qi.elft.nhs.uk

qi@elft.nhs.uk

@ELFT_QI

What does it mean to be

improvement-focused?

And why choose this path?

amar.shah@elft.nhs.uk

@DrAmarShah

First, let’s define what we mean by…

Quality improvement

improvingquality

quality improvement

=

QI: in a

nutshell!

(large)

So, what’s our theory?

Great care is discovered, not decided

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

The three characteristics of systems thinking include:

Senge, 2006

A consistent and strong commitment

to learning

A willingness to challenge your own

mental model

Always including multiple perspectives

when looking at a phenomenon

So, why do we need QI?

• Because we don’t know the answers to many of

our complex problems

• The best solutions will be discovered by those

closest to the problem (staff and service users)

• Allows testing, failing and learning

• Engaging people in change makes it more likely to

succeed

• Brings strategic alignment within an organisation

↑ staff engagement

↑ efficiency

↑ outcomes

So, what does this mean for us…

… as individuals

… as leaders

… as organisations

… as a system

Change in leadershipbehaviours

“Go see”“Gemba”Executive WalkRounds

Use of data to guide decision-making

Stop solving problems at the top

Give people time and space to solve complex problems

Manage the expectationsPaying

personal attention

Changing the way we use data to guide decision-making

Safety trust wide excluding Beds and Luton(London)

Clinical Effectivenesstrust wide excluding Beds and Luton

Patient Experiencetrust wide excluding Beds and Luton

Complaints June and July 2016.

Our Stafftrust wide excluding Beds and Luton

Reasons given by staff leaving June to July 2016

Experts by experience

All staff

Staff involved in or leading QI projects

Sponsors

Board

Estimated number needed to train = 4000Needs = introduction to QI & systems thinking,

identifying problems, how to get involved

Estimated number needed to train = 1000Needs = Model for improvement, PDSA,

measurement and using data, leading teams

Estimated number needed = 50Needs = deep understanding of method & tools,

understanding variation, coaching teams

Needs = setting direction and big goals, executive leadership, oversight of improvement,

understanding variation

Estimated number needed to train = 10Needs = deep statistical process control, deep

improvement methods, effective plans for implementation & spread

350 completed Pocket QI so far. All staff receive intro to QI at

induction

700 graduated from ISIA in 6 waves. Wave 7 in 2017-18.

Refresher training for ISIA grads.

54 QI coaches trained so far, with xx currently active. Third cohort of

20 to be trained in 2017

All Executives have completed ISIA. Annual Board session with IHI &

regular Board development

Currently have 6 improvement advisors, with 3 further QI leads in

training

Internal experts (QI

leads)

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

attended so far. Build into recovery college syllabus

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

confidence-building, presentation, contributing ideas

QI coaches

Needs = Model for improvement, PDSA, measurement & variation, scale-up and spread,

leadership for improvement

Xx current sponsors. All completed ISIA. Leadership, scale-up & refresher QI training in 2017

Psychology trainees – Pocket QI, embedded into QI project teams with 4 bespoke learning sessions

Nursing students – Intro to QI delivered within undergraduate and postgrad syllabus, embedded into QI project teams during student placements

Wo

rkin

gu

pst

ream

QI ResourcesService User Input

Support around every team

Project Sponsor QI Coach

QI Forums

QI Team

1. Create the right context for continuous quality improvement

2. Start building capability and capacity

3. Inspire and empower your workforce to lead improvement

4. Build an infrastructure to support improvement at scale

5. Align the organisation around improvement priorities – clear priorities, stop other stuff, redesign systems built for assurance

6. Constancy of purpose – relentless focus, shield the organisation from distractions

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 management

Make it feel meaningful

Make it feel possible

Make it feel valued and permanent

Provide skills and support

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. 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)

Violence reduction

150

200

250

300

350

400

450

500

550

2013 2014 2015

No

. of

Inci

den

ts

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

300

400

500

600

700

800

900

2013 2014 2015

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

Over three years, physical violence has reduced compared to other mental health

providers

Impact across all 35 East London wards =

25% reduction

60% reduction in violence across three older adult wards with highest

level of violence

40% reduction across all six wards in Tower Hamlets

50% reduction in Forensic learning disability service

UCL

67.79

51.13LCL

20

30

40

50

60

70

80

90

100

06

-Jan

-14

03

-Fe

b-1

4

03

-Mar

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No

. of

Inci

de

nts

Incidents resulting in physical violence (Trust-wide, excluding Luton and Beds) - C Chart

Improving access to services

32.21%

25.23%

26.30%

UCL

LCL

20%

25%

30%

35%

40%

Jan

-14

Feb

-14

Mar

-14

Ap

r-14

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

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No

v-14

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-14

Jan

-15

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-15

Ap

r-15

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-15

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-15

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v-15

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r-16

May

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g-1

6

Sep

-16

DN

A /

%

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

UCL

1,021.711,213.13

1,331.17

LCL700

900

1100

1300

1500

1700

Jan

-14

Feb

-14

Mar

-14

Ap

r-14

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

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-14

No

v-14

Dec

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Jan

-15

Feb

-15

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-15

Ap

r-15

May

-15

Jun

-15

Jul-

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g-1

5

Sep

-15

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No

v-15

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r-16

May

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g-1

6

Sep

-16

No

. of

Ref

erra

ls

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

30% increase in referrals across 10 community services

20% reduction in non-attendance at first appointment across 10 community services

50% reduction in waiting time from referral to first

appointment across City & Hackney community mental

health teams

60.77

40.05

UCL

LCL

20

30

40

50

60

70

80

90

Jan-1

4

Fe

b-1

4

Ma

r-14

Ap

r-1

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y-1

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No

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r-15

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Avera

ge W

ait

ing

Tim

e /

Day

s

Average waiting time from referral to 1st face to face appt (City and Hackney CMHTs) - X-bar Chart

@DrAmarShahqi.elft.nhs.uk Amar.shah@elft.nhs.uk