Quality improvement

Quality improvement (QI) aims to embed improvement at the centre of how we deliver care and services.

It’s based on the concept of testing new ideas or ways of working, starting with small tests and building as you gain confidence and can see and evidence the impact of the changes you’re making. These are known as PDSA (Plan, do, study, act) cycles. 

This approach allows those closest to the issues to drive improvement, empowering them to make a difference in how we work, develop ideas and projects across the Trust. We aim to co-produce improvements with staff, patients, service users, carers and partners, with every project having a service user or carer on the core team. 

QI can focus across a range of areas, including:

• Improving the experience and outcomes of patients and service users
• Improving how we work
• Improving the work environment to support staff in delivering services
• Recognising the importance of staff experience and wellbeing.

Our aim is for QI training to be available to all Trust staff and for peer workers to become part of the core QI team.

In developing this approach, we’re committed to:

• Building a culture that empowers everyone to make changes and improvements in the way they work
• Recognising the value and opportunity of those closest to the issue problem or area of practice
• Exploring and testing new ways of working
• Embracing opportunities to think differently. 
   

A quality improvement (QI) project is usually focused on a problem for which there isn’t an immediate or obvious simple solution. An initial focus on understanding the problem is followed by testing different ideas for change.

Projects can be any size and focused across all areas in the Trust. They don’t have to be based in one team or service and can support improvement across pathways, services and organisations.

Examples of QI projects at the Trust include:

Reducing missed appointments

Missed appointments were the focus of the Hounslow primary care mental health services team's QI project. Their caseload had doubled in the past year and patients were moving too slowly through the service. While many factors contributed to this backlog, missed appointments were thought be to the simplest to tackle.

The team took a quality, service improvement and redesign (QISR) course, which helped them identify potential service improvements and how data could be used to achieve them.

One approach they trialed was to offer telephone appointments to people who'd missed a face to face appointment.

The QI project revealed patients missed appointments for many reasons and that addressing this wasn't as simple they'd predicted. However, despite the unexpected challenges, the project led to a 10 percent drop in missed appointments overall. The team also gained valuable experience with the methodology and process mapping.

‘There was a change in the culture of the team. We learnt the importance of data. You need to think about what you want to achieve and how you are going to measure it.'

Emma Brown, Lead Nurse Practitioner

Safety huddles in mental health wards 


Safety huddles are regular meetings of multi-disciplinary teams, used to create safer environments for patients and staff, and improve teamwork and communication. Teams discuss patients at risk and agree methods to reduce their risk of harm to themselves and others. Approaches include: co-operative problem solving, shared understanding of focuses and priorities, and increasing awareness of any safety concerns.

The Trust began using safety huddles across its diverse inpatient wards in 2016. Though teams believed that ‘huddles’ led to a reduction in harm to patients and staff, the safety improvement could not be measured. Some wards performed better than others and it was hard to share good practice across the Trust.

With funding from Imperial College Healthcare Partners Patient Safety and Service Quality Centre, the Trust’s safety huddles in mental health wards QI project took a different approach, increasing the use and knowledge of data to measure improvement. 

For example, the new QI approach to safety huddles helped reduce violence and aggression on the male medium secure Windrush ward, in the Three Bridges unit in Ealing. As a result, the team could embed the least restrictive practices in management of risk and spend more time in therapeutic engagement with patients.

The QI project as a whole has seen improvements in teamwork and the safety culture of the wards, reductions in locally identified harms and better use of data.

Highlighlighting the achievements of Windrush ward, the project was shortlisted for two 2020 Health Service Journal (HSJ) patient safety awards. Other wards included in the nomination were:

• Parkland ward, also in Three Bridges
• 
Kestrel ward for people with acute mental health problems at Lakeside Mental Health Unit

• Meridian ward for people with acute mental health problems at Hammersmith and Fulham Mental Health Unit

• Euston and Newmarket high secure wards in Broadmoor Hospital

'Through collaboration, thoughtfulness and a collaborative team approach this project has yielded significant quality benefits and has re-energised the team ... We are very proud of the work done ... to achieve this and will be rolling out the learning within other areas of the Trust.'

Leeanne McGee, Executive Director of High Secure and Forensic Services

As the voice of the service, we are keen to have service users/carers/people with lived experiences be a part of Quality Improvement at West London NHS Trust. No QI project experience is required, just your voice, your own experience and the passion to drive improvement!

There are several ways you can get involved:

1. Do you have an idea for improving our service based on your lived experience? If so, please complete this form. We can potentially use your idea to form a quality improvement project. You can also opt-in for project updates.
2. Do you want to drive and be part of a QI project? There are two ways. 
   1. Co-design: This means you will receive updates on the project and have the opportunity to share your feedback on the project as it progresses.
   2. Co-produce: This means you are part of the project team and involved in making project decisions. You will help the team come up with 'change ideas', implement those ideas and measure the implementation of the ideas to check whether improvement has been made

See our current QI project opportunities:

• Improving carer's experiences in forensic services
• Culture of care collaborative

We have many more project opportunities to share – please express your interest by completing this form, and a member of the QI Team will get in touch. 

You can additionally take QI training where you will be:

• Be introduced to the fundamentals of QI
• Learn about QI methodologies  
• Learn how to plan a project, co-produce and to start a QI project

Please see the dates for our Qi curious workshops – we offer these both online and in-person. 

In-person training dates:

• Thursday 24 October 2024, 9am to 1pm at Lakeside Medical Unit
• Wednesday 13 November 2024, 1pm to 5pm at Heart of Hounslow Centre
• Tuesday 19 November 2024, 9am to 1pm at Heart of Hounslow Centre
• Tuesday 3 December 2024, 9am to 1pm at Armstrong Way, Trust Headquarters
• Thursday 5 December 2024, 1pm to 5pm at Armstrong Way, Trust Headquarters

Online training dates:

• Tuesday 12 November 2024, 9.30am to 12.30pm
• Tuesday 10 December 2024, 1pm to 4pm

If you are interested in attending our in-person or online training, please express your interest by completing this form and a member of the QI Team will get in touch.

Lastly, we have a working group designed to improve the journey of a service user/carer into QI at West London NHS.

Some of our actions include:

• Updating and co-designing our West London NHS QI page.
• Co-designing our resources and toolkits.
• Co-designing our processes – how people get involved in QI Training and projects.
• Co-designing what the QI public forum space should be used for.

If you are interested in attending our working group, please express your interest by completing this form and a member of the QI Team will get in touch.

Some helpful resources and websites in understanding quality improvement methodology. 

• Quality improvement in practice from the British Medical Journal (PDF)
• Health foundation quick guide, QI made simple 
• QI in healthcare (YouTube)
• The science of improvement (YouTube)
• NHS England – Quality, service improvement and redesign programme
• The Health Foundation 
• Q Community 
• Institute of Healthcare Improvement
• British Medical Journal Quality and Safety