East London NHS Foundation Trusts 3rd Annual Quality Improvement Conference March 2017 @ the Excel Centre "it's about progress not perfection"

The day began with a crowd pleasing joke-a-thon from Auz Chitewe, a man whose data bank for one liners, dad jokes and Quality Improvement (QI) based quips were unleashed, with no time for the audience to take in breath between the gag’s - a potential death by comedy risk to the QI conference opening. A hard act to follow, Mary Elford stepped up to the plate.

What was presented was almost bamboozling, an NHS employee standing up in a crowd saying how successful the organisation has been since the introduction of QI three years ago. Not a mention of finance, or generic patient engagement surveys but a gushing of success with data that tells stories. Staff working as teams with service users to measure improvement and bringing in their excitement of change that nicely ties into the Sustainability Transformation Plans (recently christened Sticky Toffee Pudding and reported on by the BBC). As conference attendees we were invited to explore, probe and investigate the many hundreds of QI projects ELFT has delivered/delivering and importantly consider the possibilities of how the QI work could translate across to our own trusts.

East London Foundation Trust (ELFT) certainly are proud of the work they have done and rightly so, having trained 1474 people and published 13 papers over the last 3 years. They have been awarded CQC ‘outstanding’ and recognised nationally and internationally for the improved delivery of services, quality of care and service user involvement but are only too happy to say “We still have a thirst for improvement” and have no plans to rest on their laurels as there is more to be done....

A selection of QI project videos then played, where clinical staff shared their take on QI and the impact it has directly made on reducing ward based aggression, increased service user involvement in healthy living (self care) programmes, benefited referral processes and shown how safety on wards is improving.

ELFT’s mission was displayed for all to see, on a driver diagram, showing a display of how to live the values of QI by using the very tools that build into QI work.

Breaking rules and having a different mindset are required. The work itself is hard, but this is understandable; trying to shift the mindset of an organisation (NHS) that had its values set over two generations ago is not an overnight job. But the success to make change happen within ELFT are clearly displayed for all to see for the data lovers, medically minded and strategists amongst us.

“Know the rules well, so you can break them effectively.” Dalai Lama XIV

Seeing the level of self-praise at “how good we are” could be considered by some as show-boating, but isn’t it time that as an NHS we celebrate our success? Recognise our impact for positive change and take a sigh of relief that there is more localised control on improvement with service user involvement, ELFT certainly have a considerable wealth of evidence to support their view of how good they are, so a justified praise-giving is more the case here.

After the plenary those amongst us were split up into world cafés for an opportunity to learn in more detail about 3 different and current QI projects, with other smaller sessions on ‘scale up and spread’ and ‘service users and carers involvement’ available.

Recruitment Time-line QI project
Local Complaints Resolution QI project

The ‘scale up and spread’ session was about saying how do we take isolated good practice and spread it across the organisation. Usually scale up is done through performance management and a top down approach to implementation. It was interesting to note that evidence alone is not enough to scale up good practice. Rather the rate of adoption is dependent on relative advantage (what’s in it for me?), compatibility, simplicity, trialability and observability. The two major factors for staff are concerns about uncertainty and the need for reassurance. This can be overcome through peer-to-peer conversations and the ability for adopters to tweak ideas for their context. For successful scale up, leaders should aim to pull and attract rather than push people into change. A further recommendation is to keep up the focus on the aim and what really matters, design a support system and make sure that the environment supports change.

The service user’s session was led and delivered by service users, who were able to give their take on QI; the difference that it had made to them, how they felt listened to, how there was a parity with clinicians in that they received training, skills and opportunities normally held as exclusive to a member of the Multi-Disciplinary Team (MDT), only in this instance they are part of the MDT. Currently ELFT have 85 service users and carers who are trained in QI methodology, with access to refresher courses and advanced courses.

Some of the examples of where service user involvement can be found

The success of this level of engagement with their service users has worked on the premise that the culture desired is an “us and us” partnership. With support not stopping at discharge from the service, as the view is how do we (ELFT/Service user/carer) “reach there” a metaphor for a personally related goal/target/objective that often given the complexity of the human spirit cannot always be quantified and demonstrated in a data analysis.

A role play of how service users engage within meetings was performed. It demonstrated with comedic undertones the ’tick box’, tokenistic real world experiences of patient engagement. The play then showed how things could be done. Genuine, curious and valued - all these were key elements that shone through this role play.

how it CAN be done....

The importance of service user involvement also featured in the world café with there being a mixture of staff and service users presenting the projects that they worked together on. The key for one of the solutions on service user engagement was obtaining meaningful data to make service changes from one of the tables how do you create a questionnaire that encapsulates the experience and quality of your care and treatment, get those experiencing the service to write the questionnaire and give them opportunity to share in its evolution over time.

In the closing plenary the attendees were advised that a leap of faith is sometimes needed, that rules need to sometimes be broken and that not knowing what will happen is ok- because that's the point.

The point is we don't know what will happen!

The learning outcomes of the day were how do we as an organisation get more QI embedded in our services? It is clear that the engagement of clinical staff is essential, service user parity in change to the service is to be worked on and senior leadership buy-in. For this to be a success QI needs to be in the essence of all we do as a trust and embedded from the board of directors to the patients that we serve. It will be hard work, but results for the positive are possible if we take that leap of faith as a collective.

Created By
Austin Booth

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