QI Boxset: Introduction to the what matters to you framework

RCVS Knowledge:

Welcome to the Quality Improvement Boxset by RCVS Knowledge, a series of webinars, podcasts, and video interviews for practices and practitioners.

Pam Mosedale:

Hi everyone. Today I’m talking to Angie Rayner and Mark Morton from CVS about their What Matters to You resources, which they’ve very kindly agreed to share with us at Knowledge so that we can share them with the rest of the profession, which is really great. And thank you so much, first of all, before we start talking about them, for being so generous as to share those. Angie is the QI Director at CVS and Mark is Director of Learning and Development.

So, Angie, what motivated you to start thinking about these What Matters to You? resources?

Angela Rayner:

Thanks, Pam. And thanks to RCVS Knowledge as well for sharing these resources. It was something that we would always hope would happen. So, it’s really nice to see that come to fruition. I think as far as what motivated, was the motivation behind it? This was back in the days of COVID. And you could really see the effects of that period of time and how the ways of working had changed. And I was looking for, I guess, sort of a solution towards or maybe not a solution, but a way forward to help people with burnout and some compassion fatigue potentially, or really, you know, to be able to take control of their ways of working, I guess, in this new world. And so I found the, know, the IHI website, the Institute for Healthcare Improvement, and they really presented the What Matters to You framework in a way that was really accessible and digestible.

And they promoted it in a way that this was to help with burnout within the healthcare profession as well. So really, I just got involved that way. And the more I digested it, the more it made sense. And really, I think because of my background and quality improvement, yes, this was promoted as a resource to help with burnout.

But also you can see this is just a way to really undertake the work of developing a culture of continuous improvement. That was really at the heart of it, and so I thought this is something beyond burnout. This is something beyond and is a helpful tool for everyone in that regard.

So that was the motivation behind it. And as with most things, you know, that’s new and requires more than just one person to undertake this work. I got on the phone with Mark because he’s my soundboard for new ideas and things like that. And what do you think, Mark, about this thing? And he just said, let’s give it a go. What inspired you to say, let’s give it a go?

Mark Moreton:

Yeah, so it was really exciting. Angie and I do talk about a lot of things and some things that Angie talks about just grab me and make me think, oh my goodness, I can see real use for this. And I think, as Angie said, we came out of COVID, and we were forced to work in certain ways and people’s autonomy was sort of stripped away from them because we had to comply with a lot of regulations. And when Angie started talking to me about this framework, I thought, well, this could be amazing.

I am, as Angie knows, I’m reckless and enthusiastic about trying new things. So I thought, well, let’s just go and do it. So we, we went and we talked about this framework, didn’t we? And we sort of worked out how we might, you know, read the white paper, worked out how we might do it. And then I just went to a practice, and I tried it. I just gave it a go. And, and I, wow, I learned a lot on that first session, I learned a huge amount.

But it was really, really well received by the practice that I tried in. The feedback was that it was a completely new way of thinking about things and the team absolutely loved it. They thought it was fantastic. To be really, genuinely asked what you want to do and what you want to improve was a real…sort of new thing at the time anyway, it felt it after COVID. And so we were really excited weren’t we?

Angela Rayner:

We were, yes. We were ready to try it in more places at that point to see what else we could learn from that.

Mark Moreton:

Yeah. So we tried it in a few new places, didn’t we? Just on our own. Angie and I did a few places, and the challenge then became how do we help other people to understand what this framework can do, how you might deliver it and try and share some of the things that we learnt along the way while we were doing it. Because every time we did it felt like a new experience.

Angela Rayner:

Yes, I mean, yeah, every session that we facilitated, it was another learning, you know, and so it was that we could build into this process. And so it was a real iterative process for us too, to see this whole, you know, when you implement change, it’s very iterative that you build on your learnings. So yeah, it was also a great process for us to be able to just do that too.

Pam Mosedale:

Sounds really, really interesting. When you say you went into a practice and just started, what did you do? And how did these resources that are there help someone else to do it? If you see what I mean.

Mark Moreton:

Yeah, I mean, we sort of tried to work out what we would do, didn’t we? And we didn’t really have much of an idea. So, I went to a practice with a flip chart and some pens. And that was it. I had my questions to ask, so we had our questions that we got from the white paper.

Angela Rayner:

Yeah, no, I think I was just going to add there very much what you just said was there is a bit of a conversation guide in there. Ask these questions and here’s what you might expect and here’s what you want to try and avoid. And so it’s a real nice sort of direction, and granted, it’s not going to give you all the answers. So, you just have to give it a go. But also I think it’s very important to…what we learned from that, just giving it a go, I think one of the really important things was the practice leadership really need to understand what it is, the theory behind it, and they need to be really engaged with this process, and of what it’s trying to achieve, which is to really engage the whole team in this collaborative effort of identifying what we want to improve and then how we’re going to go about it.

As Mark said, sometimes that can, you know, that’s a different way of working for people. So, it was really important that we engaged with practice leaders in that regard and that they also kind of needed to feel comfortable with being uncomfortable, I guess, in that regard. That this was new for everyone, and we’re just going to try and see what happens and just know that it’s not always going to be perfect. And we’re just going to learn along the way. Yeah.

Pam Mosedale:

I suppose you’ve got to be careful because you’ve got to keep it positive, haven’t you? Everybody knows what it’s about improving. It’s not just about complaining about everything, for instance. Are there specific resources for practice leaders?

Mark Moreton:

Yeah, so the resources that we’ve built, there’s some videos and some webinars and some written resources that are all really designed to try and improve people’s understanding of the process itself and the concepts behind it. And they do go into quite a bit of detail around some of that stuff, Pam, the things where you do have to feel a bit uncomfortable.

You’ll stand at the front of the room of people and think, do I really want to ask them this question? But trusting the process and the way that it’s designed, helping people to understand the way the process is designed so that we don’t just spiral into a place where actually people start complaining about all the things they can’t fix, and helping people to understand, helping the leaders to understand that, that yeah, you’re going to have a very uncomfortable few moments in your first session where you sort of think, not sure I want to hear some of these things. But giving them the background to understand the benefit that you’ll get from having that interaction and getting that feedback and helping the team to understand that they can solve the problems that they’re facing.

And it doesn’t all have to be your job to do. We really wanted people to understand that. We wanted people to understand a bit more about how they could solve problems in their practice using the team rather than having to do it all themselves, and the difference that might make to the engagement that the team then feels in those solutions. And so, a lot of the material is focused around helping the leaders to understand some of the concepts that lay behind the framework.

Pam Mosedale:

That’s really interesting. It’s like most of QI, I think, where you need the leaders on board, but you also need it to come from the team on the ground. It doesn’t really work unless everybody’s on board. It sounds really interesting. So, these meetings, how often would practices have them? How would this work? Is it like a one-off meeting and then they come up with some improvement projects?

Angela Rayner:

Yeah, I think it’s varied really from team to team, you know, as far as how often they had them, what it looked like, and how it felt. I think they really adapted to their own style, you know, of what made sense for them. So, some would have them monthly, where they would have a full session. And when I say a full session, that means let’s talk about what’s going well. Let’s talk about what are the pebbles in your shoe that’s getting in the way of having a good day? And what do we want to work on? It’s that sort of the full thing, but then equally you can use those techniques every day around, gosh, this thing that we’re doing isn’t working so well. Let’s just focus on that and let’s improve that, or this thing is really going well, let’s do more of that. So, these are techniques that you don’t have to have a meeting to do. You can work it in your day-to-day ways of working. So, yeah, people just did what made sense and felt right to them. And I think that’s the best way forward.

Mark Moreton:

We had a huge range, didn’t we Angie, of people who… some people who formalized these meetings on a really regular basis. People would say, actually, we’re going to run a meeting like this on a…maybe they’ll do one every three months or maybe they’ll do one every six months. And then we have people who said, we’ll just take this concept and we’ll use it in our individual team meetings. So each individual team would then really distribute the problems to be solved to team members. And then there were other people who said, actually I’m just going to run my practice like this. And we’re just going to get the team to solve the solutions, and I’ll provide some guidance. And so there was a real range, wasn’t there, of the ways that people use the framework.

Angela Rayner:

Yeah. I think the beauty of that is that it really starts to empower people. It creates some awareness of maybe what’s not working well and awareness of how to problem solve, it develops that skill. It really can change the culture within a team, within a practice, in a really positive way, where the leader is just not the sole problem solver anymore, you know? And things just start happening on their own. So yeah, it can be really, like we alluded to in the beginning, a force for continuous improvement.

Pam Mosedale:

Yeah, and I think you just kind of hit the nail on the head there, Angie, about culture because, you know, everyone’s like, we need to change our practice culture, but that’s such a big thing that you almost don’t know where to start doing it. But do you think by participating in these kinds of activities that really helps with practice culture?

Angela Rayner:

Yes, definitely. It gets people talking together. It gets people problem solving together. I think people understand better the way we all work and how we work together. It connects people, gives people a bit of a sense of belonging and that they’re making a really meaningful contribution to their work, but also giving them a sense of autonomy as well, which is so important, to feel like I can make a difference no matter what my role is.

I feel it’s a great resource. It’s a tool that we can use to do that. And I think that because the IHI has put so much research into it, I feel it’s a relatively easy tool to pick up and run with.

Pam Mosedale:

Yeah, so they researched and there was evidence base there. It wasn’t just something that they just suddenly picked out of the thin air. But do you have any practical examples of how teams have used these and what effect they’ve had?

Mark Moreton:

Yeah, there are many practical examples of how teams have used the framework and got themselves to a point where they’ve made some changes that they might not otherwise have made. I think that the consistent theme through all of these things is that there were small things that practices wanted to change, and the team didn’t feel that they could. But actually, when the leaders were sat in the room with them, they found that they could.

I think in almost every case, practices went and bought new clippers, didn’t they, Angie? Which sounds like such a ridiculously tiny thing. But actually for the team, they were really keen. They came up with some really good reasons why they wanted to do that and the reason, and the actual impact. They were able to share the impact that it was having on their day, every day. And it became really clear to them that actually something would improve as a result of a change that they’d made. I think the thing that I found incredible as well, was that when we start these sessions, the first question you ask is, why did you get into the veterinary profession? And we had teams of people who worked together for 10 years and they all learned something new about each other. The sense of collective purpose and a shared vision and goal for what they wanted to achieve was enhanced in almost every practice that we went and did this session in, because they learned something new about why they’re all doing it, and they realized that actually the whole team were really in this together and they all wanted to achieve something. And just that feeling for a practice team when they’re having a tough day, or a tough week, is so valuable. When we talk about how do we change our practice culture, that feeling of team is so important. I think that if I had to pick one thing that I saw consistently across all of our sessions that really made a difference, I say that was a key thing.

Angela Rayner:

Yeah, I agree. I think it’s that bonding together, isn’t it? Yeah. and as Mark said, the small things that make a difference. I mean, I’m just thinking of a holder for blue roll. I remember the team saying, gosh, it just seemed like a really small, silly thing that just made a big difference, removed this everyday annoyance. Just making it easier to get some blue roll.

But another, sort of bigger one was around rota, the out of hours rota. There was some disharmony within the team about, you know, we don’t really like this rota and the practice leadership has spent loads of time on it to make sure that it was all fair and they did their best. So, they gave it to a couple of people on the team and said, please have a look at it and see if it can improve. They spent some time on it, and they came back and said, no, we think there’s no improvements to be made here. And then it was all settled, right? So it’s these sorts of things that create that shared understanding of what’s happening, and I think that also built some trust there as well that we have everyone’s best interest at heart here.

Pam Mosedale:

I’m hearing it’s about listening, listening to the team on the ground, is that right? Do they know what actually happens, what really happens in the practice?

Angela Rayner:

Yes, listening and then doing something about it. [laughing]

Pam Mosedale:

Yeah, obviously there’s no point chatting about it if nothing happens, I agree. It’s the worst thing, isn’t it?

Angela Rayner:

Exactly, but also realising, as Mark was saying earlier, that not everything is within our control. So, it’s then talking about that and then, okay, so what are we going do about it? What can we do instead that will make our days a little bit better or make it easier to give patient care or whatever it is we want to focus on.

Mark Moreton:

That was really interesting, wasn’t it Angie? That one of the fears I think people had when we talked to practice leaders about would you like to do this process, would you like to start with this? The biggest fear is, well, my team are going to tell me that they want to change some stuff that we can’t change. And actually, we didn’t find that. We found that people were very aware what was in their sphere of control, what they could actually influence and so, the instance of people requesting completely different things, that were outside… that just couldn’t be changed, was extremely low. It was really, really low. Which, you know, was good news for us.

Angela Rayner:

Yes. Because we were worried about it too, in the beginning. We were worried. We’re like, no, what’s going to happen? But, but yeah, no, it worked out. Worked out okay.

Pam Mosedale

Yeah, yeah. So be brave enough to start the discussions, I suppose.

Angela Rayner:

Yes, yes. It’s preparing the team, preparing the practice leaders. If you can give the team some information about it too, it’s helpful because if you say we’re going to have a practice meeting, some people might be worried about that, right? Without knowing what it is we’re going to talk about. So, if you can give them some information about what it is you want, and what it is you’re going to talk about, then that really helps to sort of alleviate some fears. And then just give it a go. You just have to try, just have to try it and trust the process, like Mark says.

Pam Mosedale:

So, your advice for a practice that’s not on this at all, how would they actually start?

Mark Moreton:

My advice would be have a look at the material. So have a watch of some of the videos and start to understand the concepts that underlie this framework. Have a think about how you currently sit when you think about those concepts. There’s a couple of videos on delegation and on empowerment on the psychology of change.

Think about where you currently sit and what you currently do. And then I honestly think that the best thing you can do is to take the first step of sitting your team down and just asking them a question. And you might not even want to, if you’re really nervous, you might not want to go through this whole process to start with as one big thing. But if you were to sit your team down in a room and ask them all, why do they do this? Why do they work in the veterinary profession? Just spark an hours’ worth of conversation amongst your team about how they got into what they’re doing and why they do it every day. Even that is a great start and might help you to overcome some of that reluctance to then move forward with the rest of the steps.

Pam Mosedale:

You could start quite gently with that and then we have a different meeting, move on to the next question rather than asking it all in one go. It sounds amazing. And you’ve used this in a lot of practices, haven’t you?

Angela Rayner:

Yes. Gosh, Mark, how many now? Sort of off the count.

Mark Moreton:

That’s over 100, isn’t it?

Angela Rayner:

Over, yeah, it’s over a hundred. Probably 150-ish, maybe more than that, slightly. Yeah. I think. And what was great was that we were able to bring in more people to help facilitate sessions and things like that. And certainly that can be helpful, but it’s not required to have somebody external come in and do that. Anyone in the practice can do that. Then it took on a life of its own, and really didn’t need Mark and I much anymore. So that was a nice thing is that when you see that change spread on its own because of the great positive impact it’s making, then that’s a really exciting thing.

Pam Mosedale:

You must both be very proud of it because it sounds like amazing and a real game changer for veterinary practices. So just to finish, what kind of message would you have for the practices, each of you?

Mark Moreton:

I would say just give it a try, but that’s what I say about everything. But I would honestly say just give it a try because honestly, your team have probably got a load of answers that they’re not telling you and why wouldn’t you want to hear them?

Angela Rayner:

Mm hmm. Yes. Same, same. Give it a go. Prepare the team in whatever way is needed. And trust the process because your team has the answers. They have the answers.

Pam Mosedale:

Brilliant, thank you so much. And thank you again so much for sharing this with us at RCVS Knowledge so we can share it, and it’s there for anyone in the profession to look at. Thanks again and bye-bye.

Angela Rayner:

Thank you.

Mark Moreton:

Thank you, bye-bye.