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11/29/2016
1
M24: Engaging staff and building a movement for QI
qi.elft.nhs.uk
qi@elft.nhs.uk
@ELFT_QI
Monday, December 5, 2016
Introducing the ELFT team
Marie Navina Kevin Mason
Paul Leigh James Amar
11/29/2016
2
Objectives for today’s minicourse
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
1. Developing a framework for creating momentum for improvement at scale
2. Creating ideas and a strategy for engaging people in quality improvement
3. Understanding the key leadership behaviours needed to lead improvement at scale
Today’s agenda
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
• Using complexity and social movement thinking to design your improvement approach
• Executive leadership for improvement• Engaging teams and building an improvement
infrastructure• Involving patients, service users, carers and families
in quality improvement• Board leadership of improvement
11/29/2016
3
Some key principles to guide how you design your
improvement approach
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
with Dr Amar Shah (Associate Medical Director for QI)
11/29/2016
4
11/29/2016
5
Arguably the most important competency for dealing with complexity is systems thinking
The three characteristics of systems thinking include:
1.A consistent and strong commitment to learning
2.A willingness to challenge your own mental model
3.Always including multiple perspectives when looking at a phenomenon
Senge, 2006
11/29/2016
6
A social movement can be defined as…
“a voluntary collective of individuals committed to promoting or resisting change through co-ordinated activity”
Seven common characteristics of social movements:
Energy Mass Passion Commitment
Pace and momentum
Spread Longevity
Bate, Bevan & Robert, 2004)
Current prevailing beliefs about change
• Change starts at the top
• It takes a crisis to provoke a change
• Only a strong leader can change a large institution
• To lead change you need a clear agenda
• Most people are against change
• Change management is a disciplined process
A movement perspective of change
• Change builds from bottom-up action
• Change can be driven by passion to improve
• Change comes from the collective action of individuals
• You need to have a clear cause but can be uncertain about how you will achieve it
• People have an inner desire to make things better
• Change is opportunistic and spontaneous
11/29/2016
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Five key principles that can help a movement approach
1.Change as a personal mission2.Frame to connect with
hearts and minds3.Energise and mobilise4.Organise for impact5.Keep forward momentum
Things to consider
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
Planning versus Prodding, Analysing and Reacting
Who should build the movement?
Pace & momentum
Existing structures versus under the radar
11/29/2016
8
Executive leadership of improvement at scale
with Dr Kevin Cleary (Chief Medical Officer)
Mason Fitzgerald(Executive Director for Corporate affairs)
1. To provide an understanding of the quality journey that ELFT has been on;
2. To examine the role of all executives in leading quality improvement; and
3. To consider the contribution that executives need to make in order to build an organisation wide QI system and movement
Objectives for this session
11/29/2016
9
Mental health servicesNewham, Tower Hamlets, City & Hackney
Forensic servicesAll above & Waltham Forest, Redbridge, Barking & Dagenham, Havering
Child & Adolescent services, including tier 4 inpatient service
Regional Mother & Baby unit
Community health services Newham
IAPTNewham, Richmond and Luton
Speech & LanguageBarnet
web qi.elft.nhs.uk
email qi@elft.nhs.uk
@ELFT_QI
11/29/2016
10
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
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 & roadshows2. Microsite3. Using the power of narrative4. Celebrate successes5. Network of champions / ambassadors6. Learning events
1. Initial assessment of alignment & capability2. Recruiting central QI team3. Online training4. Face-to-face training5. Follow-up coaching on projects6. Develop in-house training for 2016 onwards
1. Align all projects with improvement aims2. Align team / service goals with improvement aims3. Align all corporate and support systems4. Patient and carer involvement in all improvement
work5. Embed improvement within management structures
Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from falls3. Reduce harm from pressure ulcers4. Reduce harm from medication errors5. Reduce harm from restraints
Right care, right place, right time1. Improving patient and carer experience2. Reliable delivery of evidence-based care3. Reducing delays and inefficiencies in the system4. Improving access to care at the right location
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QI ResourcesService User Input
Support around every team
Project Sponsor QI Coach
QI Forums
QI Team
The role of executives in leading
quality improvement
11/29/2016
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Kevin’s story
Dr Kevin ClearyChief Medical Officer
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
Mason’s story
Mason FitzgeraldExecutive Director of Corporate Affairs
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
11/29/2016
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Connecting with staff, and seeing them grow and develop
Spending time discussing our common purpose
Delivering outcomes for patients
Helping others, and making a contribution to national policy
Joys of leading QI
Building credibility with staff and managing
initiative fatigue
Capacity and capability
Constancy of purpose and behaviours
Managing upwards to commissioners and regulators
Challenges
11/29/2016
14
How to influence and change
behaviour at executive level
Re-visit your common purpose with the Board, staff, patients and stakeholders
Talk about quality before anything else, and with everything else
Link quality planning and quality improvement
Make quality explicit in all strategies and plans
Make quality your business strategy
11/29/2016
15
All executives to have a formal role (i.e. executive lead, directorate lead, workstreamlead, project sponsor)
Personal commitment to role
Model behaviours with our teams
Roles and role modelling
Be an umbrella for your staff – shield them from external demands
Show others how it can be done
Just say no!
Influence national policy
Managing the external world
11/29/2016
16
At your table, have a discussion on what you are currently doing and what you might like to try, in order to engage all executives in quality improvement
1. How can executives support an organisation wide QI system and movement?
2. What are the key drivers and barriers?
Executive leadership
Table Discussion
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
Engaging staff and building an infrastructure to support QI at scale
with Dr Amar Shah (Associate Medical Director for QI)
James Innes (Associate Director for QI)
11/29/2016
17
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18
And our QI Rap…..
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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)
AIM:To provide the highest
quality mental
health and community
care in England by
2020
Build the will
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20
Launch of our QI Programme February 2014
11/29/2016
21
1000 staff, service users and partners engaged in 4 months
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QI Stories at Trust Board
QI Visibility Wall
Electronic & paper newsletters
11/29/2016
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qi.elft.nhs.uk
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Visits to see QI at ELFT
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25
Influencing national policy and thinking
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Staff experience and engagement
3.5
3.6
3.7
3.8
3.9
4
2010 2011 2012 2013 2014 2015
Sco
re
Overall Engagement Score
ELFT Score
National Median
3.5
3.6
3.7
3.8
3.9
4
4.1
4.2
2010 2011 2012 2013 2014 2015
Sco
re
Staff Motivation to Work
3.3
3.4
3.5
3.6
3.7
3.8
3.9
4
4.1
2010 2011 2012 2013 2014 2015
Sco
re
Staff job satisfaction
55
60
65
70
75
80
85
90
2010 2011 2012 2013 2014 2015
Sco
re (
%)
Staff able to contribute towards improvements at work
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
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
11/29/2016
27
AIM:To provide the highest
quality mental
health and community
care in England by
2020
Build improvement
capability
Experts by experience
All staff
Staff involved in or leading QI projects
QI coaches
Board
Estimated number needed to train = 5000Needs = introduction to quality
improvement, identifying problems, change ideas, testing and measuring change
Estimated number needed to train = 1000Needs = deeper understanding of
improvement methodology, measurement and using data, leading teams in QI
Estimated number needed to train = 45Needs = deeper understanding of
improvement methodology, understanding variation, coaching teams and individuals
Needs = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead
Estimated number needed to train = 11Needs = deep statistical process control,
deep improvement methods, effective plans for implementation & spread
Pocket QI commenced in October 2015. Aim to reach 200 people by
Dec 2016.All staff receive intro to QI at
induction
500 people have undertaken the ISIA so far. Wave 5 = Luton/Beds
(Sept 2016 – Feb 2017)
29 QI coaches graduated in January 2016. Second cohort of 25 to be trained July-November 2016
Most Executives will have undertaken the ISIA.
Annual Board session with IHI & regular Board development
discussions on QI
Currently have 6 improvement advisors, with 4 wte deployed to QI. To increase to 8 IA’s in 2016/17 (6
wte).
Internal experts (QI
team)
Bespoke QI learning sessions for service users and carers. Over 50
attended in 2015. Build into recovery college syllabus, along with
confidence-building, presentation skills etc.
Needs = introduction to quality improvement, how to get involved in improving a service, practical skills in
confidence-building, presentation, contributing ideas, support structure for
service user involvement
11/29/2016
28
QI capability building
• In-depth training
• Course length is 6
months.
• 3days intensive
training; 4 WebEx
teleconferences;
2 full day learning
sets
• Applying learning
to their QI
projects in
‘action periods’
• Flexible, online training resource available to the whole Trust.
• Essential skills to support in leading QI
• Certificate which can be added to CPD portfolio.
• Apps for phone or tablet, or use browser
• Brand new modular
introduction to QI
• For anyone involved in
QI or wanting to learn
core QI skills
• Overview to using QI,
PDSAs and testing,
Using measurement &
data for improvement,
QI Tools
• One-stop shop• Learning resources
• Seminal papers, guidelines, whitepapers
• Videos• QI tools
PreworkWorkshop
9/29-10/1
Webex 1
10/14
Webex 2
11/2
Supports:
• Listserve
• Assignments
AP-1 AP-2Webex 3
11/30AP-3
Project
PlanningReliability
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.
Improvement Science in Action - 6 month learning path
Learning set 1
11/29/2016
29
Workshop 1
Overview to using QI
Workshop 3
PDSAs and testing
Workshop 4
QI Tools
All 4 workshops are between 2-3 hours in a classroom format and rotate in location throughout the
geography of the Trust.
Workshop 2Using
measurement for improvement
Pocket QI- 2 month learning path
11/29/2016
30
QI Coaches
11/29/2016
31
Intro to QI - for service users & carers
5 Executives have undertaken the ISIA course.
Estimated number needed to train = 45
Estimated number needed to train = 11
266 people trained in Pocket QI
692 people have undertaken the ISIA so
far
54 QI coaches graduated
Currently have 7improvement advisors
All staff
Staff involved in or leading QI projects
QI coaches
Board
Internal experts (QI
team)
Experts by experience
So how are we doing so far?
Estimated number needed to train = 7
Annual Board session with IHI & regular Board
development discussions on QI
Estimated number needed to train = 15
Estimated number needed to train =
5000
Estimated number needed to train =
1000
11/29/2016
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
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
AIM:To provide the highest
quality mental
health and community
care in England by
2020
Alignment
11/29/2016
33
QI ResourcesService User Input
Support around every team
Project Sponsor QI Coach
QI Forums
QI Team
11/29/2016
34
11/29/2016
35
All QI information in one place
Changing the way we look at data
11/29/2016
36
Changing the way we look at data
Data at Trust, directorate or team level
11/29/2016
37
11/29/2016
38
SPC Charts – showing
• Special cause variation• Notes• Linked PDSA’s
11/29/2016
39
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
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
AIM:To provide the highest
quality mental
health and community
care in England by
2020
QI Projects
11/29/2016
40
11/29/2016
41
Make it feel meaningful
Make it feel possible
Make it feel valued and permanent
Provide skills and support
Our QI Projects
0
50
100
150
200
250
Nu
mb
er o
f ac
tive
pro
ject
s
Month
11/29/2016
42
225Active
Projects
REDUCE HARM BY 30% EVERY YEAR
14
PHYSICAL HEALTH
ACCESS TO SERVICES
PRESSURE ULCERS
VIOLENCE REDUCTION
2 18 83
29
RIGHT CARE, RIGHT PLACE, RIGHT TIME
158
Our QI Projects
11/29/2016
43
Our QI Projects
47 showing improvement and potential for scale
up and spread
11/29/2016
44
Our QI Projects
Is it making a
difference?
11/29/2016
45
VIOLENCE REDUCTION
150
200
250
300
350
400
450
500
550
2013 2014 2015
No
. o
f In
cid
ents
Physical violence to patients (per 100,000 occupied bed days)
300
400
500
600
700
800
900
2013 2014 2015
No
. o
f In
cid
ents
Physical violence to staff (per 100,000 occupied bed days)
21% reduction
0
10
20
30
40
50
60
05-A
pr-
13
07-A
pr-
13
14-M
ay-1
3
02-J
un-1
3
07-J
un-1
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un-1
3
24-J
un-1
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10-J
ul-13
11-J
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20-J
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22-J
ul-13
15-A
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18-A
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06-S
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24-S
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13-O
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18-O
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23-O
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01-N
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05-N
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Tim
e b
etw
een
ev
en
ts /
day
s
3 days
8 days
Time between incidents of physical violence on an inpatient adult mental health ward (Globe ward) – T chart
Time between incidents of physical violence on three older adult mental health wards – T chart
Testing in different conditions - Violence reduction across the three older adult mental health wards with highest levels of violence
Initial prototype unit - violence reduction across the acute adult mental health ward with highest levels of violence
50%
63%
11/29/2016
46
Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)Orchestrated Testing
Brick Lane Ward
Mill harbour
Rosebank
Lea Ward
Globe Ward
Roman Ward
Ruth Seifert Ward
Brett Ward
Joshua Ward
Gardner Ward
Bevan PICU
Mother and Baby
Unit
ConollyWard
Topaz Ward
Opal Ward
Emerald Ward
Sapphire Ward
Jade Ward
Ruby Triage
Crystal PICU
City and Hackney
Newham
Provisional agreement by Borough QI Sponsors and
DMT to scale-up from February 2016
Tower Hamlets
Globe Ward
Shoreditch(For)
Clerkenwell
(For)
Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs)Orchestrated Testing
Brick Lane Ward
Mill harbour
Rosebank
Lea Ward
Globe Ward
Roman Ward
Ruth Seifert Ward
Brett Ward
Joshua Ward
Gardner Ward
Bevan PICU
Mother and Baby
Unit
ConollyWard
Topaz Ward
Opal Ward
Emerald Ward
Sapphire Ward
Jade Ward
Ruby Triage
Crystal PICU
City and Hackney
Newham
Provisional agreement by Borough QI Sponsors and
DMT to scale-up from February 2016
Tower Hamlets
Globe Ward
Shoreditch(For)
Clerkenwell
(For)
11/29/2016
47
Tower Hamlets Violence Reduction Collaborative
11.99
7.17
UCL
LCL
0
5
10
15
20
25
30
06
-Jan
-14
20
-Jan
-14
03
-Feb
-14
17
-Feb
-14
03
-Mar
-14
17
-Mar
-14
31
-Mar
-14
14
-Ap
r-1
4
28
-Ap
r-1
4
12
-May
-14
26
-May
-14
09
-Ju
n-1
4
23
-Ju
n-1
4
07
-Ju
l-1
4
21
-Ju
l-1
4
04
-Au
g-1
4
18
-Au
g-1
4
01
-Sep
-14
15
-Sep
-14
29
-Sep
-14
13
-Oct
-14
27
-Oct
-14
10
-No
v-1
4
24
-No
v-1
4
08
-De
c-1
4
22
-De
c-1
4
05
-Jan
-15
19
-Jan
-15
02
-Feb
-15
16
-Feb
-15
02
-Mar
-15
16
-Mar
-15
30
-Mar
-15
13
-Ap
r-1
5
27
-Ap
r-1
5
11
-May
-15
25
-May
-15
08
-Ju
n-1
5
22
-Ju
n-1
5
06
-Ju
l-1
5
20
-Ju
l-1
5
03
-Au
g-1
5
17
-Au
g-1
5
31
-Au
g-1
5
14
-Sep
-15
28
-Sep
-15
12
-Oct
-15
26
-Oct
-15
09
-No
v-1
5
23
-No
v-1
5
07
-De
c-1
5
21
-De
c-1
5
04
-Jan
-16
18
-Jan
-16
01
-Feb
-16
15
-Feb
-16
29
-Feb
-16
14
-Mar
-16
28
-Mar
-16
11
-Ap
r-1
6
25
-Ap
r-1
6
09
-May
-16
23
-May
-16
06
-Ju
n-1
6
20
-Ju
n-1
6
No
. of
Inci
de
nts
pe
r 1
00
0 O
BD
No. of Incidents resulting in physical violenceper 1000 occupied bed days (OBD) - U Chart
DIR
ECTO
RA
TE L
EVEL
(TO
WER
HA
MLE
TS)
Tower Hamlets Violence CollaborativeMonthly Report – July 2016
Trust-wide data
Tower Hamlets data
Combined wards data
Individual ward data
Key- Baseline data
- Days between todays date and the last date of incident
BASELINE DATA(BEFORE)
Learning Set 1
Test
ing
beg
ins
PDSA DATA(AFTER)
05/10 Learning Set
6: Time of Day & General
Adult wards go smoke free
10/11 Learning Set 7: Prediction + Safety Huddle Observation
Pre
-wo
rk /
en
gage
me
nt
12/01 Learning Set 8: Prediction PDSAs + Scale-up
prep
Learning Set 4
Learning Set 3
Learning Set 2
13/08 Learning Set 5: Safety
Huddle outcomes + Safewards
24/02 Learning Set 9: Effective Safety Huddle
PDSAs
24/03 Shift
pattern changes
26/04 Learning Set 10: Reflecting on why and PDSAs
17/04 Gender specific wards
40%
24/06 Learning
Set 11
11/29/2016
48
5.782.47
UCL
0
2
4
6
8
10
12
14
16
No
. of
Inci
de
nts
pe
r 1
00
0 O
BD
Incidents resulting in physical violence (Acute wards only)per 1000 occupied bed days (OBD) - U Chart
DIR
ECTO
RA
TE L
EVEL
(TO
WER
HA
MLE
TS)
BASELINE DATA(BEFORE)
PDSA DATA(AFTER)
57%
Learning Set 1
Test
ing
beg
ins
05/10 Learning Set
6: Time of Day & General
Adult wards go smoke free
10/11 Learning Set 7: Prediction + Safety Huddle Observation
Pre
-wo
rk /
en
gage
me
nt
12/01 Learning Set 8: Prediction PDSAs + Scale-up
prep
Learning Set 4
Learning Set 3
Learning Set 2
13/08 Learning Set 5: Safety
Huddle outcomes + Safewards
24/02 Learning Set 9: Effective Safety Huddle
PDSAs
24/03 Shift
pattern changes
26/04 Learning Set 10: Reflecting on why and PDSAs
17/04 Gender specific wards
34.98
17.05
UCL
0
10
20
30
40
50
60
70
80
90
06
-Jan
-14
20
-Jan
-14
03
-Feb
-14
17
-Feb
-14
03
-Mar
-14
17
-Mar
-14
31
-Mar
-14
14
-Ap
r-1
4
28
-Ap
r-1
4
12
-May
-14
26
-May
-14
09
-Ju
n-1
4
23
-Ju
n-1
4
07
-Ju
l-1
4
21
-Ju
l-1
4
04
-Au
g-1
4
18
-Au
g-1
4
01
-Sep
-14
15
-Sep
-14
29
-Sep
-14
13
-Oct
-14
27
-Oct
-14
10
-No
v-1
4
24
-No
v-1
4
08
-De
c-1
4
22
-De
c-1
4
05
-Jan
-15
19
-Jan
-15
02
-Feb
-15
16
-Feb
-15
02
-Mar
-15
16
-Mar
-15
30
-Mar
-15
13
-Ap
r-1
5
27
-Ap
r-1
5
11
-May
-15
25
-May
-15
08
-Ju
n-1
5
22
-Ju
n-1
5
06
-Ju
l-1
5
20
-Ju
l-1
5
03
-Au
g-1
5
17
-Au
g-1
5
31
-Au
g-1
5
14
-Sep
-15
28
-Sep
-15
12
-Oct
-15
26
-Oct
-15
09
-No
v-1
5
23
-No
v-1
5
07
-De
c-1
5
21
-De
c-1
5
04
-Jan
-16
18
-Jan
-16
01
-Feb
-16
15
-Feb
-16
29
-Feb
-16
14
-Mar
-16
28
-Mar
-16
11
-Ap
r-1
6
25
-Ap
r-1
6
09
-May
-16
23
-May
-16
06
-Ju
n-1
6
20
-Ju
n-1
6
No
. of
Inci
de
nts
pe
r 1
00
0 O
BD
Incidents resulting in physical violence (PICU wards only)per 1000 occupied bed days (OBD) - U Chart
51%
24/06 Learning
Set 11
City and Hackney Violence Reduction Collaborative
11/29/2016
49
16.9
7.9
UCL
LCL
0
5
10
15
20
25
30
35
40
13-A
pr-
16
16-A
pr-
16
19-A
pr-
16
22-A
pr-
16
25-A
pr-
16
28-A
pr-
16
01-M
ay-1
604-M
ay-1
607-M
ay-1
610-M
ay-1
613-M
ay-1
616-M
ay-1
619-M
ay-1
622-M
ay-1
625-M
ay-1
628-M
ay-1
631-M
ay-1
603-J
un-1
606-J
un-1
609-J
un-1
612-J
un-1
615-J
un-1
618-J
un-1
621-J
un-1
624-J
un-1
627-J
un-1
630-J
un-1
603-J
ul-1
606-J
ul-1
609-J
ul-1
612-J
ul-1
615-J
ul-1
618-J
ul-1
621-J
ul-1
624-J
ul-1
627-J
ul-1
630-J
ul-1
602-A
ug-1
605-A
ug-1
608-A
ug-1
611-A
ug-1
614-A
ug-1
617-A
ug-1
620-A
ug-1
623-A
ug-1
626-A
ug-1
629-A
ug-1
601-S
ep-1
604-S
ep-1
607-S
ep-1
610-S
ep-1
613-S
ep-1
616-S
ep-1
619-S
ep-1
622-S
ep-1
625-S
ep-1
628-S
ep-1
601-O
ct-
16
04-O
ct-
16
07-O
ct-
16
10-O
ct-
16
Control Chart: Number of recorded red incidents (physical violence) every 3 days on Safety Cross - Conolly, Gardner, Joshua, Ruth Seifert
& Brett
Incidents
Wh
ole
Co
lla
bo
rati
ve
Me
asu
res
fro
m S
afe
ty C
ross
01/04: Testing started on all wards except
Conolly
01/04: CHVRC* 2
13/04: Testing started Conolly
24/06: CHVRC* 4
*CHRVC = Meetings of the “City and Hackney Violence Reduction Collaborative”
13/05: CHVRC* 3
01/08: CHVRC* 5
30/09: CHVRC* 6
53%
^ 05/09
X transferred
Newham Violence Reduction Collaborative
11/29/2016
50
PRESSURE ULCERS
2 new teams join
collaborative
AV
ERA
GE
WA
ITIN
G T
IME
October 2016 1- Baseline data
Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets)
Psychological Therapy Service (City and Hackney, Newham & Tower Hamlets)
Average Waiting Time from Referral to 1st face to face appointment – I Chart
MHCOP Memory Service (City and Hackney, Newham & Tower Hamlets)
103.8788.80
51.52
45.56
57.46
36.45
53.77
31.44
16/02Learning
Set 1
10/05Learning
Set 9Test
ing
beg
ins
28/03Learning
Set 2
27/07Learning
Set 3
03/09Learning
Set 4
01/10Learning
Set 5
25/11Learning
Set 6
05/01Learning
Set 7
16/02Learning
Set 8
3 teams leave collaborative
39.85
60.66
53.17
44.51
51.23
UCL
LCL
35
40
45
50
55
60
65
70
Jan-1
4
Feb-1
4
Ma
r-14
Ap
r-14
Ma
y-1
4
Jun-1
4
Jul-14
Au
g-1
4
Se
p-1
4
Oct-
14
Nov-1
4
Dec-1
4
Jan-1
5
Feb-1
5
Ma
r-15
Ap
r-15
Ma
y-1
5
Jun-1
5
Jul-15
Au
g-1
5
Se
p-1
5
Oct-
15
Nov-1
5
Dec-1
5
Jan-1
6
Feb-1
6
Ma
r-16
Ap
r-16
Ma
y-1
6
Jun-1
6
Jul-16
Au
g-1
6
Se
p-1
6
Ave
rage W
aitin
g T
ime / D
ays
Average waiting time from referral to 1st face to face appt (Collaborative, 10/12 teams) - X-bar Chart
16%
11/29/2016
51
DID
NO
T A
TTE
ND
(D
NA
)
October 2016 3- Baseline data
Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets)
Psychological Therapy Service (City and Hackney, Newham & Tower Hamlets)
% of first appointment non-attendance – I Chart
MHCOP Memory Service (City and Hackney, Newham & Tower Hamlets)
28.32%
40.08%29.61%29.96%
22.05%
23.86%
32.21%
25.23%26.30%
UCL
LCL
20%
22%
24%
26%
28%
30%
32%
34%
36%
38%
40%
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
DN
A /
%
% of 1st face to face appts DNAs (Collaborative, 10/12 teams) - P Chart
2 new teams join
collaborative
16/02Learning
Set 1
10/05Learning
Set 9Test
ing
be
gin
s
28/03Learning
Set 2
27/07Learning
Set 3
03/09Learning
Set 4
01/10Learning
Set 5
25/11Learning
Set 6
05/01Learning
Set 7
16/02Learning
Set 8
3 teams leave collaborative
19%
REF
ERR
ALS
October 2016 2- Baseline data
Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets)
Psychological Therapy Service (City and Hackney, Newham & Tower Hamlets)
No. of Referrals Received – I Chart
MHCOP Memory Service (City and Hackney, Newham & Tower Hamlets)
211.86
414.21
556.50126.43
145.82
646.60
716.00
UCL
1,021.711,213.13
1,331.17
LCL700
900
1100
1300
1500
1700
Jan
-14
Feb
-14
Mar
-14
Ap
r-1
4
May
-14
Jun
-14
Jul-
14
Au
g-1
4
Sep
-14
Oct
-14
No
v-1
4
Dec
-14
Jan
-15
Feb
-15
Mar
-15
Ap
r-1
5
May
-15
Jun
-15
Jul-
15
Au
g-1
5
Sep
-15
Oct
-15
No
v-1
5
Dec
-15
Jan
-16
Feb
-16
Mar
-16
Ap
r-1
6
May
-16
Jun
-16
Jul-
16
Au
g-1
6
Sep
-16
No
. of
Re
ferr
als
No. of referrals received (Collaborative, 10/12 teams) - I Chart
2 new teams join
collaborative
16/02Learning
Set 1
10/05Learning
Set 9Test
ing
beg
ins
28/03Learning
Set 2
27/07Learning
Set 3
03/09Learning
Set 4
01/10Learning
Set 5
25/11Learning
Set 6
05/01Learning
Set 7
16/02Learning
Set 8
3 teams leave collaborative
30%
11/29/2016
52
103
41% reduction
80% reduction
104
41% reduction
19% reduction
80% reduction
11/29/2016
53
Medication safety across all 6 older adult mental health wards
95%
UCL
LCL0
5
10
15
20
25
30
35
40
45
50
07.0
8.1
4
13.0
8.1
4
18.0
8.1
4
28.0
8.1
4
16.0
9.1
4
17.0
9.1
4
30.0
9.1
4
06.1
0.1
4
13.1
0.1
4
20.1
0.1
4
27.1
0.1
4
13.1
1.1
4
17.1
1.1
4
18.1
1.1
4
03.1
2.1
4
04.1
2.1
4
04.1
2.1
4
15.1
2.1
4
17.1
2.1
4
05.0
1.1
5
12.0
1.1
5
26.0
1.1
5
24.0
2.1
5
27.0
2.1
5
16.0
3.1
5
24.0
3.1
5
21.0
4.1
5
23.0
4.1
5
24.0
4.1
5
11.0
5.1
5
28.0
5.1
5
05.0
6.1
5
10.0
6.1
5
17.0
6.1
5
29.0
6.1
5
06.0
7.1
5
20.0
7.1
5
28.0
7.1
5
01.0
8.1
5
21.0
8.1
5
25.0
8.1
5
Num
ber
of days
Number of days taken from request for Serum level to receipt of results
Transitional Phase starts
New clinic established
Improving clozapine results handling in City & HackneyImproving clozapine results handling in City & Hackney
54%
11/29/2016
54
UCL
LCL0
50
100
150
200
250
05 J
an 1
5
20 J
an 1
5
13 F
eb 1
5
03 M
ar
15
17 M
ar
15
30 M
ar
15
21 A
pr
15
11 M
ay 1
5
19 M
ay 1
5
04 J
un 1
5
16 J
un 1
5
25 J
un 1
5
15 J
ul 15
04 A
ug 1
5
18 A
ug 1
5
25 A
ug 1
5
10 S
ep 1
5
18 S
ep 1
5
02 O
ct 15
09 O
ct 15
23 O
ct 15
08 N
ov 1
5
DA
YS
Date of referral
Length of time from referral to delivery of products (Whole Pathway)
Shift
46.534.1 18.4
Reducing waiting times for products from NHS supplies for patients in the community
61%
33%
Reducing time taken to complete disciplinary investigations
11/29/2016
55
@ELFT_QIqi.elft.nhs.uk qi@elft.nhs.uk
Service User and Carer
Quality Improvement
with Paul Binfield(Head of People Participation)
Leigh Bell(People participation lead)
11/29/2016
56
What do you need to think
about when involving
service users & carers in
your QI project?
Paul Binfield Head of People Participation
Hannah Mellor Health -Development Co-
ordinator
Zaffran Jami City & Hackney
Marica Wainner Executive Assistant
David Kreikmeier-Watson - Patient & Carer
Experience Manager
John Kauzeni CHN
John Southam Luton
William Fitzpatrick
Central Bedford
Kamila Naseova Bedford
Elena Trivelli -Volunteer Co-
ordinator
Helena Maine MHCOP
Alan StrachanCAMHS
Sophie Akehurst Forensics
Suzanne Goulding -
Tower Hamlets
Leigh BellNewham
Ann Lacey –Volunteer Co-
ordinator
PEOPLE PARTICIPATION LEADS
ELFT People Participation Team
11/29/2016
57
Getting team structure right from the start…
Successful QI team
Team Diversity
Team leadership
Stakeholderinvolvement
(patients, carers, staff)l
Subject matter expert
Little i
Regularly consulted during
lifetime of the project
Big I
Act as a full member of the QI project team
Surveys
Focus groups
Community meetings
Service user
forum
Different Types of Involvement
11/29/2016
58
To a
chie
ve %
se
rvic
e
use
r/ca
rer
invo
lve
me
nt
in Q
I ac
ross
ELF
T
Communication (in and out)
Advertising
Access to information
Support structure
Big I
Service user/carer specific role in project team
Training
Structure/process outlining how service users/carers get involved
Payment
Service user/carer led or co-led projects
Little I
Service user/carer feedback
Partnership working between Quality team and QI Team
Overview of service user/carer
involvement
Monitoring & reporting
Regular Reviews
• Booklet outlining all information about involvement in QI
• Clear structure outlining different levels of support and outlining responsibilities
• Service user/carer involvement in QI forum
• Service user/carer lead in QI central team and each project team
• Role descriptions and contracts • Incorporate QI into recovery syllabus • Buddying up • Regular support sessions for service
users/carers similar to coaches. • Training – not focused on
methodology – more focus communication skills and role plays.
• Service user/carer bespoke group –similar to support QI coaches receive.
• Induction to team and/or trust induction.
• A trust wide survey service users/carers can complete about quality of service and/or QI project on that ward/in that team – similar to friends and family test.
Change Ideas – from strategy meeting 29/10/15
• Regular steering group/oversight meeting.
• Monitoring informatics system that reviews service user/carer involvement at all different stages of the QI project.
• Dashboards
11/29/2016
59
Role description
Reward and recognition
http://qi.elft.nhs.uk/engaging-service-users-and-carers/
Board leadership for
improvement
with Dr Navina Evans(Chief Executive)
Marie Gabriel(Chair of the Board)
qi@elft.nhs.uk @ELFT_QIhttps://qi.elft.nhs.uk
11/29/2016
60
@ELFT_QIqi.elft.nhs.uk qi@elft.nhs.uk
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