Learning from East London NHS Foundation Trust's quality improvement programme - some thoughts on how to set up an organisation-wide QI programme

1. Our quality
improvement programme
web qi.elft.nhs.uk
email qi@elft.nhs.uk
@ELFT_QI Conflicts of interest: None

2. 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

3. Challenges
and
opportunities
in East
London
Cultural
diversity
Social
deprivation
Geographical
diversity
Commissioning
arrangements
Financial
stability and
strong
assurance
systems
@ELFT_QI

4. Our quality
improvement programme
Why?
@ELFT_QI

5. 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

6. 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
@ELFT_QI

7. Our quality
improvement programme
How?
@ELFT_QI

8. 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

9. STARTING TO BUILD THE WILL
• The events led the trust to question
whether it had the right processes in
place to deliver quality care
• Robust assurance
• Staff and patient experience feedback not
very good
• Arrival of MD from NPSA who made a
case for more co-ordinated and systemic
trust wide approach.

10. 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
qi.eastlondon.nhs.uk
Staff and service
user newsletter
reaches 4000
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
@ELFT_QI

11. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
35,000

12. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
35,000page views of the QI microsite in the last year
our one-stop shop for QI
built and managed by
the QI team, total cost
£300
qi.elft.nhs.uk

14. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
Introducing microsite 2.0

15. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
1,000

16. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
1,000Staff, service users, carers, Governors,
commissioners engaged in the first 4 months of
the programme

17. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
Bespoke learning sessions
Specialist
services
leadership
Service users
and carers
Finance team
Health visitors
Nursing
students
Band 3 nursing
staff
Psychology
trainees
Trainee
doctors
External
partners

18. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
5,000

19. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
5,000staff receiving the monthly QI e-newsletter

20. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
Percentage of staff opening the e-newsletter

21. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
550

22. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
550local services receiving the quarterly paper
newsletter, including GP practices and voluntary
sector organisations

23. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
the will
6projects shortlisted
for regional or
national awards
1regional award
7projects being
written up for
publication with BMJ
6teams presenting
their work to the Trust
board each year

24. 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

25. 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
Support for
improvement work from
the Trust’s QI team
IHI Open School
available to all
Strategic
partnership
with IHI
Board
sessions
@ELFT_QI

26. Experts
Front line staff
Clinical leaders
Directorate
improvement
leads
Board
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 = 30
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 senior staff
being encouraged to join QI
training over next 2 years
New need recognised.
Developing improvement
coaches programme will train
30 QI coaches in 2015
On track. Most Executives
will have undertaken the
ISIA, and Board training has
been delivered in 2015.
Currently have 3
improvement advisors, with
1.5wte deployed to QI.
Will need to build more
capacity at this level.

27. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
1,100
Build
improvement
capability

28. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
1,100Open School lessons completed
Build
improvement
capability

29. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build
improvement
capability
Recruited a central QI team
Board sessions
Developed 3
improvement advisors

30. 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
@ELFT_QI

31. Prework
Workshop
9/29-10/1
Webex 1
10/14
Webex 2
11/2
Supports:
• Listserve
• Assignments
AP-1 AP-2
Webex 3
11/30
AP-3
Project
Planning
Reliability
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.
Learning
set 1
@ELFT_QI
Learning and coaching over 6 months

32. 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

33. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Alignment

34. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Alignment

35. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Alignment

36. 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

37. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
How have our
projects developed
over time?

38. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
September 2014

39. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
October 2014

40. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
November 2014

41. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
December 2014

42. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
January 2015

43. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
QI Projects
February 2015

44. Right Care, Right
Place, Right Time
TH Collaborative
Roman, Globe, Bricklane, Lea,
Millharbour, Rosebank
MHCOP
Larch Lodge, Cedar Lodge,
Sally Sherman Ward
CHN
EPCS Teams (North East,
North West, Central, South)
Multiple I/P Wards
C&H
Rehab, AOS, Connolly, Bevan
Newham
Multiple I/P wards
Newham
Psychology
MHCOP
Training Lodge
Children’s
CDC x2
CAMHS x3
MHCOP
Memory Service
C&H
All CMHTS
Forensics
Clerkenwell
REDUCE HARM
BY 30% EVERY
YEAR
RIGHT CARE,
RIGHT PLACE,
RIGHT TIME
VIOLENCE
REDUCTION
PHYSICAL
HEALTH
ACCESS
PRESSURE
ULCERS
@ELFT_QI

45. Is it making a difference?
@ELFT_QI

46. UCL
LCL
50
70
90
110
130
150
170
190
210
230
Dec12
Jan13
Feb13
Mar13
Apr13
May13
Jun13
Jul13
Aug13
Sep13
Oct13
Nov13
Dec13
Jan14
Feb14
Mar14
Apr14
May14
Jun14
Jul14
Aug14
Sep14
Oct14
Nov14
Dec14
Jan15
Feb15
Incidentseachmonth
Month
Incidents of physical violence across the Trust (C Chart)
179 per
month
145 per
month
19% reduction across the Trust
Datix incident reporting
@ELFT_QI

47. UCL
LCL
10
20
30
40
50
60
70
80
90
100
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
No.ofRestraints
Episodes of Restraint in Prone Position - C Chart
UCL
LCL
50
70
90
110
130
150
170
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13
Aug-13
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
No.ofIncidents
Incidents resulting in the use of Restraint (C Chart)
68 per month
30 per month
56% reduction
134 per month
112 per month
16% reduction

48. UCL
LCL0
1
2
3
4
5
6
7
8
07Apr
21Apr
05May
19May
02Jun
16Jun
30Jun
14Jul
28Jul
11Aug
25Aug
08Sep
22Sep
06Oct
20Oct
03Nov
17Nov
01Dec
15Dec
29Dec
12Jan
26Jan
09Feb
23Feb
09Mar
23Mar
06Apr
Grade 3-4 Pressure Ulcers - C ChartNumber
UCL
LCL0
2
4
6
8
10
12
14
16
24Mar
31Mar
07Apr
14Apr
21Apr
28Apr
05May
12May
19May
26May
02Jun
09Jun
16Jun
23Jun
30Jun
07Jul
14Jul
21Jul
28Jul
04Aug
11Aug
18Aug
25Aug
01Sep
08Sep
15Sep
22Sep
29Sep
06Oct
13Oct
20Oct
27Oct
03Nov
10Nov
17Nov
24Nov
01Dec
08Dec
15Dec
22Dec
29Dec
05Jan
12Jan
19Jan
26Jan
02Feb
09Feb
16Feb
23Feb
02Mar
09Mar
16Mar
23Mar
30Mar
06Apr
Grade 2 Pressure Ulcers - C ChartNumber
6.4 per week
2.8 per week
56% reduction

49. Buildingwill
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

50. Buildingcapability&
capacity
Be prepared
to invest
Train all levels
and across
disciplines
Realign
existing
resources
Stop lower
value work

51. Alignment&integration
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

53. Organisational culture is created by what
leaders pay attention to…

54. web qi.elft.nhs.uk
email qi@elft.nhs.uk
@ELFT_QI