Are you an Improver? by Paul Sammons

I caught a bug back in 2008 – the Patient Safety bug. I caught it when I became involved in the Scottish Patient Safety Programme. I have kept it and cultivated it ever since.
Before that time I thought that rapid cycle improvement was something about new carbon fibre bicycle frames!

OK so I was wrong – as an ex banking project manager, I knew loads about change, but was hit with the realisation that in the past we did things to people rather than with people, and used hierarchy to make people do as they were told. A bit like inviting folk round for dinner and telling them what they will enjoy eating. Not the best recipe for embedding change.
And so I was smitten, with the likes of Jason Leitch talking about the lens of profound knowledge, small tests of change and measurement for improvement.
After a sabbatical into NHS IT work, I became an improvement advisor, and saw that the same bug had visited Dumfries and Galloway and taken hold, with lots of measurement and improvement going on, aimed at process improvement and reducing harm to patients.
But see this Model for Improvement methodology and all that goes with it – is it portable? Can it be used where there are no doctors?
In 2016 I am lucky enough to be supporting a new improvement collaborative, working with 5 dental practices to apply the set of improvement related tools and principles to address the question – does dentistry harm patients? Well there is risk of getting it wrong in all walks of life, and dentistry is no exception. Since we are people, dealing with other people, we may be able to address unnecessary harm, reduce variation in processes and improve communication. To anybody who has teeth – this matters.
This opportunity allows me to support dental practices to identify where they want to focus their improvement efforts, apply the Model for Improvement methodology and see if the concept works.
The dentists enjoyed a learning session around improvement methodology, and collaborated to agree an aim around improving the quality and use of medical histories in dentistry. Locally we built a process map so the practices involved could see, and discuss where medical histories matter. We saw a number of areas where a medical history influences treatment planning, for example diabetes, allergies and certain medicines. Dentists, hygienists, nurses and practice managers agreed measures that we could use to track the improvement journey, and to feed into improvement conversations.
The methodology tells us that measurement should continue objectively all the while we identify and test change theories – ideas that may (or may not) result in improvement.
The theories in the model for improvement are logical and simple to use. Say for example, if we need to know if a patient takes a medicine called a bisphosphonate – and we don’t actually ask that question on the medical history form – might it be an idea to change the way we ask for the information? Well it might – but how do we know that any change actually improves anything?

The methodology suggests that we don’t waste time implementing ideas that might not work. So the practices might say, change the form for one patient, and determine if the change worked for that patient. If it did they might try with say 5 patients, redesigning and refining each time. As the theory develops the form is likely to get better, and spread to a wider group. Eventually, if the small tests of change go well, the change might be adopted across the practice. And if the collaboration aspect does its job the change would be available for other practices to try out for themselves.
So six months into this application of the Model for Improvement, I have to say I m completely convinced that it has the potential to deliver small changes that will collectively result in significant improvements, as well as developing the collaborative culture within and across practices.
OK so I am sold on the benefits of the Model for Improvement, and in my role I am lucky enough to spread its virtues daily.
But that’s me. What about you?
What I do see is that when folk are granted permission and have capacity to take part in improvement work – they love it. But rarely is it seen as part of their every day workload, and the skills that make it happen are not often embedded in the team or the individual. So as an improvement advisor it may be that when I walk away the focus on improvement activity can reduce.
So the skills, knowledge and experience needed to take part in or lead an improvement project – do you have them? Do you know what they look like? Would you have the confidence to lead an improvement project – and do you have access to the support that you might want to secure?
I truly believe that these capabilities should form part of everybody’s role. So it is with that in mind that I would love to do myself out of a job. If everybody could do this work, then I would not be needed – right?
What gives me the most pleasure is when I leave the room knowing that the people I work with no longer need an improvement advisor. That they can run small tests of change, that they can measure the effectiveness of, and the variation across processes, and use the results to discuss and promote improvement in their team, and also that they don’t rely on hierarchy to determine whose ideas are considered.
Right now the Patient Safety & Improvement team have a programme on offer called the Scottish Improvement Skills programme where many of these skills are offered. You may have seen the flyers across Dumfries and Galloway. Applications close on 30th June however, so you may need to get your skates on! This is a great way to prepare for involvement in improvement work – and to do me out of a job!
Do I not like my job I hear you ask? Well with my involvement in the dental collaboration I am lucky enough to see this cross fertilisation of capability unfolding before my eyes every day. Now that’s job satisfaction for you. Long may it continue!

Paul Sammons is an Improvement Advisor with NHS Dumfries and Galloway

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