team is ending
Acknowledgement Note: The Tuckman's Team Development Model was referenced from the Institute for Innovation and Improvement's Improvement Leader Guide.
Tuckman is a helpful model for understanding the stage your team is in, but it does have its limitations (such as team development not being linear).
Teams should consider:
Teams should consider:
Helping people come together by building an improvement team, but there are some dynamics we need to be aware of and the various stages of team building.
Outline the model and its stages
Discuss roles at each stage when building a team, i.e. at the Forming stage, you will need to bring people together, and it will be challenging as there is likely no aim/ team agreement at this point.
Storming: start to introduce the problem and how the team will use an Improvement approach and tools to solve it. Useful to bring in data sources and the M4I with a focus on getting agreement around the SMART Aim.
Norming: Facilitate meetings using QI tools and activities.
Performing: shared vision/ SMART Aim is very clear and well understood by all, and actions are delegated to start progressing the project.
Adjourning: key successes/ improvements are celebrated, and the change idea becomes embedded. This is where the project then ends.
Leadership changes from tighter leading towards facilitation as the team matures.
Case example of multi-agency team collaboration and governance
Case example of multi-agency team collaboration and governance
Local Harrow team staffing and resource
Local Harrow team staffing and resource
The team’s mission and aim is to focuses on improving the health outcomes of children aged 5 years and under, living in the most deprived postcodes in Harrow. The target group is the first 1000 days of a child’s life, preventative care, and embedding health promotion at the very early stages of development.
Effective MDT Approach to Integration
Effective MDT Approach to Integration
For the majority of children in this cohort, coordination will probably take place within the family hubs, and if there are complex socio-economic needs, they will be picked up by the Family Hub MDT Meeting. However, for those with more complex health issues, a referral to GP Practice MDTs and the Child Health Hub MDTs is recommended (where they exist). MDT members are able to refer to each other, preferably with consent.
The Role of the Family Navigator
The Role of the Family Navigator
Data Sharing and maintaining a watchlist
Data Sharing and maintaining a watchlist
Family Navigators
Family Navigators maintain a watchlist of the CORE20 families with children under 5 years old in the area, where families consent. The NHS list is checked against local authority-held information. One list is based in each Family Hub serving the GPs aligned to that location.
The role of the Family Navigator is to identify professionals with an existing relationship to the children/families who can be used to facilitate conversations around the priority areas. For those children without existing relationships, the Family Navigator will initiate conversations after building a connection with the family.
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