Improvement Method Olympics Day 6

Posted by: NHS Horizons - Posted on:

  1. Experience-based codesign (method)

Experience-based codesign (EBCD) is a method for people who work at the point of care and service users to work together to co-design services. It is actioned by gathering experiences through observations, interviews, films, group discussions and identifying key emotionally significant points. EBCD focuses on people’s experiences and emotions rather than attitudes and opinions. The approach uses storytelling to identify opportunities for improvement and focuses on the usability of the service for people who both use and provide the service. It gives them power to make changes.

Flow chart with text & arrows. Text reads: setting up - engaging staff and gathering experiences - engaging patients/carers and gathering experiences - co-design meeting - small codesign team - celebration event

Source of graphic: Gloucestershire Hospitals NHS FT

Get the Experience-based co-design toolkit from the Point of Care Foundation:  You have to submit your email address to access the resources.

2. SIPOC (method)

SIPOC stands for Suppliers – Inputs – Process – Outputs – Customers.

A SIPOC diagram basically helps understand how a business process works by visualising it through suppliers, inputs, process, outputs and customers. Typically, it is in a tabular form with separate columns for each element. Information regarding the roles, responsibilities, and standards are outlined in the diagram. The main aim of presenting the information in a tabular form is to structure the data to make it quick and easy to read. A glance at a SIPOC diagram can tell you the following

  • What is the number of steps involved in the process?
  • Who is responsible for each step?
  • What are the required inputs and outputs?
  • Who are the suppliers and customers of the process?

Teams use SIPOC diagrams in many different approaches to improvement. They promote better job understanding of each person’s part in the process, the steps before and the steps after them They provides a means to streamline workload, increase efficiencies and reduce waste: SIPOC diagrams also help us decide what to measure and what must be measured in what order to focus the project and achieve success.

Graphic showing what SIPOC means - suppliers, inputs, process, outputs, customers

Source of image

More information from ThedaCare

3. Positive Deviance (methodology)

Positive Deviance (PD) is a well-validated approach to actionable change. It is based on the observation that in every system or community there are certain groups whose uncommon behaviour, strategies and practices enable them to find better solutions to problems than their peers. PD aims to identify these behaviours and allow the rest of the community to learn from them and take action to address the problem.

In PD, it is the community, not the experts and leaders that drive the process. These are the typical guiding principle for a PD project:

  • The community owns the entire process.
  • All individuals or groups who are part of the problem are also part of the solution – “don’t do anything about me without me.”
  • The community discovers existing uncommon, successful behaviours and strategies (PD inquiry).
  • The community designs ways to practice and amplify successful behaviours and strategies and unleashes innovation.
  • Community members recognise that “someone just like me” can get results, even in the worst case scenarios (social proof).
  • PD emphasises practice instead of knowledge – the “how” instead of the “what” or “why.” The PD mantra is: “You are more likely to act your way into a new way of thinking than to think your way into a new way of acting
  • The community creates its own benchmarks and monitors progress.
  • PD facilitation is based on deep respect for community, its members, and its culture, focuses on interactive engagement and capacity to let the community lead.
  • The PD process expands existing networks and creates new ones.

Source: adapted from Tufts University Basic field guide to the positive deviance approach

Graphic showing the stages that the community goes through in a PD project

Source: adapted from Tufts University Basic field guide to the positive deviance approach

4. Visual Management (tool)

Visual management is a simple, yet effective way of indicating what should happen (by setting a visual standard) and what is actually happening in the work environment. At a glance, people who work in an area and visitors to that area should be able to understand the process and see what is under control and what isn’t without having to ask a question.

There are two types of visual management:

  • Visual display – the provision of information
  • Visual control –  associated with action

One specific form of visual display is a “Kanban Board” where the team leading the improvement show their work that is “is the pipeline”, “to do next”, “in progress” and “done” (or similar labels). When a Kanban Board is set up and run effectively correctly, it serves as a real-time information repository, highlighting bottlenecks within the system and anything else that might interrupt smooth working practices or continuous improvement.

Both types of visual management allow people to gain the maximum amount of information without having to leave the work environment or access a computer system. Visual management provides the knowledge and certainty to make the lives of service users and providers safer and easier.

Read Bringing Lean to Life

Pciture of a whiteboard with the words "we kanban, can you". Whiteboard is divided into sections in pipeline, to do next, in progress, done. There are lots of coloured sticky notes in each section.

Source of graphic: East London NHS Foundation Trust