Improvement Method Olympics Day 7

Posted by: NHS Horizons - Posted on:

  1. Statistical process control (tool)

Statistical process control (SPC) is an analytical technique that plots data over time. It helps us understand variation and in so doing guides us to take the most appropriate action. SPC is a good technique to use when implementing change as it tracks the impact of improvement interventions and enables you to understand whether changes you are making are resulting in improvement.

Example statistical process control chart from the Improvement Academy, Yorkshire and Humber

Graph showing proportion of patients in hospital at end of month who are male

Read more about statistical process control

2. Pareto Analysis

Pareto analysis is a simple technique that helps you to focus efforts on the problems that offer the greatest potential for improvement by showing their relative frequency or size in a descending bar graph. Pareto’s 80/20 principle states that roughly 80% of the effects come from 20% of the causes.

Read more.

Red arrow with the words '20% arrow' intersecting with a blue circle and the words 80% results

3. Schein’s culture iceberg

Edgar Schein’s organisational culture triangle (often drawn as an iceberg) suggests that there are different layers to the cultures within organisations. There are shallow layers that give a superficial view of the culture. There are also deeper layers which provide a much greater insight into what a culture is actually like.

The three key layers in Schein’s model are:

  1. Artifacts –  the visible signs of an organisational culture. They are the shallowest indicator of what an organisation’s culture is actually like. Artifacts can include things like policies, procedures, job-titles used, how the structure works and the style and design of workspaces.

While analysing artifacts may give you some insight into what an organisation’s culture is like, they won’t provide much insight. Similarly, while changing an organisation’s artifacts might lead to some change in culture, it won’t achieve significant change.

2. Espoused Values – the things that an organisation says about its culture and ways of working. These are deeper indicators and levers of culture than artifacts, but shallower than underlying beliefs. Espoused values include things like organisational values and behaviours, company or employee charters, team contracts, perhaps vision and mission statements and the types of things promoted through newsletters and so on.

Analysing espoused values will provide some insight into an organisation’s culture, and changing them will provide some level of change to organisational culture. The effects though won’t be huge.

3. Underlying Beliefs – held by members of an organisation are significantly deeper indicators of an organisation’s culture than either its artifacts or espoused values. They reflect the way that the organisational really works on the inside. Underlying beliefs held by employees of an organization include assumptions about how they should work with each other. They also include beliefs about what behaviours will really lead to workplace success or failure. For example, many organisations espouse that remote working is a great thing, however employees may have underlying beliefs that you need to be physically present at work to be recognised by the organization.

Employees’ underlying beliefs are the strongest indicator of what an organisation’s culture is actually like. This makes them the strongest levers of organisational change. However, they are also the hardest levers to influence.

The reason this model is often drawn as an iceberg is that the superficial layers are above the waterline but the true indicators of culture are unseen, in the lower layers deep below the water line.

We can use this model to think about the true indicators of organisational culture and the actions needed to change it in a deep rather than superficial way.

Content adapted from: World of Work:

Picture of an iceberg. Above the waterline in section 1 is artifacts; below the waterline in section 2 is 'espoused values', under the waterline in section 3 is 'basic underlying assumptions'

Source of graphic: Michelle Veenis

4. Diffusion of innovation adoption code (method)

Adoption of a new idea or way of working (i.e., “innovation”) does not happen simultaneously across a system; rather it is a process whereby some people are more apt to adopt the innovation than others.   Researchers have found that people who adopt an innovation early have different characteristics than people who adopt an innovation later. When promoting an innovation to a target population, we need to think about the characteristics of the target population that will help or hinder adoption of the innovation. There are five “adopter” categories and we need to use different strategies used to appeal to the different groups:

  • Innovators – These are people who want to be the first to try the innovation. They are venturesome and interested in new ideas. Very little, if anything, needs to be done to appeal to this population.
  • Early Adopters – These are people who represent opinion leaders. They enjoy leadership roles, and embrace change opportunities. Strategies to appeal to this population include how-to manuals and information sheets on implementation. They do not need information to convince them to change.
  • Early Majority – These people are rarely leaders, but they do adopt new ideas before the average person. Strategies to appeal to this population include success stories and evidence of the innovation’s effectiveness.
  • Late Majority – These people are sceptical of change, and will only adopt an innovation after it has been tried by the majority. Strategies to appeal to this population include information on how many other people have tried the innovation and have adopted it successfully.
  • Laggards – These people are the hardest group to bring on board. Strategies to appeal to this population include statistics, fear appeals, and pressure from people in the other adopter groups.

From Boston University School of Public Health

Picture of a bell curve