Thank you for supporting practices in the RAFT Collaboratives. This is a significant opportunity for BSol to accelerate shared improvement.
What is an improvement collaborative?
Put simply an improvement collaborative is a group of people leading improvement work in their practice who meet regularly to share, learn and plan. It’s similar to an action learning set, except that everyone is working on the same kind of improvements (improving access in this case) and the focus is the work of the practice rather than the individual participant. Collaboratives enable the kind of sharing of solutions and ideas which we all moan is lacking in the NHS, and makes it easier to bring in ideas and support from elsewhere.
What’s the agenda?
Practices signing you for the collaborative in each locality have said what their top priorities for action are in 2023-24. This will shape the topics we address in each meeting. Additionally we will ensure practices get to meet their contractual requirements – so, for example, we’ll include a discussion about reducing avoidable appointments on at least 2 occasions before the end of March 2024 (for the QOF QI domain).
Most meetings will have a similar structure:
- Updates from practices about what they’ve been working on, how it’s going and what they’re learning.
- Updates from the PSU and others about about access-related developments for practices.
- Group work on 2 or 3 of the access actions. Each will usually be around 50 minutes, and include:
- Review of where we’re at
- Shared problem solving on challenges
- Shared development of action plans for the next few weeks
- The group work will be supported by prepared templates that ensure all the important questions are addressed, and that practices come away with high quality actionable plans. The templates will draw on best practice such as the use of SMART objectives, PDSA cycles and real-time measurement of progress and lessons. These will be produced in such a way that each practice benefits from the wisdom of the group while still being able to adapt plans to their specific situation. The PSU will also provide tools for simple data entry and analysis, to reduce the work involved for practices.
We aim to provide facilitators to support the group work sessions in each collaborative meeting. The facilitators are there to help keep the focus on solutions and practical plans. It’s inevitable that the conversation will sometimes stray off-topic, so having a facilitator who can gently refocus the group is very helpful.
Facilitating this kind of groupwork primarily involves listening and asking questions – the facilitator acts as a coach rather than an expert in their own right. Effective facilitators tend to:
- Make the conversation about the contributors and the task, not themselves
- Encourage constructive contributions from everyone in the group
- Enable people to question their assumptions
- Ask “what else?” and “why?”
- Help people be clear about what is being said and not being said
- Point out differences, similarities, themes and linkages between different contributions
- Keep the conversation focused on the task
- Help the group keep to time where relevant
- Remind people to write down important ideas or plans for themselves and their team
The most common challenges in this kind of group work are:
- the conversation gets stuck on discussing problems rather than solutions. Usually everyone already knows these very well – and they’re the reason we’re at a meeting about solutions. The facilitator can help by respectfully reminding the group that our main purpose is to agree actions.
- Ideas for action are proposed but the conversation moves on before the idea has been turned into a plan. In the early stages of brainstorming this is productive, but our aim in each collaborative meeting is that participants leave with an action plan for their practice.
- Facilitators can help by enquiring about the idea using the SMART framework – eg “so what specifically would we be aiming to achieve there?”. When the group is at the planning stage, they he facilitator can coach the conversation using the PDSA framework- eg “who in your team is going to do that? When? What are you going to measure to know if it’s working?”.
We’re encouraging participants to bring a laptop or tablet to make it easier for them to write notes and plans. If facilitators wish, they can also offer to act as a “scribe” for the group. The templates we use will be accessible to multiple people simultaneously, so several people can be writing at once.