QI in Luton
Welcome to the home of QI in Luton!
It’s a pleasure to work with and to witness the commitment and dedication of staff working in Luton – in spite of several wide-scale and far-reaching changes starting when services transferred to ELFT in 2015, staff who continually work hard to ensure that patients get the highest quality of care. In spite of near constant change, we have seen our enthusiasm and our passion for high quality care, coupled with the systematic methodology of Quality Improvement (QI), produce some fantastic project teams and innovative solutions to problems facing our Directorate.
The QI methodology guides our passions and moves us away from status quo, from relying on the assumptions that the answers lie with “those at the top” but values the contribution of those on “shop floor”, those who actively engage with our patients on the day to day. QI allows us all to work together to engage and tackle the problems and challenges facing our Directorate.
We are working together to build the foundations and infrastructure to support brave new QI projects in Luton through capacity building and training. Using Pocket QI, the Improvement Leaders Programme and with the help of our coaches, we are tooling our workforce to break down the barriers of status quo and address challenges in a whole new way. With the help of the People Participation Leads, QI moves the patients and carers into the conversation, allowing them to share their insights and experiences as part of a whole new wave of co-production in Luton.
There’s still a lot to do still in Luton and we know it can be difficult to keep on top of all that’s happening with the QI programme and about how to get involved, so we’ve created this space with the support of the QI Team to capture all our QI stories, share all our learning and provide key resources about QI in Luton. Just like our work in QI is still quite new, so is this page, so feel free to drop us a line if you have any ideas of what you’d like to see here or how we could make it better.
Let’s keep making this QI journey together!
Ola Hill, Governance Manager
Dr Farid Jabbar, Clinical Director
Luton violence collaborative – video
Luton and Bedfordshire adult mental health wards were the last to trial the Trust’s violence reduction package, spread from Tower Hamlets ward-by-ward across the Trust. Their aim was to reduce physical violence on inpatient wards by 30% by September 2018.
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Over 18 safety huddles a week and we’re just getting started
Luton and Bedfordshire adult mental health wards were the last to trial the Trust’s violence reduction change bundle, spread from Tower Hamlets ward-by-ward across the Trust. Their aim was to reduce physical violence on inpatient wards by 30% by September 2018.
Between July and September 2018, progress was rapid. Wards started holding regular safety huddles and completing data recording more reliably, yet not reliable enough to be confident of quantitative improvements. What was clear was that the whole MDT were starting to huddle, wards were sharing learning with each other, service users were becoming increasingly involved and staff were seeking out best practice activities and improving ward environments.
The wards describe how they came to feel really different. Wards felt calmer and less reactive. Moreover, there were unexpected benefits from the time and energy that has been released, including more time with service users, reduced length of stay and lower staff sickness. The violence reduction work has now ramped up, with half the wards now huddling over 18 times per week, more active experimentation and new insights.
This month we are going to reflect on how it all started in Luton and Bedfordshire, the challenges they faced and overcame, the new things they’ve tried and what next.
Where did they start?
In December 2017, seven adult mental health wards across Luton and Bedfordshire joined a collaborative to be a part of the Trust’s violence reduction work.
Collectively they were experiencing an average of 51 physically violent incidents per month. Each incident was affecting the victims and witnesses and the ward’s morale.
What did they do?
In December 2017, the wards began to trial the safety package (namely the safety cross, daily safety huddles, Broset Violence Checklist and safety discussions in weekly community meetings).
In the first six months, the work existed but was struggling to create momentum. Then Borough Lead Nurses and ward leaders gave the work a fresh push, starting fortnightly breakfast meetings for all ward MDTs. The Forensics directorate kicked off the first breakfast by sharing experiences of their journey, followed by an open conversation. Then each ward was scheduled to present at each upcoming breakfast.
Through these meetings, the challenges started to be vocalised and wards also committed to what they would try. These commitments included understanding how violence makes people feel, having set times for safety huddles, wider MDT engagement and including service users in the process.
Then light began to appear starting with the safety huddles. Gareth Steiner, Ward Manager for Jade PICU Ward describes how the huddles changed staff so that they planned how to reduce any conflict in real time and now rely on each other to act cohesively and early:
“In the past, I would see early warning signs and want to do something about it, but I felt anxious about the implications of tackling it on my own. Before that there is a large amount of anxiety because you never know how it is going to go. However, the minute you get organised and prepared, that goes straight away. If someone is kicking the door, I call a safety huddle and in less than three minutes we talk about immediate concerns, what the plan is going to be, and you are no longer holding this alone.”
Gareth goes on to describe an example of being proactive by creating an escalation plan for an individual with the team:
“We have a very volatile person on the ward. Historically if something happened we would respond, restrain and take him to seclusion. But the safety culture change bundle has really impacted how we now approach things. In this case, the staff called a huddle and agreed ‘If this happens, the first step is to have 1:1 talk with him. If that fails, we’ll offer him PRN. Next step is we take him off the ward to the quiet room for a 1:1 with the MDT around. Failing that, if violence increases, we’ll look at seclusion’. The staff followed the plan and were able to deescalate the situation at step three, before it got to seclusion. As a result, no one got hurt, no hands were laid on anyone. It is a really good example of what can be achieved as a result of this work”.
The frequency of huddles increased dramatically. They went from being held only a few times a week (when Gareth describes “staff didn’t really understand why they were valuable”) up to a consistent two or three times a day across many of the wards (at least two a day and in some cases one at night). For example, Ash, Onyx, Crystal, Willow and Jade Wards have recently achieved 19-21 huddles per a week; two in the day and one at night seven days a week.
Bedfordshire wards led the trust in utilising visual management boards specifically to quality control the outcome measure and safety change bundle processes. Willow ward helped other wards in the trust to create their boards, through sharing their whiteboard template.
Bedfordshire inpatient wards’ first visual management board session
Successful MDT involvement has been key. Lorraine Esther-Armstrong, Matron on Crystal Ward, describes why that has been so helpful:
“In huddles you’re assigning specific tasks to individuals. So it is great to have the doctors in that meeting, for example, because then they will act immediately”.
A spirit of celebration emerged. When the Institute for Healthcare Improvement came to visit in October 2018, Luton created this video describing the violence reduction package they had implemented. It includes their own addition tested by Crystal Ward of a tabard to protect staff doing observations from distractions:
Then the conversation around violence continued to improve through increased service user involvement. Service users were initially involved through safety discussions in community meetings. Daisy Mudoni, Borough Lead Nurse for Luton describes how this expanded to involvement in the huddles and the collaborative:
“Instead of violence being a staff issue, it affects everybody. Service users needed to know what is happening with the collaborative and contribute their views. Now service users are involved in some huddles and wards have brought service users along to their presentation at the collaborative. This is the beginning of the next step – how do we work in partnership? Instead of something staff do to service users, how do we work together with the same priorities?”
What has been the impact and how does it feel?
Reliability of data recording still needs to improve to have confidence that there has really been quantitative improvement. However, the staff have experienced a meaningful improved experience on the wards.
Tracey Morrison, Life Skills Recovery Worker on Crystal Ward describes the wider impacts of the work:
“Proactively reducing violence has freed up staff to spend more time with service users. As a result, service users have usually been more settled, creating a much calmer, more therapeutic ward, reducing length of stay and reducing staff sickness. Improving on violence has had a knock-on effect on every aspect of the ward. Once people see the benefits, they are so wide.”
Lorraine Esther-Armstrong, sees the shift too:
“Once the momentum starts going and you start seeing the benefits, it changes everything. I don’t think there is anyone who openly says this is rubbish or doesn’t want to be part of it”.
Gareth Steiner further captures the change in staff attitude and describes how it has changed his view of QI also:
“Staff went from saying ‘another unnecessary meeting’, ‘this will never work’ and ‘too much paperwork’ to ‘it was easy to introduce’, ‘we can see a reduction in incidents’, ‘the paperwork is not that much’ and ‘doctors are coming to the huddles’”.
“When I started at ELFT, I tried to keep aloof of QI. But through this work I now see why people get passionate about it because you enjoy working again all of a sudden and are not dreading coming into work”.
The past six months
Momentum has continued to escalate. The active experimentation by staff and their enthusiasm about what have learned and adopted is really striking. Learning has been both short-term on the best way to support individual service users and longer-term on how to risk assess, de-escalate and create ward conditions conducive to low conflict. Examples of changes they have implemented and tests they have run to de-escalate violence include:
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- Psychologists introducing self-soothing boxes on the wards
- A mood management group providing distraction through meaningful activities
- Displaying the Safewards de-escalation tips chart
- Picture boards to giver service users personal recognition by displaying their artwork
- 1:1 OT sessions to understand triggers and develop strategies with service users, including increasing community activities outside the wards
- Reviewing enhanced observations in safety huddles to ensure people are not on enhanced observations for longer than necessary
- Three times a day a nominated service user liaises with all other service users to discuss the ward’s atmosphere and RAG rate the shift on a blank safety cross in the patient area; they can also inform staff of any concerns on the ward
- Reaching out to other wards to get advice, e.g. on a service user that ward cared for before or advice from the PICU
- More proactive support from the Duty Senior Nurse
- Coaching junior staff to risk assess
- Introducing t-shirts saying ‘Go Green for December’.
Next steps
We will continue to further work with service users in partnership to understand and reduce violence together. Staff have made great progress with recording data reliably, with reliability growing across the wards. The next step is to support staff to more frequently use of data as part of decision making, for example by building training into Away Days, and to clarify the quantitative impact of the work.
The wards are continuing to experiment to reduce violence further. For example, work will continue to reduce restrictive practices including improving de-escalation to avoid chemical and physical restraints. A new project on improving the reporting of violent incidents to the police aims to ensure violence on wards is treated equally as violence everywhere. Another project is looking to increase carer involvement on the wards.
The wards have a better handle on how to work together to make a safer therapeutic and work environment. It is really exciting seeing all the work they have done together and what they have achieved.
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QI Celebration in Bedfordshire & Luton – 22 May 2018
Please find slides available from the Bedfordshire & Luton QI Celebration event on Tuesday 22 May 2018. Thank you to all presenters at the event. Our keynote speaker was Dr Helen Bevan, Chief Transformation Officer at NHS England, you can find her presentation ‘Rocking the boat and staying in it: Bringing change to health and healthcare’ within this file.
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Improving the Conversion Rate in Luton Wellbeing Service
Please learn more about this completed ELFT QI project from the adjacent poster.
ELFT staff, service users and carers can access full details of this project on Life QI .The project code is 101214 please log onto your Life QI account before clicking the logo below.
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Reducing Wait Times
Learn more about this QI project presented at the ELFT Quality Conference in April 2018
Please find the team’s poster available here>>
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Reducing Wait Time for First Contact with Psychology in Luton
Learn more about this QI project presented at the ELFT Quality Conference in April 2018
Please find the team’s poster available here>>
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Luton Wellbeing Service: achieving enjoyment at work through engagement and communication
In this blog, the Enjoying Work QI team at Luton Wellbeing Service share their journey towards increasing the percentage of staff having a good day at work from 55% to 75% in four months. Words by Kelly Gale (Improvement Advisor) and Sharon Gugerly (Project Lead).
Luton Wellbeing Service was one of services at East London NHS Foundation Trust that volunteered to be an early prototype team for Enjoying Work, which is aimed at helping increase staff experience of work using quality improvement methods. The team comprised of Sharon Gugerly (Project Lead), Douglas Hiscock (Coach), Brian Toye (Sponsor), Jen Taylor-Watt (Improvement Advisor), Giap Huynh, Sandra Brown, Syed Ali Naqvi, Faz Parker (Team Members) and Shefa Begum (Business Partner – Human Resources).
The project was launched in June 2017 and the first task was to gather baseline data using the online survey tool Survey Monkey. The survey asked all staff to rate their day using the Likert Scale:
To what extent do you agree with the following statement?:
Did you have a good day at work yesterday?
The answers on the Likert Scale were: “Strongly Disagree”, “Disagree”, “Agree”, “Strongly Agree”.
All staff members were asked to complete this daily for the month of June and 185 responses were collected. Of those, only 55% said they “Agreed” or “Strongly Agreed” that they had had a good day. Using that baseline as starting point, the team created their driver diagram and identified which factors they needed to work on.
The team used a board to communicate with staff.
From the responses to the survey and from engagement sessions with the whole staff team, four themes emerged which were contributing to people not have a good day. They were: Stress, Work Environment, Management Communication and IT.
The staff engagement session had developed many change ideas, so all staff were invited to rank them in order of importance, so that the project team could start on identifying change ideas that meant the most to most staff.
Some ideas were tasks, things they could just get done without the need to test first. Staff were also asked to rank these in order of importance to them. The results from the staff ranking were acted upon and a communications board was placed in the main staff area so that everyone could be informed and kept updated as to what was happening.
Changing the way the whole team meeting was used and executed was ranked as the number one change idea, so the team started a PDSA (Plan, Do, Study, Act) cycle on how they were going to do this.
Changing the time of the meeting was the first thing that they tried; this was quite successful with the team. The next change they agreed on was to add a lunch break in the meeting as it was conducted over the whole of the lunch period. Their third cycle was to have a much more structured meeting with an agenda and a way of providing feedback about the meetings.
The team created a Kanban board, the board was a great success as the staff team were able to see what had been completed, what was in the process of being done and what was lined up to do next.
Kanban board
The whole team were asked to continue completing the survey throughout the project to see whether the changes and improvements being made were having the desired affect and whether this would be reflected in the data.
The percentage of staff members who responded with “Strongly agree” or “Agree” that they had had a good day increased from the baseline of 55% to 75% and this was being maintained.
Towards the end of 2017, the service was commissioned to a different provider, which meant that it would be transferred from ELFT. Staff enjoyment at work was subsequently affected and the project team decided it was not viable to continue with the project in its current format.
Although they were not able to run the project in its entirety as they intended to, they used the learning and structures they had developed to refocus the work on supporting staff during this period of change. They also took time to capture and share some of the outstanding work and valuable learning from their original project.
The lessons from the project are:
Complete the small tasks first – this shows that things will be done and encourages others to become involved and builds the momentum for the others to join in.
Involve the whole team: the project was designed to help everyone in the team and the more of the team involved, the better the ideas generated and the outcomes will be.
Clear communication: Let everyone know what is going on, get everyone involved and keep them updated.
If you are part of ELFT and are interested in taking part in an Enjoying Work project please click here to know more.
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Learn more about this project on Life QI – Project Code #103865
East London NHS Foundation Trust (ELFT) has been using the Life QI platform since June 2015 to manage our Quality Improvement (QI) portfolio. Projects are proposed, approved and worked on through the platform. Learn more about how important this platform is in this blog by our Data Manager Forid Alom.
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Pursuing enjoyment at work within the ELFT Quality Improvement team
In this blog, Deeksha Mehta, QI Principle Information Analyst and Project Lead, shares her experience with the Enjoying Work project.
Deeksha Mehta
We began thinking about improving our enjoyment at work when we kicked of a whole team project in June 2017. Initially we undertook an appreciative inquiry and began to gather some baseline data about whether or not people were having a good day. At first people were keen to share what was holding them back and we were able to quickly build a driver diagram and develop some change ideas.
However, over time we found that interest in the work from the wider team was mixed and people were less forthcoming about providing feedback and contributing to measuring our enjoyment at work. On reflection this made sense; people had provided feedback but as a project team we had struggled to be responsive to this, get to testing ideas and being transparent.
As part of the wider trust learning set on enjoying work we had an opportunity to learn from the other 6 pilot teams around the trust doing this work. One great idea we learnt about was the Kanban board that Luton IAPT had developed as part of this work.
The team used a board to communicate with staff.
A Kanban board is a visual management tool that lets people know what tests of change are planned in progress and completed. We’ve recently introduced one of these to help develop team engagement more and develop transparency around the work.
An important part of the work we have done recently was developing our anonymous We Care survey. This was an opportunity for the wider team to give some more feedback about things that were still affecting them and provide some ideas about how to change it. In addition to this, it also provided an opportunity to see if our original driver diagram still reflected what was going on within our system.
We would like wrap up my story with a quote “If you focus on results nothing changes , if you focus on change you will see the result”.
If you are part of ELFT and are interested in taking part in an Enjoying Work project please click here to know more.
Learn more about this project on Life QI – Project Code #105547 .
East London NHS Foundation Trust (ELFT) has been using the Life QI platform since June 2015 to manage our Quality Improvement (QI) portfolio. Projects are proposed, approved and worked on through the platform. Learn more about how important this platform is in this blog by our Data Manager Forid Alom.
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Reducing Time Taken to Complete Neuropsychological Assessments in Memory Assessment Services in Luton and Bedfordshire
Memory Assessment Services in Luton and Bedfordshire have been working hard to reduce time taken to complete neuropsychological assessment. Read more about their journey and achievement below.
The Psychology members of four multidisciplinary Memory Assessment Service (MAS) Clinics across Luton and Bedfordshire, collaborated on a cross-clinic project to reduce the time taken to complete a neuropsychological assessment to six weeks.
The team, made up of Clinical Psychologists, Trainee Psychologists and Assistant Psychologists used a nominal group technique to build their driver diagram. The team found this method to be inclusive of everyone in the team and an efficient way to decide on the important factors which made up their primary drivers.
Click on the image to see the flow chart ion full size
Since the QI Project spanned over four MAS Clinics, it was vital that operational definitions were clarified so that the data collected were comparable across teams. To do this the team decided to flow chart their assessment process to ensure that all teams were following the same procedures and to clarify when and how data would be collected.
Through process mapping it became apparent that each Clinic had difficulties in different parts of the process. Therefore, the teams decided on testing some ideas across all teams, as well as some change ideas which were specific to their Clinic.
The teams started with change ideas in areas which they felt they had most control over. For example, they wanted to reduce the delay between the assessment taking place and the draft report being available by allocating specific time for this as close as possible to the assessment appointment. Initially this was trialled with one Assistant Psychologist, using a number of Plan Do Study Act (PDSA) cycles to refine the changes to account for competing priorities, before scaling up to all Assistant Psychologists utilising this method.
Implementing this change led to greater efficiency in writing reports, as the information was clearer in mind. Assistant Psychologists report that the new structure helped to manage the workload and clear backlog. Since testing this change, all four MAS clinics have seen reductions in time from assessment to draft report ranging from 52% – 92%.
Click on the Image to see the charts in full size.
The teams have also been testing team specific change ideas through PDSA cycles and have already seen significant reductions in the time from referral to final report. Mid Bedford are already averaging 38.5 days; Luton at 42 days, Bedford is averaging at 39 days and South Beds is at 44 days. Although the aim was to reach 42 days, teams believe more can be done to reduce this time further and are now looking to gain service user feedback to inform their next change ideas.
The project team used a force field analysis to reflect on challenges they faced, such as the changeover in Assistant Psychologists. They also identified that working in small teams meant having to take on multiple roles and manage workloads with competing priorities. However, they found the QI meetings to be a useful platform to discuss these difficulties, which helped the team stay focussed and motivated.
Initially the team struggled to understand the progress of the project in the context of the wider team. However, having clear operational definitions helped them to develop a consistent data collection plan, which led to having visible data to illustrate how the changes had affected their system. This helped them to celebrate their successes and to consider the bigger picture by taking into account balancing measures to provide more clarity on how the system was performing.
The team also shared learning on their experience of running a project across four different Clinics. They recognised that each Clinic had differences in their process, which had to be considered when thinking of change ideas and developing a data collection plan. The project team found QI life to be a useful platform, as it could be accessed from anywhere. Together with Skype and disseminating minutes QI project meetings were made more accessible.
The team also appreciated the energy and enthusiasm bought to the project meetings by the Assistant and Trainee Clinical Psychologists. Project Lead, Emma Ellis has also bought forward great leadership skills to the team, moving the project forward through setting meetings and keeping on top of the process. We look forward to hearing how the project develops over the next couple of months.
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Trust Board QI Story: reducing waiting times at Luton CMHT Psychology service
Dr Timothy Sporle, Consultant Clinical Psychologist, presented some results from the QI project aimed at reducing wait times for 1st appointments in Luton in the latest ELFT Trust Board meeting. The presentation is available below.
The Luton Community Mental Health Team (CMHT) Psychology service has seen a 50% drop in first contact wait times over the past few months, as a result of change ideas put into practice as part of a QI project. Dr Timothy Sporle, Consultant Clinical Psychologist, presented results from the Reducing Wait Time for 1st appointment QI project in the ELFT Trust Board meeting, which took place on 14 December 2017.
Service user waiting times to first face to face contact was between 11-13 weeks before July 2014. There was also evidence of lack of service user knowledge about the psychology assessment, whilst staff also felt that receiving more information before an assessment could be more effective.
In an attempt to tackle those problems, the team then implemented a Psychology Awareness Programme (PAP) as a change idea. The programme is comprised of three group sessions and allows service users to gain more understanding about the service. Also as a result of the programme, service users are receiving wellbeing advice more quickly and are encouraged to think about their goals early on.
“By the time they reached their first assessment, service users were better informed about the process”, said Dr Timothy Sporle. The team is now focusing on processing staff and service user feedback in order to refine the PAP programme. The project will also concentrate on assessing whether the introduction of the PAP could also have led to a drop in DNA rates for first assessments.
The slides prepared by Dr Timothy Sporle and Assistant Psychologist Ros Humphreys are available below:
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Improving access to Learning Disability Occupational Therapy services in Beds and Luton
Please learn more about this completed ELFT QI project from the adjacent poster.
ELFT staff, service users and carers can access full details of this project on Life QI
The project code is 101269 , please log onto your QI Life account before clicking the image below.
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Violence Reduction on Adult Inpatient Units; what has been achieved so far at ELFT?
Between 2012 and 2015, Tower Hamlets Adult Mental Health inpatient wards reduced violence by over 40% and by 60% on the acute admissions wards, using a Quality Improvement approach. Since then we have scaled up the work to City & Hackney in early 2016 and Newham in mid-2016. Forensics also launched its own Collaborative in late 2016, testing the extent to which ideas developed in general adult units is effective in Forensics, as well as developing their own ideas.
Overall, violence reduction work across ELFT has meant that we have seen a 42% reduction in incidents of physical violence across our East London services since 2013 (see figure 1).
Figure 1
The change ideas that have helped in general adult settings work on 2 main drivers:
- Increasing teams ability to identify and predict risks of violence and to take action proactively as a team. Two change ideas work on this; Safety Huddles and the Broset Violence Checklist
- Creating a culture of much greater openness and transparency around the issue of violence with the whole ward community, including service users. Two ideas work on this: using Safety Crosses and having proactive discussions around violence and safety in ward community meetings. (See articles on City & Hackney and Newham Adult Mental Health Services)
For more information about these ideas see the other articles in this newsletter and this article, published in February 2017 in the Journal of Mental Health Nursing>>
Local reductions
Since the beginning of the work, local collaboratives have achieved the following reductions:
Tower Hamlets has reduced violence across all 6 wards by 40% and restraints by 60%, using Datix data. There has been a 57% reduction in violence and a 77% reduction in restraints across the acute wards.
In City & Hackney, violence has reduced by 40% across the unit and upwards of 60% on the acute wards, according to Datix data. Gardner Ward and Joshua Ward in City and Hackney have sustained 65-75% reductions in violence for 6-9 months. There has also been a 54% reduction in use of restraint on Conolly Ward and there are early signs of reduction on Bevan Psychiatric Intensive Care Unit (PICU).
In Newham , Topaz Ward has seen a reduction of 66%, Emerald Ward has seen a reduction of 74% and Sapphire has seen a reduction of 84%. Jade Ward are also seeing very positive signs of change, with no incidents at all between 30th September 2016 and 12th January 2017.
Forensics has just seen early signs of a 51% reduction in physical violence across Bow, Broadgate, Clerkenwell, Shoreditch and West Ferry wards. Shoreditch and Bow have seen individual reductions of 82% and 51% respectively. For more information see our article – Perspectives from Forensics; Early signs of reduction and an exciting journey ahead for further specific detail on the directorate’s journey for far and the impact this work has had.
In 2017-18 we will be looking at extending the work to Luton and Bedfordshire and focusing dedicated work on restricted practices, as well as consolidating the work in existing Collaboratives and developing a Quality Control strategy (see this article).
For any queries get in touch with Jen Taylor-Watt, QI Lead for City & Hackney & IAPT and Lead Improvement Advisor for Violence Reduction and/or Andy Cruickshank, Associate Director of Nursing for QI and Senior Improvement Advisor for Violence Reduction.
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Improving the triaging process
Creating a new triage tool leading to better risk management…
This clip was shown to delegates attending the 2017 Annual QI Conference in Bedfordshire & Luton
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Congratulations to Wave 5 ISIA Graduates
On Tuesday 14 March 2017 our Wave 5 Improvement Science in Action (ISIA) trainees in Bedfordshire & Luton graduated from this six month QI learning programme.
Over this period they have been working on a variety of quality improvement work across the two Directorates. The final learning set and graduation day was a great opportunity to learn from each other and share the progress that has been made since ISIA training began in September.
Special thanks to the four QI project teams who presented their work to the whole group. It was also great to be joined by Jonathan Warren, Chief Nursing Officer, who passed on his congratulations and gave his encouragement for the continued progress of QI across Bedfordshire & Luton.
The training commenced in September 2016 and the first three days were led by Robert Lloyd, Vice President, Institute for Healthcare Improvement. Bob couldn’t be with the group for graduation but sent us this message.
Congratulations to all of our Wave 5 graduates. We look forward to seeing how your improvement works continues to progress.
See how keen they all were to graduate here!
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Bedfordshire & Luton QI Journey 2016-2017
A quick review of the year in quality improvement for our Bedfordshire & Luton Directorates. Looking back at everything that’s happened since our QI launch event and conference in March 2016.
This video was first shown at the second annual QI conference in Bedfordshire & Luton on Tuesday 7th March 2017
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2017 Bedfordshire & Luton QI Conference Slides
Download the slides for the second annual Bedfordshre & Luton QI Conference, held on Tuesday 7th March 2017
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Navina’s reflection on 2016
Dr Navina Evans, Chief Executive of ELFT reflects on quality improvement at ELFT in 2016
This is my first message as CEO of ELFT. We hosted the IHI summer camp, attended by strategic partners from across the world. We were proud to show them the work we have done in ELFT and with partners.
We were especially proud of the work with service users. 2016 has been an exciting year for the Trust with a visit from CQC which resulted in an outstanding rating. The inspectors were particularly impressed with the way in which QI thinking was being embedded in the culture of the organisation. Bedfordshire and Luton colleagues were very keen to start on their own QI journey. Training has begun and projects are beginning to take shape.
In 2017 I will support our ambition to further embed improvement practice as the norm within ELFT and to take QI to the wider system to deliver improved outcomes for the communities we serve.
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A look back at QI in Bedfordshire & Luton in 2016
By Ishrat Love-Chowdhury, QI Lead for Luton
It’s been an exciting year for QI in Bedfordshire and Luton. With much preparatory work taking place with senior leaders early in the year, the official launch for QI took place in April 2016 with the Annual Conference in the Rufus Centre, followed by a series of roadshows and events in a host of venues across town. Over 200 people have been involved in these events and 95 people are currently undergoing their 6 month Improvement Science in Action QI Training programme. With the help of structured training in QI Methodology, staff have developed 28 exciting QI Projects so far. These projects are looking at improving a wide range of issues identified by staff and service users for better access to services, to reduce violence and aggression on in-patient wards and improve physical health.
Over the course of next year, even more staff are signing up to be trained in Pocket QI, a shorter course on the methodology and tools for QI so that even more projects can get started in the months to come. Click here to see dates of upcoming training.
There has also recently been 2 “Intro to QI” sessions held in Bedfordshire and Luton encouraging Service Users and Carers to learn more about why we use QI in the Trust and get more actively involved in the improvement work happening across the directorate
Service Users and Carers complete their Quality Improvement training in Luton
We’re excited to see what 2017 will hold!
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Active QI Projects – June 2019
This is the monthly report generated from Life QI, showing all active projects within all the directorates.
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Bedfordshire & Luton Wave 5 ISIA
Bedfordshire and Luton staff share their thoughts on Wave 5 Improvement Science in Action (ISIA) training.
From 14th-16th September 2016 over 100 staff joined Dr Robert Lloyd from IHI and the QI team for their first face to face training workshop of the 6 month ISIA programme.
The ISIA teaches QI project teams to refine their aims, use Driver Diagrams to understand their system and prioritise change ideas, measure data for improvement, test changes using Plan Do Study Act (PDSA), and introduces many other concepts and tools that teams can use throughout the project’s lifecycle.
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Bedfordshire & Luton Wave 5 ISIA
Bedfordshire and Luton staff share their thoughts on Wave 5 Improvement Science in Action (ISIA) training.
From 14th-16th September 2016 over 100 staff joined Dr Robert Lloyd from IHI and the QI team for their first face to face training workshop of the 6 month ISIA programme.
The ISIA teaches QI project teams to refine their aims, use Driver Diagrams to understand their system and prioritise change ideas, measure data for improvement, test changes using Plan Do Study Act (PDSA), and introduces many other concepts and tools that teams can use throughout the project’s lifecycle.
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90 Seconds with Neil Lad
We spoke to Neil Lad, Clinical Practice Lead for Onyx Ward and QI Coach in Luton, about his role and his thoughts on quality improvement…
Neil Lad (Neil.Lad@elft.nhs.uk) QI Coach for Luton
Thank you for agreeing to be interviewed today. Firstly, could you give us a brief summary of your role and what a typical day at work is for you?
As a clinical practice lead my role is to provide clinical leadership in front line delivery of care alongside my colleagues. Onyx ward is a busy and unpredictable 20 bedded female ward in Luton so there is no typical day! No two minutes are ever the same, definitely keeps you on your toes!
What do you enjoy most about your role?
Working with service users. Every individual has their own story and are an inspiration in their own right. It’s the one thing that will continue to wake me up in the morning to come in to work.
What do you do in your day-to-day work to support us to continually improve?
In my day to day work I encourage the team to continually take feedback from service users and carers and how we can look to improve on what we already do. I’m a perfectionist so I’m always looking for ways to improve our delivery of care and encourage others to do so.
What would you say to someone who feels that QI is a box ticking exercise and is unsure about the benefits of QI to us as a whole Trust and themselves individually?
The stories of success for service users and staff speak for themselves! Who wouldn’t want to work in an environment where there was less violence or where service users are continually receiving the right care at the right time in the right place?! If QI was a tick box exercise it wouldn’t be receiving the acclaim that it is and actively improving service user and staff experience.
Do you have a story of something inspiring that has occurred through QI?
The most inspiring thing that I see are service users and staff being able to channel their passion into improving services. QI truly embraces a bottom up approach which is vital in ensuring inclusivity and collaborative working.
What do you see as the biggest challenge to embed quality improvement, and what can we do to tackle this?
The biggest challenge is making it business as usual. However, the array of options for training and involvement with QI now can reach a wider audience. For example, not everyone can commit to the 6 month ISIA programme therefore pocket QI may be beneficial. Plus, to be involved with QI you don’t need to have completed the training, there is such an extensive support structure in place that there really is no excuse!
Where do you see us as a Trust in 3 years’ time?
I see the trust building upon its growing reputation and becoming a centre of excellence!
Finally, could you sum up what quality improvement means to you and why you feel it is so important to us as a Trust to embrace.
To me QI is a way of working that allows anyone, irrespective of job role or experience to help improve the lives of service users and staff. If you’ve got an idea or a theory about how something can be improved QI encourages you to try this out. It’s inevitable that not every idea will work; however, it allows us to learn and grow as individuals, teams and as an organisation.
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A Carnival Atmosphere for QI in Bedfordshire & Luton!
The quality improvement programme
ISIA training was held at the UK Centre for Carnival Arts
in Bedfordshire and Luton is now well underway with the start of Wave 5 Improvement Science in Action (ISIA) training. From 14th-16th September over 100 staff joined Dr Robert Lloyd from IHI and the QI team for their first face to face training workshop of the 6 month ISIA programme.
Over the last few months training participants have been developing service improvement ideas that are now becoming fully formed be QI projects as the training progresses.
The ISIA teaches QI project teams to refine their aims, use Driver Diagrams to understand their system and prioritise change ideas, measure data for improvement, test changes using Plan Do Study Act (PDSA), and introduces many other concepts and tools that teams can use throughout the project’s lifecycle.
Around 30 QI projects across the two Directorates are now up and running, see some of the themes below. Look out for the improvements they will bring for our service users!
ELFT have now trained over 500 staff, service users and carers in ISIA, equipping them with core skills to lead improvement to all our services. If you’re interested in ISIA or any other QI training, have a look at this to see what best suits you.
Delegates on Wave 5 ISIA training
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