I decided to write a tweet a day this Christmas (2021) during the 24 days of advent. Here are all the tweets and links in the thread*. It’s a bit easier to read on here imho.
Day 1/24 The simplest #QI safety tool – making safety visible, a great place to begin with the 5S (Or 6S)
I just saw some lovely stock labelling at North West Ambulance NHS Trust’ Wigan joint ambulance/fire station.
Day 2/24 we can more easily see if we are safe using 5S, but where do we want to go next? what’s our direction of travel, what is our purpose?
Here is a lovely example of #purposepyramid from an NHS organisation.
Day 3/24 after the purpose, what’s next? setting goals, aims and challenges… how can we be more specific and how will we know? I find the model for improvement model can be helpful here at the beginning whilst scoping. Www. ihi.org/resources/Page…
Day 4/24. Now we have set a goal, how are we going to know where we are and track it, especially when a measurement system might not be in place yet? Time to set up some simple visual management complementing the 5S work. (Second part of the ‘cell’)
Day 5/24 now we have start to collect the ‘real numbers’. We might want to think about plotting those dots over time, to spot any patterns or odd variation and process behaviour. Www.england.nhs.uk/wp-content/upl…
Day 6/24.. spotting anything in that data yet on the visual management board, run chart or something ‘not in its place’ during a 5S sustain audit? Time to talk about it. Shall we think about a team huddle? (Third part of the cell)
Day 7/24 did we spot something that looked a bit unusual, perhaps time to go and see that process a little more closely, time for patient safety walk around / gemba walk and/or Ohno Circle to help us to learn more, what did we notice about flow, demand or safety? (Rest of the cell)
Day 8/24.. ok we have observed & listened time to think & reflect back on our initial aim and goals, do they need adjusting? have we scoped this work well?; might be helpful to use a SIPOC now before getting into the detail.
Day 9/24… might time to think about who else needs to be involved in this improvement based on what we have learnt so far, some stakeholder analysis might be helpful now… don’t forget to involve patients by now, if not already.
10/24 time to do some valuestream (or process etc) mapping to help all to learn together to see the whole system
The gemba walk, SIPOC, data & stakeholder work already done shld be invaluable. Loved this map from the QI team at Plymouth Hospital.
11/24 can our team now get our waste goggles on frm the patients perspective consider what steps are value added or non value added
Be brutal but don’t take it personally if the things you do are NVA, that doesn’t mean YOU aren’t valued. Removing waste.. what are you noticing about the obstacles to safety and the flow of value?
12/24 now we have thought about the waste, it might be helpful as a whole team to review, but there are toooo many post-its
Might be useful to theme and review, a cause and effect diagram (fishbone) is helpful now.
13/24 now the maps clearer as you moved the waste to the fishbone, ensure the maps current state data is good..this is what will help you to measure benefits later… scroll down on this link to see examples from Outside healthcare.
14/24 use our data boxes to quantify our biggest fishbone themes next
helpful now to consider possible causes using Root Cause Analysis (5 whys). If we get to ‘because no money/staff’ then we’ve gone too far or been too in-specific.
15/24 25 years ago in the chemicals sector, I learnt to use a CEDAC at this point, (but no-one else in healthcare seems to know what that is… a cause and effect diagram with the addition of action cards, or maybe this approach) next best thing imho is this to now think about actions connected to the themes/possible causes that may help resolve these issues, what’s our theory here?
16/24 we have an outline programme theory & actions to try
we might want to test our assumptions here using our data with some rapid experiments to see what we learn before implementation, many ways to do that eg #toyotakata & #pdsa. Let’s keep iterating some standard work now and see what we learn from taking that step
17/24 time to revisit that aim from the beginning, have we learnt enough to be much clearer about what a future state looks like? Time to revitalise why change is needed & direction of travel before starting implementation, maybe tweak? Some limited guidance here.
18/24 let’s check out gap analysis from the fishbone, 5 whys with the future state map now as we move towards implementation
We need to prioritise what we are going to do in the implementation phase. A PICK chart might be helpful now.
19/24 let’s check in again on those stakeholders from that map, and update our comms plan now we are clearer on our problem, potential solutions, and our priorities and urgency.
I like this learning from Wales.
20/24, maybe you thought we would never get there, go slow to go fast they say. We’ve planned, done & studied our experiments, & + talked, now action.
Helpful to have a clear timeline & who etc >ways to do this, a Gantt chart is a classic.
21/24 it’s hard & exhausting doing the actions: ‘no one told us’ & ‘but I’ve a better idea’ & ‘there will be these problems’ & ‘this solution isn’t perfect’ & emotions. Helpful to check on how people are feeling, the change curve could be of benefit.
22/24 time to think about making all these new changes stick? What’s the quality management system going to be & who will do what in the longer term to support sustainability and to help spot new opportunities for improvement? What is our standard work?
23/24 beginning to get out of the doing mess and think about the achievements now, time to reflect and learn, loads and loads of different models and theories for this, here is a bit of an overview.
24/24 yay, time to celebrate 🎉 reflect on the improvement achievement, the what went well, what could be better if, and take pride in what has been learnt so far, get a breather in before the next cycle of improvement 🎉🎉🎉🎉🤩🤩🤩.
(Disclaimer, I am not endorsing any of the companies linked here, it was just a quick link on Twitter, you might know of a better link/source).
Healthcare Quality Improvement 