Improvement Method Olympics Day 2

Posted by: NHS Horizons - Posted on:

  1. Prosci ADKAR (method)

The ADKAR model is a five stage model of change. It’s built on the premise that large organisational or system changes are the product of many individual changes.

  1. Awareness: Before people can even consider a change, they must be aware of the need to change / case for change. Creating awareness often involves communication and education. Increasingly peer advocacy is seen as a powerful tool to raise awareness.
  2. Desire: Awareness alone isn’t enough. Individuals still won’t change unless they want to. Creating desire for change may involve communication, listing, co-creation, peer-advocacy, clear visions and explaining benefits.
  3. Knowledge: To change effectively individuals must not only want to change, but also know how to change. Increasing knowledge involves communication and training. People want to know the goal and the stages to follow to get there.
  4. Ability: Once people know how to change they can start to develop their ability to do things in new ways. Helping people increase their new abilities requires support, permission to fail, patience, quick wins and celebrating success.
  5. Reinforcement: Change will only be lasting if people keep using the new ways of working that they’ve learned. To help embed new ways of doing or being so they become habits requires both positive and negative reinforcement. In other words, good behaviours need to be celebrated and rewarded and bad habits need to be challenged.
ADKAR Model of change:
A - awareness of the need to change
D - desire to support and take part in the change
K - knowledge of how to change
A - ability to implement the change
R - reinforcement to sustain the change

2. Service user stories (tool)

If we want to ensure that service users and their families feel informed, cared for and listened to so that they can make meaningful decisions and choices about their health and care, we have to gain an understanding from their perspective of what good care looks like, what is not good and how we can improve the experience of care.

We can use patient stories to get a better understanding of individuals’ experiences and perspectives on a whole range of issues and services. Collectively users’ stories help to build a powerful picture of what it’s like from a patient viewpoint as in listening to their story, our focus of attention will be on the service user as a whole person rather than a clinical condition. It is important to recognise that we cannot use individual stories to make generalisations about service user experience but that each story is valid as it represents an individual’s experience. We can, however, use stories alongside other data sources to gain powerful insight into what is happening with our service and/or system.

Read a guide to patient stories.

White text on a black background saying "what's your story"

3. Five Whys (tool)

By repeatedly asking the question ‘why?’ (using five as a rule of thumb), we can peel away the layers of an issue, which can lead us to the root cause of a problem. The reason for a problem can often lead into another question; we may need to ask the question fewer or more than five times before we get to the origin of a problem. The real key is to avoid assumptions and logic traps and encourage the team to keep drilling down to the real root cause.

See root cause analysis from NHS Elect.

This example from Lothian Quality gives an example of 5 whys.

Example of 5 whys - Mrs X fell when entering the building Why? the floor was wet as it was raining outside. Why? The wet mat hadn't been put out when the rain started. Why? Only mat was still wet from yesterday. Why? There is only one wet mat.

4. Ishikawa/fishbone diagram (tool)

The Ishikawa or fishbone diagram helps us to work on cause and effect in our improvement challenges. It allows us to work through the possible ‘underlying factors’ of a problem – i.e. the possible contributory and causal factors (not just the symptoms), before you start to work on designing effective solutions. It creates a snapshot of the team’s collective knowledge of the issue, gain a shared insight into the problem, and start to consider the design of possible improvements or solutions.

Read a cause and effect (fishbone) guide

Ishikawa diagram from East London Foundation Trust

Fishbone diagram showing cause and effect issues