m24: engaging staff and building a movement for qi -...

11/29/2016

1

M24: Engaging staff and building a movement for QI

qi.elft.nhs.uk

[email protected]

@ELFT_QI

Monday, December 5, 2016

Introducing the ELFT team

Marie Navina Kevin Mason

Paul Leigh James Amar

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2

Objectives for today’s minicourse

[email protected] @ELFT_QIhttps://qi.elft.nhs.uk

1. Developing a framework for creating momentum for improvement at scale

2. Creating ideas and a strategy for engaging people in quality improvement

3. Understanding the key leadership behaviours needed to lead improvement at scale

Today’s agenda


• Using complexity and social movement thinking to design your improvement approach

• Executive leadership for improvement• Engaging teams and building an improvement

infrastructure• Involving patients, service users, carers and families

in quality improvement• Board leadership of improvement

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Some key principles to guide how you design your

improvement approach


with Dr Amar Shah (Associate Medical Director for QI)

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Arguably the most important competency for dealing with complexity is systems thinking

The three characteristics of systems thinking include:

1.A consistent and strong commitment to learning

2.A willingness to challenge your own mental model

3.Always including multiple perspectives when looking at a phenomenon

Senge, 2006

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A social movement can be defined as…

“a voluntary collective of individuals committed to promoting or resisting change through co-ordinated activity”

Seven common characteristics of social movements:

Energy Mass Passion Commitment

Pace and momentum

Spread Longevity

Bate, Bevan & Robert, 2004)

Current prevailing beliefs about change

• Change starts at the top

• It takes a crisis to provoke a change

• Only a strong leader can change a large institution

• To lead change you need a clear agenda

• Most people are against change

• Change management is a disciplined process

A movement perspective of change

• Change builds from bottom-up action

• Change can be driven by passion to improve

• Change comes from the collective action of individuals

• You need to have a clear cause but can be uncertain about how you will achieve it

• People have an inner desire to make things better

• Change is opportunistic and spontaneous

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Five key principles that can help a movement approach

1.Change as a personal mission2.Frame to connect with

hearts and minds3.Energise and mobilise4.Organise for impact5.Keep forward momentum

Things to consider


Planning versus Prodding, Analysing and Reacting

Who should build the movement?

Pace & momentum

Existing structures versus under the radar

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Executive leadership of improvement at scale

with Dr Kevin Cleary (Chief Medical Officer)

Mason Fitzgerald(Executive Director for Corporate affairs)

1. To provide an understanding of the quality journey that ELFT has been on;

2. To examine the role of all executives in leading quality improvement; and

3. To consider the contribution that executives need to make in order to build an organisation wide QI system and movement

Objectives for this session

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Mental health servicesNewham, Tower Hamlets, City & Hackney

Forensic servicesAll above & Waltham Forest, Redbridge, Barking & Dagenham, Havering

Child & Adolescent services, including tier 4 inpatient service

Regional Mother & Baby unit

Community health services Newham

IAPTNewham, Richmond and Luton

Speech & LanguageBarnet

web qi.elft.nhs.uk

email [email protected]

@ELFT_QI

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The culture we want to nurture

A listening and learning organisation

Empowering staff to drive improvement

Increasing transparency and openness

Re-balancing quality control, assurance and

improvement

Patients, carers and families at the heart of all

we do

AIM:To provide the highest

quality mental

health and community

care in England by

2020

Build the will

Build improvement

capability

Alignment

QI Projects

1. Launch event & roadshows2. Microsite3. Using the power of narrative4. Celebrate successes5. Network of champions / ambassadors6. Learning events

1. Initial assessment of alignment & capability2. Recruiting central QI team3. Online training4. Face-to-face training5. Follow-up coaching on projects6. Develop in-house training for 2016 onwards

1. Align all projects with improvement aims2. Align team / service goals with improvement aims3. Align all corporate and support systems4. Patient and carer involvement in all improvement

work5. Embed improvement within management structures

Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from falls3. Reduce harm from pressure ulcers4. Reduce harm from medication errors5. Reduce harm from restraints

Right care, right place, right time1. Improving patient and carer experience2. Reliable delivery of evidence-based care3. Reducing delays and inefficiencies in the system4. Improving access to care at the right location

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QI ResourcesService User Input

Support around every team

Project Sponsor QI Coach

QI Forums

QI Team

The role of executives in leading

quality improvement

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Kevin’s story

Dr Kevin ClearyChief Medical Officer


Mason’s story

Mason FitzgeraldExecutive Director of Corporate Affairs


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Connecting with staff, and seeing them grow and develop

Spending time discussing our common purpose

Delivering outcomes for patients

Helping others, and making a contribution to national policy

Joys of leading QI

Building credibility with staff and managing

initiative fatigue

Capacity and capability

Constancy of purpose and behaviours

Managing upwards to commissioners and regulators

Challenges

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How to influence and change

behaviour at executive level

Re-visit your common purpose with the Board, staff, patients and stakeholders

Talk about quality before anything else, and with everything else

Link quality planning and quality improvement

Make quality explicit in all strategies and plans

Make quality your business strategy

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All executives to have a formal role (i.e. executive lead, directorate lead, workstreamlead, project sponsor)

Personal commitment to role

Model behaviours with our teams

Roles and role modelling

Be an umbrella for your staff – shield them from external demands

Show others how it can be done

Just say no!

Influence national policy

Managing the external world

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At your table, have a discussion on what you are currently doing and what you might like to try, in order to engage all executives in quality improvement

1. How can executives support an organisation wide QI system and movement?

2. What are the key drivers and barriers?

Executive leadership

Table Discussion


Engaging staff and building an infrastructure to support QI at scale

with Dr Amar Shah (Associate Medical Director for QI)

James Innes (Associate Director for QI)

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And our QI Rap…..

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quality mental


care in England by

2020

Build the will

Build improvement

capability

Alignment

QI Projects

1. Newsletters (paper and electronic)2. Stories from QI projects - at Trust Board, newsletters3. Annual conference4. Celebrate successes – support submissions for awards5. Share externally – social media, Open mornings, visits,

microsite, engage key influencers and stakeholders

1. Build and develop central QI team capability2. Online learning options3. Pocket QI for those interested in QI4. Improvement Science in Action waves5. Develop cohort and pipeline of QI coaches6. Bespoke learning, including Board sessions & commissioners

1. Embed local directorate structures & processes to support QI

2. Align projects with directorate and Trust-wide priorities3. Support staff to find time and space for QI work4. Support deeper service user and carer involvement5. Support team managers and leaders to champion QI6. Align research, innovation, improvement and operations

Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from pressure ulcers

3. Other harm reduction projects (not priority areas)

Right care, right place, right time1. Improving access to services2. Improving physical health 3. Other right care projects (not priority areas)


quality mental


care in England by

2020

Build the will

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Launch of our QI Programme February 2014

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1000 staff, service users and partners engaged in 4 months

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QI Stories at Trust Board

QI Visibility Wall

Electronic & paper newsletters

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qi.elft.nhs.uk

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Visits to see QI at ELFT

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Influencing national policy and thinking

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Staff experience and engagement

3.5

3.6

3.7

3.8

3.9

4

2010 2011 2012 2013 2014 2015

Sco

re

Overall Engagement Score

ELFT Score

National Median

3.5

3.6

3.7

3.8

3.9

4

4.1

4.2

2010 2011 2012 2013 2014 2015

Sco

re

Staff Motivation to Work

3.3

3.4

3.5

3.6

3.7

3.8

3.9

4

4.1

2010 2011 2012 2013 2014 2015

Sco

re

Staff job satisfaction

55

60

65

70

75

80

85

90

2010 2011 2012 2013 2014 2015

Sco

re (

%)

Staff able to contribute towards improvements at work

1. How would you rate the will to undertake a QI programme in your organisation?

2. What are the barriers stopping you from undertaking this work?

3. In light of what you heard today, will you be doing anything differently in order to make a case for change?

Building the Will

Table Discussion


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quality mental


care in England by

2020

Build improvement

capability

Experts by experience

All staff

Staff involved in or leading QI projects

QI coaches

Board

Estimated number needed to train = 5000Needs = introduction to quality

improvement, identifying problems, change ideas, testing and measuring change

Estimated number needed to train = 1000Needs = deeper understanding of

improvement methodology, measurement and using data, leading teams in QI

Estimated number needed to train = 45Needs = deeper understanding of

improvement methodology, understanding variation, coaching teams and individuals

Needs = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead

Estimated number needed to train = 11Needs = deep statistical process control,

deep improvement methods, effective plans for implementation & spread

Pocket QI commenced in October 2015. Aim to reach 200 people by

Dec 2016.All staff receive intro to QI at

induction

500 people have undertaken the ISIA so far. Wave 5 = Luton/Beds

(Sept 2016 – Feb 2017)

29 QI coaches graduated in January 2016. Second cohort of 25 to be trained July-November 2016

Most Executives will have undertaken the ISIA.

Annual Board session with IHI & regular Board development

discussions on QI

Currently have 6 improvement advisors, with 4 wte deployed to QI. To increase to 8 IA’s in 2016/17 (6

wte).

Internal experts (QI

team)

Bespoke QI learning sessions for service users and carers. Over 50

attended in 2015. Build into recovery college syllabus, along with

confidence-building, presentation skills etc.

Needs = introduction to quality improvement, how to get involved in improving a service, practical skills in

confidence-building, presentation, contributing ideas, support structure for

service user involvement

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QI capability building

• In-depth training

• Course length is 6

months.

• 3days intensive

training; 4 WebEx

teleconferences;

2 full day learning

sets

• Applying learning

to their QI

projects in

‘action periods’

• Flexible, online training resource available to the whole Trust.

• Essential skills to support in leading QI

• Certificate which can be added to CPD portfolio.

• Apps for phone or tablet, or use browser

• Brand new modular

introduction to QI

• For anyone involved in

QI or wanting to learn

core QI skills

• Overview to using QI,

PDSAs and testing,

Using measurement &

data for improvement,

QI Tools

• One-stop shop• Learning resources

• Seminal papers, guidelines, whitepapers

• Videos• QI tools

PreworkWorkshop

9/29-10/1

Webex 1

10/14

Webex 2

11/2

Supports:

• Listserve

• Assignments

AP-1 AP-2Webex 3

11/30AP-3

Project

PlanningReliability

Sustaining

Gains

Workshop

(3 days)

Webex #2Webex #1

• Faculty consults• Webex calls• Coaching calls

Webex #3 Learning Set 2 &

graduation

AP-5AP-4

The two learning sets will be focused on sharing the participants’ work on their projects and learning from each

other. These sessions also will reinforce the content from the Webex calls and the ISIA workshop.

Improvement Science in Action - 6 month learning path

Learning set 1

http://technology-trust-news.org/1TXQ-3N68A-JKM3NG-1R3UYD-1/c.aspx

http://technology-trust-news.org/1TXQ-3N68A-JKM3NG-1R3UYD-1/c.aspx

http://technology-trust-news.org/1TXQ-3N68A-JKM3NG-1R2DFR-1/c.aspx

http://technology-trust-news.org/1TXQ-3N68A-JKM3NG-1R2DFR-1/c.aspx

http://technology-trust-news.org/1TXQ-3N68A-JKM3NG-1R2DFS-1/c.aspx

http://technology-trust-news.org/1TXQ-3N68A-JKM3NG-1R2DFS-1/c.aspx

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Workshop 1

Overview to using QI

Workshop 3

PDSAs and testing

Workshop 4

QI Tools

All 4 workshops are between 2-3 hours in a classroom format and rotate in location throughout the

geography of the Trust.

Workshop 2Using

measurement for improvement

Pocket QI- 2 month learning path

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QI Coaches

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Intro to QI - for service users & carers

5 Executives have undertaken the ISIA course.

Estimated number needed to train = 45


266 people trained in Pocket QI

692 people have undertaken the ISIA so

far

54 QI coaches graduated

Currently have 7improvement advisors

All staff

Staff involved in or leading QI projects

QI coaches

Board

Internal experts (QI

team)

Experts by experience

So how are we doing so far?


Annual Board session with IHI & regular Board

development discussions on QI


Estimated number needed to train =

5000

Estimated number needed to train =

1000

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1. What improvement capability exists in your organisation?

2. How could you shuffle existing resources to create some capacity to start improvement work?

3. How would you build a business case and convince your leadership team about the need to invest in building capability and capacity for improvement?

Building Capability

Table Discussion



quality mental


care in England by

2020

Alignment

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QI ResourcesService User Input

Support around every team

Project Sponsor QI Coach

QI Forums

QI Team

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All QI information in one place

Changing the way we look at data

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Changing the way we look at data

Data at Trust, directorate or team level

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SPC Charts – showing

• Special cause variation• Notes• Linked PDSA’s

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1. What would you have to change to produce alignment in your organisation?

2. How do you look at data, and talk about improvement and safety at every level?

3. What can you change, stop or review to create space for improvement? What are the structures in place to support improvement?

Alignment

Table Discussion



quality mental


care in England by

2020

QI Projects

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Make it feel meaningful

Make it feel possible

Make it feel valued and permanent

Provide skills and support

Our QI Projects

0

50

100

150

200

250

Nu

mb

er o

f ac

tive

pro

ject

s

Month

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225Active

Projects

REDUCE HARM BY 30% EVERY YEAR

14

PHYSICAL HEALTH

ACCESS TO SERVICES

PRESSURE ULCERS

VIOLENCE REDUCTION

2 18 83

29

RIGHT CARE, RIGHT PLACE, RIGHT TIME

158

Our QI Projects

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Our QI Projects

47 showing improvement and potential for scale

up and spread

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Our QI Projects

Is it making a

difference?

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VIOLENCE REDUCTION

150

200

250

300

350

400

450

500

550

2013 2014 2015

No

. o

f In

cid

ents

Physical violence to patients (per 100,000 occupied bed days)

300

400

500

600

700

800

900

2013 2014 2015

No

. o

f In

cid

ents

Physical violence to staff (per 100,000 occupied bed days)

21% reduction

0

10

20

30

40

50

60

05-A

pr-

13

07-A

pr-

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14-M

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Tim

e b

etw

een

ev

en

ts /

day

s

3 days

8 days

Time between incidents of physical violence on an inpatient adult mental health ward (Globe ward) – T chart

Time between incidents of physical violence on three older adult mental health wards – T chart

Testing in different conditions - Violence reduction across the three older adult mental health wards with highest levels of violence

Initial prototype unit - violence reduction across the acute adult mental health ward with highest levels of violence

50%

63%

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Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)Orchestrated Testing

Brick Lane Ward

Mill harbour

Rosebank

Lea Ward

Globe Ward

Roman Ward

Ruth Seifert Ward

Brett Ward

Joshua Ward

Gardner Ward

Bevan PICU

Mother and Baby

Unit

ConollyWard

Topaz Ward

Opal Ward

Emerald Ward

Sapphire Ward

Jade Ward

Ruby Triage

Crystal PICU

City and Hackney

Newham

Provisional agreement by Borough QI Sponsors and

DMT to scale-up from February 2016

Tower Hamlets

Globe Ward

Shoreditch(For)

Clerkenwell

(For)

Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)Orchestrated Testing

Brick Lane Ward

Mill harbour

Rosebank

Lea Ward

Globe Ward

Roman Ward

Ruth Seifert Ward

Brett Ward

Joshua Ward

Gardner Ward

Bevan PICU

Mother and Baby

Unit

ConollyWard

Topaz Ward

Opal Ward

Emerald Ward

Sapphire Ward

Jade Ward

Ruby Triage

Crystal PICU

City and Hackney

Newham

Provisional agreement by Borough QI Sponsors and

DMT to scale-up from February 2016

Tower Hamlets

Globe Ward

Shoreditch(For)

Clerkenwell

(For)

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Tower Hamlets Violence Reduction Collaborative

11.99

7.17

UCL

LCL

0

5

10

15

20

25

30

06

-Jan

-14

20

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03

-Feb

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17

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03

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-Mar

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No

. of

Inci

de

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pe

r 1

00

0 O

BD

No. of Incidents resulting in physical violenceper 1000 occupied bed days (OBD) - U Chart

DIR

ECTO

RA

TE L

EVEL

(TO

WER

HA

MLE

TS)

Tower Hamlets Violence CollaborativeMonthly Report – July 2016

Trust-wide data

Tower Hamlets data

Combined wards data

Individual ward data

Key- Baseline data

- Days between todays date and the last date of incident

BASELINE DATA(BEFORE)

Learning Set 1

Test

ing

beg

ins

PDSA DATA(AFTER)

05/10 Learning Set

6: Time of Day & General

Adult wards go smoke free

10/11 Learning Set 7: Prediction + Safety Huddle Observation

Pre

-wo

rk /

en

gage

me

nt

12/01 Learning Set 8: Prediction PDSAs + Scale-up

prep

Learning Set 4

Learning Set 3

Learning Set 2

13/08 Learning Set 5: Safety

Huddle outcomes + Safewards

24/02 Learning Set 9: Effective Safety Huddle

PDSAs

24/03 Shift

pattern changes

26/04 Learning Set 10: Reflecting on why and PDSAs

17/04 Gender specific wards

40%

24/06 Learning

Set 11

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5.782.47

UCL

0

2

4

6

8

10

12

14

16

No

. of

Inci

de

nts

pe

r 1

00

0 O

BD

Incidents resulting in physical violence (Acute wards only)per 1000 occupied bed days (OBD) - U Chart

DIR

ECTO

RA

TE L

EVEL

(TO

WER

HA

MLE

TS)

BASELINE DATA(BEFORE)

PDSA DATA(AFTER)

57%

Learning Set 1

Test

ing

beg

ins

05/10 Learning Set

6: Time of Day & General

Adult wards go smoke free

10/11 Learning Set 7: Prediction + Safety Huddle Observation

Pre

-wo

rk /

en

gage

me

nt

12/01 Learning Set 8: Prediction PDSAs + Scale-up

prep

Learning Set 4

Learning Set 3

Learning Set 2

13/08 Learning Set 5: Safety

Huddle outcomes + Safewards

24/02 Learning Set 9: Effective Safety Huddle

PDSAs

24/03 Shift

pattern changes

26/04 Learning Set 10: Reflecting on why and PDSAs

17/04 Gender specific wards

34.98

17.05

UCL

0

10

20

30

40

50

60

70

80

90

06

-Jan

-14

20

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-14

03

-Feb

-14

17

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-De

c-1

5

21

-De

c-1

5

04

-Jan

-16

18

-Jan

-16

01

-Feb

-16

15

-Feb

-16

29

-Feb

-16

14

-Mar

-16

28

-Mar

-16

11

-Ap

r-1

6

25

-Ap

r-1

6

09

-May

-16

23

-May

-16

06

-Ju

n-1

6

20

-Ju

n-1

6

No

. of

Inci

de

nts

pe

r 1

00

0 O

BD

Incidents resulting in physical violence (PICU wards only)per 1000 occupied bed days (OBD) - U Chart

51%

24/06 Learning

Set 11

City and Hackney Violence Reduction Collaborative

11/29/2016

49

16.9

7.9

UCL

LCL

0

5

10

15

20

25

30

35

40

13-A

pr-

16

16-A

pr-

16

19-A

pr-

16

22-A

pr-

16

25-A

pr-

16

28-A

pr-

16

01-M

ay-1

604-M

ay-1

607-M

ay-1

610-M

ay-1

613-M

ay-1

616-M

ay-1

619-M

ay-1

622-M

ay-1

625-M

ay-1

628-M

ay-1

631-M

ay-1

603-J

un-1

606-J

un-1

609-J

un-1

612-J

un-1

615-J

un-1

618-J

un-1

621-J

un-1

624-J

un-1

627-J

un-1

630-J

un-1

603-J

ul-1

606-J

ul-1

609-J

ul-1

612-J

ul-1

615-J

ul-1

618-J

ul-1

621-J

ul-1

624-J

ul-1

627-J

ul-1

630-J

ul-1

602-A

ug-1

605-A

ug-1

608-A

ug-1

611-A

ug-1

614-A

ug-1

617-A

ug-1

620-A

ug-1

623-A

ug-1

626-A

ug-1

629-A

ug-1

601-S

ep-1

604-S

ep-1

607-S

ep-1

610-S

ep-1

613-S

ep-1

616-S

ep-1

619-S

ep-1

622-S

ep-1

625-S

ep-1

628-S

ep-1

601-O

ct-

16

04-O

ct-

16

07-O

ct-

16

10-O

ct-

16

Control Chart: Number of recorded red incidents (physical violence) every 3 days on Safety Cross - Conolly, Gardner, Joshua, Ruth Seifert

& Brett

Incidents

Wh

ole

Co

lla

bo

rati

ve

Me

asu

res

fro

m S

afe

ty C

ross

01/04: Testing started on all wards except

Conolly

01/04: CHVRC* 2

13/04: Testing started Conolly

24/06: CHVRC* 4

*CHRVC = Meetings of the “City and Hackney Violence Reduction Collaborative”

13/05: CHVRC* 3

01/08: CHVRC* 5

30/09: CHVRC* 6

53%

^ 05/09

X transferred

Newham Violence Reduction Collaborative

11/29/2016

50

PRESSURE ULCERS

2 new teams join

collaborative

AV

ERA

GE

WA

ITIN

G T

IME

October 2016 1- Baseline data

Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets)

Psychological Therapy Service (City and Hackney, Newham & Tower Hamlets)

Average Waiting Time from Referral to 1st face to face appointment – I Chart

MHCOP Memory Service (City and Hackney, Newham & Tower Hamlets)

103.8788.80

51.52

45.56

57.46

36.45

53.77

31.44

16/02Learning

Set 1

10/05Learning

Set 9Test

ing

beg

ins

28/03Learning

Set 2

27/07Learning

Set 3

03/09Learning

Set 4

01/10Learning

Set 5

25/11Learning

Set 6

05/01Learning

Set 7

16/02Learning

Set 8

3 teams leave collaborative

39.85

60.66

53.17

44.51

51.23

UCL

LCL

35

40

45

50

55

60

65

70

Jan-1

4

Feb-1

4

Ma

r-14

Ap

r-14

Ma

y-1

4

Jun-1

4

Jul-14

Au

g-1

4

Se

p-1

4

Oct-

14

Nov-1

4

Dec-1

4

Jan-1

5

Feb-1

5

Ma

r-15

Ap

r-15

Ma

y-1

5

Jun-1

5

Jul-15

Au

g-1

5

Se

p-1

5

Oct-

15

Nov-1

5

Dec-1

5

Jan-1

6

Feb-1

6

Ma

r-16

Ap

r-16

Ma

y-1

6

Jun-1

6

Jul-16

Au

g-1

6

Se

p-1

6

Ave

rage W

aitin

g T

ime / D

ays

Average waiting time from referral to 1st face to face appt (Collaborative, 10/12 teams) - X-bar Chart

16%

11/29/2016

51

DID

NO

T A

TTE

ND

(D

NA

)




% of first appointment non-attendance – I Chart


28.32%

40.08%29.61%29.96%

22.05%

23.86%

32.21%

25.23%26.30%

UCL

LCL

20%

22%

24%

26%

28%

30%

32%

34%

36%

38%

40%

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

DN

A /

%

% of 1st face to face appts DNAs (Collaborative, 10/12 teams) - P Chart

2 new teams join

collaborative

16/02Learning

Set 1

10/05Learning

Set 9Test

ing

be

gin

s

28/03Learning

Set 2

27/07Learning

Set 3

03/09Learning

Set 4

01/10Learning

Set 5

25/11Learning

Set 6

05/01Learning

Set 7

16/02Learning

Set 8


19%

REF

ERR

ALS




No. of Referrals Received – I Chart


211.86

414.21

556.50126.43

145.82

646.60

716.00

UCL

1,021.711,213.13

1,331.17

LCL700

900

1100

1300

1500

1700

Jan

-14

Feb

-14

Mar

-14

Ap

r-1

4

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

Dec

-14

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

No

. of

Re

ferr

als

No. of referrals received (Collaborative, 10/12 teams) - I Chart

2 new teams join

collaborative

16/02Learning

Set 1

10/05Learning

Set 9Test

ing

beg

ins

28/03Learning

Set 2

27/07Learning

Set 3

03/09Learning

Set 4

01/10Learning

Set 5

25/11Learning

Set 6

05/01Learning

Set 7

16/02Learning

Set 8


30%

11/29/2016

52

103

41% reduction

80% reduction

104

41% reduction

19% reduction

80% reduction

11/29/2016

53

Medication safety across all 6 older adult mental health wards

95%

UCL

LCL0

5

10

15

20

25

30

35

40

45

50

07.0

8.1

4

13.0

8.1

4

18.0

8.1

4

28.0

8.1

4

16.0

9.1

4

17.0

9.1

4

30.0

9.1

4

06.1

0.1

4

13.1

0.1

4

20.1

0.1

4

27.1

0.1

4

13.1

1.1

4

17.1

1.1

4

18.1

1.1

4

03.1

2.1

4

04.1

2.1

4

04.1

2.1

4

15.1

2.1

4

17.1

2.1

4

05.0

1.1

5

12.0

1.1

5

26.0

1.1

5

24.0

2.1

5

27.0

2.1

5

16.0

3.1

5

24.0

3.1

5

21.0

4.1

5

23.0

4.1

5

24.0

4.1

5

11.0

5.1

5

28.0

5.1

5

05.0

6.1

5

10.0

6.1

5

17.0

6.1

5

29.0

6.1

5

06.0

7.1

5

20.0

7.1

5

28.0

7.1

5

01.0

8.1

5

21.0

8.1

5

25.0

8.1

5

Num

ber

of days

Number of days taken from request for Serum level to receipt of results

Transitional Phase starts

New clinic established

Improving clozapine results handling in City & HackneyImproving clozapine results handling in City & Hackney

54%

11/29/2016

54

UCL

LCL0

50

100

150

200

250

05 J

an 1

5

20 J

an 1

5

13 F

eb 1

5

03 M

ar

15

17 M

ar

15

30 M

ar

15

21 A

pr

15

11 M

ay 1

5

19 M

ay 1

5

04 J

un 1

5

16 J

un 1

5

25 J

un 1

5

15 J

ul 15

04 A

ug 1

5

18 A

ug 1

5

25 A

ug 1

5

10 S

ep 1

5

18 S

ep 1

5

02 O

ct 15

09 O

ct 15

23 O

ct 15

08 N

ov 1

5

DA

YS

Date of referral

Length of time from referral to delivery of products (Whole Pathway)

Shift

46.534.1 18.4

Reducing waiting times for products from NHS supplies for patients in the community

61%

33%

Reducing time taken to complete disciplinary investigations

11/29/2016

55

@ELFT_QIqi.elft.nhs.uk [email protected]

Service User and Carer

Quality Improvement

with Paul Binfield(Head of People Participation)

Leigh Bell(People participation lead)

11/29/2016

56

What do you need to think

about when involving

service users & carers in

your QI project?

Paul Binfield Head of People Participation

Hannah Mellor Health -Development Co-

ordinator

Zaffran Jami City & Hackney

Marica Wainner Executive Assistant

David Kreikmeier-Watson - Patient & Carer

Experience Manager

John Kauzeni CHN

John Southam Luton

William Fitzpatrick

Central Bedford

Kamila Naseova Bedford

Elena Trivelli -Volunteer Co-

ordinator

Helena Maine MHCOP

Alan StrachanCAMHS

Sophie Akehurst Forensics

Suzanne Goulding -

Tower Hamlets

Leigh BellNewham

Ann Lacey –Volunteer Co-

ordinator

PEOPLE PARTICIPATION LEADS

ELFT People Participation Team

11/29/2016

57

Getting team structure right from the start…

Successful QI team

Team Diversity

Team leadership

Stakeholderinvolvement

(patients, carers, staff)l

Subject matter expert

Little i

Regularly consulted during

lifetime of the project

Big I

Act as a full member of the QI project team

Surveys

Focus groups

Community meetings

Service user

forum

Different Types of Involvement

11/29/2016

58

To a

chie

ve %

se

rvic

e

use

r/ca

rer

invo

lve

me

nt

in Q

I ac

ross

ELF

T

Communication (in and out)

Advertising

Access to information

Support structure

Big I

Service user/carer specific role in project team

Training

Structure/process outlining how service users/carers get involved

Payment

Service user/carer led or co-led projects

Little I

Service user/carer feedback

Partnership working between Quality team and QI Team

Overview of service user/carer

involvement

Monitoring & reporting

Regular Reviews

• Booklet outlining all information about involvement in QI

• Clear structure outlining different levels of support and outlining responsibilities

• Service user/carer involvement in QI forum

• Service user/carer lead in QI central team and each project team

• Role descriptions and contracts • Incorporate QI into recovery syllabus • Buddying up • Regular support sessions for service

users/carers similar to coaches. • Training – not focused on

methodology – more focus communication skills and role plays.

• Service user/carer bespoke group –similar to support QI coaches receive.

• Induction to team and/or trust induction.

• A trust wide survey service users/carers can complete about quality of service and/or QI project on that ward/in that team – similar to friends and family test.

Change Ideas – from strategy meeting 29/10/15

• Regular steering group/oversight meeting.

• Monitoring informatics system that reviews service user/carer involvement at all different stages of the QI project.

• Dashboards

11/29/2016

59

Role description

Reward and recognition

http://qi.elft.nhs.uk/engaging-service-users-and-carers/

Board leadership for

improvement

with Dr Navina Evans(Chief Executive)

Marie Gabriel(Chair of the Board)


11/29/2016

60

@ELFT_QIqi.elft.nhs.uk [email protected]

m24: engaging staff and building a movement for qi -...

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