The Model for Improvement is a regular topic on my blog—a general purpose guide to reaching an aim. It’s particularly useful when you don’t quite know how to get to a destination but have some way to measure and some ideas about how to start.
In a workshop session on 8 June, I had the opportunity to engage with two dozen people who have a role as local improvement advisors, each one part of a team working to improve health in their community.
Our workshop time (3 hours) was supposed to be dedicated to help the improvement advisors develop their skills.
The challenge: I had some sense of what they were supposed to do (their job) but I also sensed there was a great deal of variation in knowledge and skills concerning their job.
Here the job description that I’d been given before the session:
What is a Local Improvement Advisor?
This is a person from your community who has the knowledge and skills to help your organization carry out successful improvement initiatives and who wants to learn how to be an effective change agent. Examples of improvement activities you will likely be asked to complete include:
1. Understanding your needs and assets as a community; participating in human-centered design approaches;
2. Stating a clear aim; creating, testing, and continually improving a theory of change with community members who might be affected by the change;
3. Implementing a portfolio of projects that will help you accelerate the improvement of health in your community;
4. Identifying and using measures (and data) to guide the work;
5. Testing new ideas that will help achieve your aim; implementing effective change, changing course if you realize you are not getting to outcomes, and leading successful change in a way that builds joy and momentum in the process.
To start, I asked each person to consider the five activities and to self-rate using this scale:
|Not sure what this means||Need/want more skills right now||Have solid skills now|
Here’s how they voted:
The group was already strong in Activity 1. Activity 2 (Theory of Change) and Activity 3 (developing a portfolio of projects) build on fundamentals in Activities 4 and 5, using measures and testing. We decided to focus on those two topics.
Planners of the workshop had predicted that local improvement advisers would need skills development in these areas so I had handouts and exercises already prepared.
Aim: We set an aim that people in the workshop session would gain skills in the two topics by the end of the afternoon.
Measures: How would we know if we were getting close to our aim? I decided ask people to judge themselves, if they learned one or more ideas on each topic.
Changes: I was still worried about the three or four people who were quite skilled in the two topics. How could they be engaged? Plus, I had another ten people in the room with solid knowledge of improvement, who had roles in the network as support staff. Could we use these people too?
We had an idea from one of the participants—how about a buddy system? Good idea, worth testing. I asked each person who self-rated highly on use of measures to sit with a person who self-rated as in need of more skills.
I asked the buddies to read and work through a few exercises on measures, checking in with the pairs along the way to invite questions and reflections.
We then studied the 45 minute workshop session: almost everyone voted (again with sticky dots) that they had learned two or more ideas about measurement useful to their project work and they felt that the buddy system was worth it.
So we continued the same approach in a second PDSA cycle, now applied to practicing Plan-Do-Study-Act. Most of the experts in PDSA were the experts in measures, so we kept the buddies intact. Again, at the end, I asked people to self-assess their learning about PDSA. Again, everyone learned at least one idea about PDSA (most learned three or more ideas).
I had more fun developing the session on the fly than if I had plowed through a pre-cooked plan. It helped tremendously that the audience was primed with ideas about participative design and had experienced the Mr. Potato Head simulation. Nonetheless, using the Model for Improvement was a great way to engage the audience and have them help me help them to improve their skills and knowledge.