qi.elft.nhs.uk qi@elft.nhs.uk

@ELFT_QI

Welcome to the ELFT QI

open morning

Our focus on Quality Improvement

with Dr Kevin Cleary (Medical Director)

Professor Jonathan Warren (Director of Nursing)

Mental health services Newham, Tower Hamlets, City & Hackney, Luton & Bedford

Forensic services All above & Waltham Forest, Redbridge, Barking & Dagenham, Havering

Child & Adolescent services, including tier 4 inpatient service Regional Mother & Baby unit

Community health services Newham

Urgent care centre

Newham

IAPT Newham, Richmond and Luton

Speech & Language

Barnet

Challenges and

opportunities in East London

Cultural diversity

Social deprivation

Geographical diversity

Commissioning arrangements

Financial stability and

strong assurance systems

@ELFT_QI

The strategic case for change

Make quality our absolute priority

Improving quality of care is our core purpose

Of greatest importance to all our stakeholders

Build on the excellent work already happening to improve quality

National drivers

The need to focus on a more compassionate, caring service with patients first and foremost

More structured and bottom-up approach to improvement

Enable our staff to lead change

The desire to engage, free and support our staff to innovate and drive change

Engaged and motivated staff leads to improved patient outcomes

The economic climate

The need to do more with less improving quality whilst reducing cost

@ELFT_QI

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

Research & innovation

Quality improvement

Assurance, control &

performance managament

A perspective from a non-executive

member of our Board

with Jennifer Kay

Our quality

improvement programme

with Dr Amar Shah (Associate Medical Director for QI)

James Innes (Head of Quality Improvement)

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 & roadshows 2. Microsite 3. Using the power of narrative 4. Celebrate successes 5. Network of champions / ambassadors 6. Learning events

1. Initial assessment of alignment & capability 2. Recruiting central QI team 3. Online training 4. Face-to-face training 5. Follow-up coaching on projects 6. Develop in-house training for 2016 onwards

1. Align all projects with improvement aims 2. Align team / service goals with improvement aims 3. Align all corporate and support systems 4. Patient and carer involvement in all improvement

work 5. Embed improvement within management structures

Reducing Harm by 30% every year 1. Reduce harm from inpatient violence 2. Reduce harm from falls 3. Reduce harm from pressure ulcers 4. Reduce harm from medication errors 5. Reduce harm from restraints

Right care, right place, right time 1. Improving patient and carer experience 2. Reliable delivery of evidence-based care 3. Reducing delays and inefficiencies in the system 4. Improving access to care at the right location

@ELFT_QI

Trust board bespoke learning sessions

Visiting other organisations that successfully implemented QI

Sentinel event

Focus groups

Building the will for change

Early small scale tests of QI methodology

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

QI microsite the online hub for the programme has 50,000 page views to date qi.elft.nhs.uk

Staff and service user newsletter reaches 5000 people every month

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

QI microsite the online hub for the programme has 60,000 page views to date qi.elft.nhs.uk

Staff and service user newsletter reaches 5000 people every month

QI launch event and roadshows attended by over 1000 staff, service users and carers

Bespoke QI learning events for staff, service users, commissioners, governors

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Build the will

QI microsite the online hub for the programme has 50,000 page views to date qi.elft.nhs.uk

Staff and service user newsletter reaches 5000 people every month

QI launch event and roadshows attended by over 1000 staff, service users and carers

Bespoke QI learning events for staff, service users, commissioners, governors

Annual QI conference attended by over 270 staff, patients and external partners

ELFT experience day attended by over 70 international delegates

QI visibility wall to describe programme & update on progress

AIM: To provide the highest

quality mental

health and community

care in England by

2020 Build improvement

capability

Experts

Front line staff

Clinical leaders

Directorate improvement

leads

Executives

Estimated number = 3300 Requirement = introduction to quality improvement, identifying problems, change ideas, testing and measuring

change Time-frame = train 10-20% in 2 years

Estimated number = 250 Requirement = deeper understanding

of improvement methodology, measurement and using data, leading

teams in QI Time-frame = train 30-50% in 2 years

Estimated number = 25 Requirement = deeper understanding

of improvement methodology, understanding variation, coaching

teams and individuals Time-frame = train 100% in 2 years

Estimated number = 10 Requirement = setting direction and

big goals, executive leadership, oversight of improvement, being a

champion, understanding variation to lead

Time-frame = train 100% in 2 years

Estimated number = 5 Requirement = deep statistical process control, deep improvement methods, effective plans for implementation &

spread Time-frame = train 100% in 2 years

Where are we?

On track to train over 500 people through 5 six-month waves of learning between

2014-16. First 3 waves delivered with the IHI

On track. All clinical and service leads to have

completed the ISIA training within 2 years

Leading & Facilitating change programme will train 30 QI

coaches in 2015

On track. Most Executives will have undertaken the

ISIA, and all will have received Board training with

the non-Executives

Currently have 3 improvement advisors, with

1.5wte deployed to QI. To develop 5 more in 2015.

AIM: To provide the highest

quality mental

health and community

care in England by

2020 Build improvement

capability

Support for improvement work from the Trusts QI

team

Partnership with IHI on delivery of QI training to

staff and Trust Board, and strategic guidance from IHI

executive team

AIM: To provide the highest

quality mental

health and community

care in England by

2020 Build improvement

capability

Face to face improvement training - hundreds of staff, services users, Governors to be trained over the next few years

IHI Open School online training resource available to all. Providing essential skills to support people leading quality improvement.

Support for improvement work from the Trusts QI

team

Partnership with IHI on delivery of QI training to

staff and Trust Board, and strategic guidance from IHI

executive team

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 #2

Webex #1

Faculty consults Webex calls Coaching calls

Webex #3

Learning Set 2 &

graduation

AP-5 AP-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

AIM: To provide the highest

quality mental

health and community

care in England by

2020 Build improvement

capability

Face to face improvement training - hundreds of staff, services users, Governors to be trained over the next few years

QI coaches- 30 staff to become coaches, spending 1 day/week

supporting local QI projects

IHI Open School online training resource available to all. Providing essential skills to support people leading quality improvement.

Support for improvement work from the Trusts QI

team

Working upstream with external partners to build capability around continuous improvement

Partnership with IHI on delivery of QI training to

staff and Trust Board, and strategic guidance from IHI

executive team

Time for a video

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Alignment

Starting an

Improvement Project

At ELFT

qi.elft.nhs.uk

28

To assist in this process we

have a Project Charter form that defines

what we want to accomplish.

Driver Diagrams

Support and resources available on microsite: http://qi.elft.nhs.uk/driver-diagrams/

http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/http://qi.eastlondon.nhs.uk/driver-diagrams/

Complete Your Charter and Driver Diagram!

Email to QI team

qi@elft.nhs.uk

QI team or QI coach will get in contact in a few days

mailto:qi@eastlondon.nhs.uk

QI Resources

Project Sponsor

QI Forums

QI Coach

Coaching teams from the very start

Success

Form a team

Agree the quality issue to be tackled

Ensure patient (and

carer) involvement

Find time to meet

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 #2

Webex #1

Faculty consults Webex calls Coaching calls

Webex #3

Learning Set 2 &

graduation

AP-5 AP-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.

Learning set 1

Learning and coaching over 6 months

AIM: To provide the highest

quality mental

health and community

care in England by

2020

A process is in place for teams to submit project ideas to the QI team, who will help with planning, structure and measurement, and ensure projects are aligned with our high-level aims.

Quality improvement programme-project support structures

Alignment

AIM: To provide the highest

quality mental

health and community

care in England by

2020

Alignment

AIM: To provide the highest

quality mental

health and community

care in England by

2020

QI projects

Our QI Projects

Trust project status over time

14 12 11 11 15 11

60

16 17 17 1815

15

15

31 2925 23 25

22

21

1919

20 2024

26

25

99 13 13

1716

15

97 10 10

1217

17

26

7 7

9 9

10

3 32 2

4 3

3

1 1 2 2

5 7

7

16-Mar-15 30-Mar-15 13-Apr-15 27-Apr-15 19-May-15 28-May-15 15-Jun-15

May

June

July

1

7

0 0 1

5 63

11

4

33

2 1

0

9

4

33

2

4

2

6

3

3

2

3

62

4

3

2

6

2

1

1

2 3

1

2

2

1

7

7

1

1

3

2

1

3

0

12

5

2

1

Addictions Children'sServices

CommunityHealth Newham

MHCOP City and HackneyMental Health

Corporate Forensics Newham MentalHealth

PsychologicalServices &LearningDisability

Tower HamletsMental Health

5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5

Right Care, Right Place, Right Time

MHCOP Larch Lodge, Cedar Lodge, Sally Sherman Ward

CHN EPCS Teams (North East, North

West, Central, South) Multiple I/P Wards (Cazebon, Sally

Sherman and Fothergaile)

City & Hackney Adult Psychiatry CMHT, All CMHTs, Assertive Outreach, Rehab, Joshua, Conolly

Newham CMHTs, Newham Centre for Mental Health

CHN / MHCOP Urgent Care Centre

Childrens Newham CFCS, CDC West Ham

Lane, Community CAMHS TH, OT, Health Visiting

CHN / MHCOP Newham Memory Service

C&H South CMHT, AOS & CRRT, North

Team 1 Recovery/Primary Care

Forensics Clerkenwell, West Ferry Ward

REDUCE HARM BY 30% EVERY

YEAR

RIGHT CARE, RIGHT PLACE, RIGHT TIME

VIOLENCE REDUCTION

PHYSICAL HEALTH

ACCESS TO SERVICES

PRESSURE ULCERS

TH Collaborative Roman, Globe, Bricklane, Lea, Millharbour, Rosebank

Childrens All Community CAMHS, Adolescent MHT

Forensics Woodberry, Victoria, Limehouse, Morrison

Psychological / LD Community Learning Disability Service

Smoking Forensics, Millharbour

Psychological Older People Richmond /

Newham, City and Hackney, Newham

CAMHS Coborn Unit

Tower Hamlets

Time to meet some of our

projects

Rooms:

4 (lower ground floor) 5 (lower ground floor) Training room (ground floor) 9 (4th floor)

Is it making a difference?

Datix incident reporting 40% reduction across the Trust

170.9

103.1

UCL

LCL

70

90

110

130

150

170

190

210

230

Jan

-13

Fe

b-1

3

Ma

r-1

3

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-

13

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Dec-1

3

Jan

-14

Fe

b-1

4

Ma

r-1

4

Ap

r-14

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Se

p-1

4

Oct-

14

Nov-1

4

Dec-1

4

Jan

-15

Fe

b-1

5

Ma

r-1

5

Ap

r-15

Ma

y-1

5

No

. o

f In

cid

en

ts

Number of Incidents resulting in Physical Violence (Trust-wide) - C Chart

171 per month

103 per month

0

5

10

15

20

25

30

35

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

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

No

. o

f In

cid

en

ts p

er

10

00 O

BD

Incidents of physical violence per 1000 occupied bed days (OBD)

Participating wards

Non-Participating wards

UCL

LCL

10

20

30

40

50

60

70

80

90

Jan

-13

Fe

b-1

3

Ma

r-1

3

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-

13

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Dec-1

3

Jan

-14

Fe

b-1

4

Ma

r-1

4

Ap

r-14

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Se

p-1

4

Oct-

14

Nov-1

4

Dec-1

4

Jan

-15

Fe

b-1

5

Ma

r-1

5

Ap

r-15

Ma

y-1

5

No

. o

f In

cid

en

ts

Incidents resulting in restraint in prone position at ELFT - C Chart

59 per month

33 per month

44% reduction

UCL

LCL

70

80

90

100

110

120

130

140

150

160

170

Jan

-13

Fe

b-1

3

Ma

r-1

3

Ap

r-13

Ma

y-1

3

Jun

-13

Jul-

13

Au

g-1

3

Se

p-1

3

Oct-

13

Nov-1

3

Dec-1

3

Jan

-14

Fe

b-1

4

Ma

r-1

4

Ap

r-14

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Se

p-1

4

Oct-

14

Nov-1

4

Dec-1

4

Jan

-15

Fe

b-1

5

Ma

r-1

5

Ap

r-15

Ma

y-1

5

No

. o

f In

cid

en

ts

Incidents resulting in Restraint at ELFT - C Chart 134 per month

114 per month

15% reduction

UCL

LCL 0

1

2

3

4

5

6

7

8

9

10

Ap

r-14

Ap

r-14

Ma

y-1

4

Ma

y-1

4

Jun

-14

Jun

-14

Jun

-14

Jul-

14

Jul-

14

Au

g-1

4

Au

g-1

4

Se

p-1

4

Se

p-1

4

Oct-

14

Oct-

14

Nov-1

4

Nov-1

4

Dec-1

4

Dec-1

4

Dec-1

4

Jan

-15

Jan

-15

Fe

b-1

5

Fe

b-1

5

Ma

r-1

5

Ma

r-1

5

Ap

r-15

Ap

r-15

Ma

y-1

5

Ma

y-1

5

Jun

-15

Jun

-15

Jun

-15

Grade 3-4 Pressure Ulcers - C Chart

6.4 per month

3.2 per month

50% reduction

Series3

Series4

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%2

8-A

pr-

14

05-M

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41

2-M

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9-M

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6-M

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2-J

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9-J

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6-J

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3-J

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43

0-J

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7-J

ul-1

41

4-J

ul-1

42

1-J

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42

8-J

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4-A

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-14

11-A

ug

-14

18-A

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-14

25-A

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-14

01-S

ep

-14

08-S

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15-S

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22-S

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29-S

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06-O

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13-O

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20-O

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27-O

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03-N

ov-1

41

0-N

ov-1

41

7-N

ov-1

42

4-N

ov-1

40

1-D

ec-1

40

8-D

ec-1

41

5-D

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2-D

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5-J

an-1

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2-J

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2-F

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-15

09-F

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02-M

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16-M

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23-M

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3-J

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Overall Waterlow Completion Rate in EPCT - P Chart

57%

97%

40% increase in reliability

Leading cultural

transformation through QI

Bu

ildin

g w

ill

Build a broad coalition for

change

Take time to bring people

with you

Shift decision-making to the

edge

Develop a compelling narrative

Find some clear signals

of change

Use the power of stories

Take every opportunity to

celebrate

Bu

ildin

g ca

pab

ility

&

cap

acit

y

Be prepared to invest

Train all levels and across disciplines

Realign existing

resources

Stop lower value work

Alig

nm

ent

& in

tegr

atio

n

Start at the top Create a support

structure

Build a learning system

Ensure patients and carers are

integral

Ensure the context is ripe

Line of sight from team to system goals

qi.elft.nhs.uk qi@elft.nhs.uk @ELFT_QI