Everyone – staff, service users, carers and partners – has a role in helping to ensure our services are the best they can be to meet the needs of our communities.
Quality improvement (QI) is about looking at what we’re doing, seeing if we could do it better and bringing everyone together to test new ways of working. It’s about making change happen, supporting and empowering those closest to the issues to think differently and make real improvement.
Co-production is central to developing a culture of continuous improvement to support creativity and innovation.
Read our quality improvement strategy here.
Quality improvement (QI) aims to embed improvement at the centre of how we deliver care and services.
It’s based on the concept of testing new ideas or ways of working, starting with small tests and building as you gain confidence and can see and evidence the impact of the changes you’re making. These are known as PDSA (Plan, do, study, act) cycles.
This approach allows those closest to the issues to drive improvement, empowering them to make a difference in how we work, develop ideas and projects across the Trust. We aim to co-produce improvements with staff, patients, service users, carers and partners, with every project having a service user or carer on the core team.
QI can focus across a range of areas, including:
- Improving the experience and outcomes of patients and service users
- Improving how we work
- Improving the work environment to support staff in delivering services
- Recognising the importance of staff experience and wellbeing.
Our aim is for QI training to be available to all Trust staff and for peer workers to become part of the core QI team.
In developing this approach, we’re committed to:
- Building a culture that empowers everyone to make changes and improvements in the way they work
- Recognising the value and opportunity of those closest to the issue problem or area of practice
- Exploring and testing new ways of working
- Embracing opportunities to think differently.
The quality improvement team consists of:
- Head of quality improvement
- Improvement facilitator and practice development clinician
- Programme support officer.
In addition to the core team, we have a growing number of Trust staff with advanced knowledge and expertise in quality improvement. They’ve completed their training at the Institute for Healthcare Improvement or ACT Academy (QSIR associates) and they actively support the development of a quality improvement culture across the organisation through our quality improvement steering group.
Improvement advisers
A number of staff have completed formal Institute for Healthcare Improvement training to become improvement advisers.
QSIR associates
Our quality, service improvement and redesign (QSIR) associates have completed ACT academy training so that they can teach and deliver QSIR training to others.
Improvement coaches
Our improvement coaches have completed advanced training so that they can coach teams undertaking improvement projects and support improvement projects across the Trust. They also champion quality improvement in their own teams and services. We’re growing the number of improvement coaches across the Trust, with new cohorts supported to access training every year.
A quality improvement (QI) project is usually focused on a problem for which there isn’t an immediate or obvious simple solution. An initial focus on understanding the problem is followed by testing different ideas for change.
Projects can be any size and focused across all areas in the Trust. They don’t have to be based in one team or service and can support improvement across pathways, services and organisations.
Examples of QI projects at the Trust include:
Reducing missed appointments
Missed appointments were the focus of the Hounslow primary care mental health services team's QI project. Their caseload had doubled in the past year and patients were moving too slowly through the service. While many factors contributed to this backlog, missed appointments were thought be to the simplest to tackle.
The team took a quality, service improvement and redesign (QISR) course, which helped them identify potential service improvements and how data could be used to achieve them.
One approach they trialed was to offer telephone appointments to people who'd missed a face to face appointment.
The QI project revealed patients missed appointments for many reasons and that addressing this wasn't as simple they'd predicted. However, despite the unexpected challenges, the project led to a 10 percent drop in missed appointments overall. The team also gained valuable experience with the methodology and process mapping.
‘There was a change in the culture of the team. We learnt the importance of data. You need to think about what you want to achieve and how you are going to measure it.'
Emma Brown, Lead Nurse Practitioner
Safety huddles in mental health wards
Safety huddles are regular meetings of multi-disciplinary teams, used to create safer environments for patients and staff, and improve teamwork and communication. Teams discuss patients at risk and agree methods to reduce their risk of harm to themselves and others. Approaches include: co-operative problem solving, shared understanding of focuses and priorities, and increasing awareness of any safety concerns.
The Trust began using safety huddles across its diverse inpatient wards in 2016. Though teams believed that ‘huddles’ led to a reduction in harm to patients and staff, the safety improvement could not be measured. Some wards performed better than others and it was hard to share good practice across the Trust.
With funding from Imperial College Healthcare Partners Patient Safety and Service Quality Centre, the Trust’s safety huddles in mental health wards QI project took a different approach, increasing the use and knowledge of data to measure improvement.
For example, the new QI approach to safety huddles helped reduce violence and aggression on the male medium secure Windrush ward, in the Three Bridges unit in Ealing. As a result, the team could embed the least restrictive practices in management of risk and spend more time in therapeutic engagement with patients.
The QI project as a whole has seen improvements in teamwork and the safety culture of the wards, reductions in locally identified harms and better use of data.
Highlighlighting the achievements of Windrush ward, the project was shortlisted for two 2020 Health Service Journal (HSJ) patient safety awards. Other wards included in the nomination were:
- Parkland ward, also in Three Bridges
- Kestrel ward for people with acute mental health problems at Lakeside Mental Health Unit
- Meridian ward for people with acute mental health problems at Hammersmith and Fulham Mental Health Unit
- Euston and Newmarket high secure wards in Broadmoor Hospital
'Through collaboration, thoughtfulness and a collaborative team approach this project has yielded significant quality benefits and has re-energised the team ... We are very proud of the work done ... to achieve this and will be rolling out the learning within other areas of the Trust.'
Leeanne McGee, Executive Director of High Secure and Forensic Services
Some helpful resources and websites in understanding quality improvement methodology.
- Quality improvement in practice from the British Medical Journal (PDF)
- Health foundation quick guide, QI made simple
- QI in healthcare (YouTube)
- The science of improvement (YouTube)
- NHS England – Quality, service improvement and redesign programme
- The Health Foundation
- Q Community
- Institute of Healthcare Improvement
- British Medical Journal Quality and Safety
Find out about a successful QI project to reduce segregation at Broadmoor Hospital