1 April 2021

Springtime for QI in CNWL

The clocks have gone forward for British Summer Time and we can start to enjoy the lighter evenings along with the prospect of the easing of lockdown.  

As we reflect, respond and re-plan after marking one year on from the start of the Covid-19 pandemic, this issue aims to do all three: reflecting on a successful QI project, responding to the need to restart QI training and planning for the year ahead.  

Our lead article this month considers the stage of a QI project that can be quite a conundrum; how do you know when the time is right to bring your QI project to a conclusion?  Using an example from the Falls QI Programme, we examine what questions the project team need to address to consider a project to be complete and return to business as usual.

We also look ahead at the planning of the CNWL QI Practicum 2021 and welcome Geetika Singh as our new Head of QI at CNWL.

Plus, we have dates for the restart of monthly Bitesize QI training this month, now available to book via LDZ.

We welcome your feedback and if there is anything you would like to see in future editions of the newsletter, do please get in touch by e-mailing cnw-tr.improvementsupport@nhs.net.

Returning to business as usual

 

All project work, by its very definition, should have a beginning and an end, with a story to tell about the journey in-between those points in time.  But, how do we know that we are ready to end a QI Project and what do you need to think about and do before you ‘complete’ a QI project?

For many of us working on QI projects, we can often find that as we start to see the improvements that we wanted, it can be hard to think how, or even if, we can end a project and return to business as usual.  So here, we look at a case study of a mature and successful QI project that has made improvements and been ended; that status drop-down menu on Life QI has been changed from ‘active’ to ‘completed’.

Ellington Ward is a 24 bedded acute assessment unit for older adults with mental health issues, many of whom have co-morbidity of physical health issues.  Patient falls on the ward have been a source of anxiety for staff in the service for some while, with some sad experiences of the severe consequences of a patient fall in the past. So, the team were keen to tackle this issue using a QI approach and were eager to benefit from the training offered in the Improvement Science in Action Practicum.

In July 2019, Ellington Ward joined 10 other CNWL services in the Falls QI Programme.  The Ellington Team have worked very hard over the course of 2019/2020 to improve their management of falls and as a result, now have much longer times between falls occurring on the unit.  But what has led the team to be able to confidently move their project to ‘completed’?

Ellington Ward – Falls QI Poster

There are a number of changes to working practices that Ellington Ward have maintained beyond the end of the Falls QI Project:

  • Adhering to falls policy in assessing falls risk on admission
  • Handovers about those at risk of falling, using a whiteboard as prompt
  • Completing post falls MFRA after each fall 
  • Adapting care plan following each fall
  • Ensuring environmental adaptations are, e.g. lowest bed heights, shower chairs
  • All beds on the ward are now hi-low beds.
  • Ensuring non-slip socks are available and worn correctly - alerting ward clerk to order more supplies when stocks run low
  • ‘Help us reduce falls’ posters in bedrooms and some communal areas
  • Call don't fall alerts available to go next to nurse call bells in individuals' rooms when appropriate
  • Oxehealth sensors in bedrooms
  • Falls QI is part of the induction of new staff
  • The team have taken falls reduction on board and it is a shared responsibility across disciplines and grades

Each of these changes are seen across the wider team and are evidence that the ‘system’; both processes and people’s behaviours, have changed as a result of the QI project, even to the level that new staff are inducted into the new way of working.  The Team have addressed the question of ‘how do we make this the new and only way of working?’ and written this into their processes, effectively developing a Standard Operating Procedure or SOP document.

The Ellington Team also know that they have a fantastic story to tell about what they have done; not only were they able to produce a QI poster (see above) for the Safety Conversation Day back in November 2020, they also appeared on a QI video talking about their work.

Not every QI project has to produce a poster or a video to prove that the project is complete, but if you have put things in place so that everyone in the service works in the new way and have data that shows that your improvement is being sustained, you are probably able to see the end of your improvement project.  It is time to complete your project, stand down the project team and move on to the next project!

CNWL Quality Improvement Practicum 2021

 

Planning is now well underway for CNWL’s QI Practicum 2021, with a faculty of teaching drawn from the CNWL QI Team.  Starting later this year, the Practicum will feature a mixture of teaching workshops and learning sessions over a period of 12 months, aimed at teaching an improvement science level of understanding of the model for improvement, whilst a set of themed cohorts of staff undertake a QI project to bring improvement to their services.

 

The key features and benefits of the Practicum programme approach can be summarised as:

  • Attendees will learn about improvement science and application of the Model for Improvement whilst undertaking a live QI project in their service
  • 20-30 project teams in total
  • 3-4 staff per project team
  • Each project team will be supported by a dedicated Improvement Coach and a Divisional Senior Sponsor
  • Virtual workshops and learning sessions throughout 
  • All teach, all learn approach
  • Teaching subjects will be in line with project progress and adapted to suit the pace of the projects 

Similar to the previous Practicum course, the QI Team are in discussion with each Division to select themes for their project teams that reflect Divisional and Trust quality priorities.  We are currently looking at developing themes around safety and reducing harm and we are considering analysis of incident data to understand where the hotspots of need for improvement are greatest around the Trust.  Although discussions are yet to be concluded, emerging areas for work include reducing pressure ulcers, increasing safety and improving access to services.

We will bring you more details when the discussions have been concluded, but we are really looking forward to embarking on what will be an intense yet highly rewarding programme of work.

Meet the team – Geetika Singh

 

This month we welcome Geetika Singh as our new Head of QI.

Geetika joins us from the Royal Free London NHS Foundation Trust where she has worked for 10 years, most recently as Patient Safety CPG Programme Manager.

Geetika is a physiotherapist by background, an IHI trained Improvement Advisor and brings valuable experience of QI including leading a breakthrough programme on falls prevention in partnership with the IHI.

We wish Geetika well in her new role at CNWL.

Coming soon

 

The QI Team are hard at work to get ready for the next year of QI, with the CNWL QI Practicum to feature majorly in the Trust and we will keep you up to date with how the project teams in the Practicum are developing their QI work.

Very soon we will relaunch the QI website and we will be introducing you to the new look and refreshed content in the next issue.

Also coming up, we will be introducing the CNWL apprentices who are joining the Improvement Leaders course with partner organisations across London.

Upcoming Training Dates

Bitesize QI returns!  

Our popular monthly 3-hour QI training on the model for improvement and how to set out on a QI project will recommence in April and is now bookable on the Learning and Development Zone.

Search for ‘Bitesize QI’ to find the course, which is available on these dates all starting at 9.30am:

  • Tuesday 13 April 2021
  • Tuesday 11 May 2021
  • Tuesday 15 June 2021
  • Tuesday 13 July 2021
  • Tuesday 17 August 2021  
  • Tuesday 14 September 2021  
  • Tuesday 12 October 2021
  • Tuesday 16 November 2021 
  • Tuesday 14 December 2021

Useful links

Contact information for Improvement Advisors: