Posted on: 15 July 2022
July 2022 
In this edition, we have a lot of great improvement news to share with you including (click the titles below to go directly to that section):
- Our feature article: Where can we find Value in our Quality Improvement work?
- An update on our Improvement Practicum in-person celebration event
- An update on International #WMTY2022 Day @ CNWL
- Executive QI Conversations with Hannah Witty, Chief Financial Officer & HMP High Down
In addition, we also have exciting news from the Improvement Academy including links to great opportunities that are coming up.
- Level 3: Gold QI training – Senior Leaders - Applications are now open!
- Level 1: Bronze QI training – Bitesize – Now CPD accredited! – Book now!
Each month we will be sharing great examples from across CNWL where individuals and teams are improving systems and processes to ensure that we deliver the best evidence-based service user and carer experience where ever teams are delivering care across the trust.
Image: Nick Youngson
Where can we find Value in our Quality Improvement work?
As we bring the current improvement practicum to a close and celebrate both successes and learning in all its forms with our 22 participating practicum teams, we would like to build on previous newsletters where we explored both the IHI Quadruple aim and the What matters to you? Movement.
There is increasing interest and belief in applying quality improvement (QI) to help solve our most complex challenges in healthcare, yet according to Shah & Course (2018) there is limited literature to support healthcare leaders develop business cases and evaluate return on investment (ROI) from QI. This is even more prominent in fields such as mental health and community health services. Ross & Naylor (2017) identified that ROI from applying QI at scale is not just about cost reduction as a single objective, but more about bringing new strategic capability to the organisation which can drive productivity, improving efficiency and increased revenue, while also aligning the organisation more directly with a common purpose of high quality and safe care.
Dixon-Woods & Martin (2016) found that demonstrating cause and effect within the real-life complexity of a healthcare organisation is difficult. Dixon-Woods & Martin (2016) suggest that there are often likely going to be multiple interventions within a complex system, so attributing effects to a single intervention such as QI can be difficult. Historically, it has been found that value added to the system by QI can range from the more intangible, such as revenue growth of the organisation or staff engagement, where the link between QI and the outcome is less easy to define but broadly believed to be true by those working in the system, to more concrete tangible added value, such as cost avoided or cost removed, where economic analysis is precise enough to estimate the number of pounds saved or removed due to an improvement intervention (Shah & Course, 2018). Calculating the value added requires an evaluation of costs as well as benefits.
Service User, Carer and family experience and outcomes
The primary reason for applying QI within healthcare organisations is to improve outcomes for those we serve, therefore this should be the primary benefit that is realised from our improvement work (Ross & Naylor, 2017). At the CNWL Improvement Academy, we encourage every team to consider what matters most to staff working in the team and the service users, carers and families that receive care and to support teams to use QI methodology to solve their greatest quality issues. By focusing on what matters most to those closest to the care, both receiving and delivering care, we are attempting to design our improvement work to be as personal and as meaningful as possible (Perlo,2017). Improving the experience and outcomes of the population we serve is the ultimate purpose of any healthcare provider, so this aspect of the business case for QI should align directly with the core purpose of the organisation (Dixon-Woods & Martin, 2016).
Improved staff experience
The QI approach requires devolving power to teams to identify and solve their biggest challenges and equipping them with the right tools and skills to address these systematically (Shah & Course, 2018). This should, in theory, empower staff to have more control over the system they work in, more autonomy to make changes and help staff feel more engaged in their work (Perlo, 2017). There is strong evidence that healthcare providers with happier, more engaged staff have better patient outcomes and improved financial performance (West & Dawson, 2012).
Improving efficiency and streamlining processes
One of the goals of QI is to reduce unwanted variation and remove waste from the system, through supporting teams to focus on what matters to their service users (Ross & Naylor, 2017). By removing non-value adding steps in the process, and redesigning care around what adds value to the service user, teams are likely to see improvements in productivity and efficiency. These may free up time for teams and clinicians to focus on providing care, but may not have any effect on avoiding or removing costs (Dixon-Woods & Martin, 2016).
Cost avoidance & reduction
In some areas of QI work, improving the system may mean that we are able to avoid significant costs that were previously being incurred – either staff costs, or for equipment, materials or other overheads. Improving safety and staff experience at work is likely to lead to a reduction in staff absence from work or staff turnover and in turn a reduction in agency staff usage (Perlo, 2017). This concept will also hold true where ever you may sit within the wider health and social care system as per the NHS long term plan and the implemention of Intergraded Care Systems (ICS).
Improved organisational reputation
Applying QI at scale can bring new strategic capability within an organisation, adding competitive advantage within the market (Shah & Course, 2018). This has the potential to realise the benefit of attracting new staff and potential new revenue opportunities, including through acquiring new business based on organisational reputation for quality and improvement.
In summary, when evaluating the ROI or the added value delivered through the use of QI, it is key to evaluate this at multiple levels. Undoubtedly, the primary driver is to improve outcomes and experience for those that receive care and services. However, the organisation will also reap dividend from enhanced engagement and motivation of staff, improved productivity and efficiency of teams, cost avoidance (reducing cost pressures), cost reduction and the possibility of increased revenue. All of these potential avenues for quantifying added value should be evaluated and considered as part of evaluating the impact of applying QI (Dixon-Woods & Martin, 2016).
At CNWL we have designed a framework for evaluating added value from QI (Figure 1).
If you would like to explore this framework further with a member of our team please do not hesitate to get in touch with Geetika Singh, our Head of Quality Improvement at geetika.singh@nhs.net and we will be more than happy to help you.
Additional ways of gaining support are at our QI Clinic by contacting us at cnw-tr.improvementsupport@nhs.net and other educational opportunities here.
Figure 1
References:
Dixon-Woods, M. & Martin, G. (2016) ‘Does quality improvement improve
quality?’ Future Hospital Journal, Vol.3, pp.191-4.
Perlo, J. et al. (2017). IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. Available at: http://www.ihi.org/resources/Pages/IHIWhitePapers/Framework-Improving-Joy-in-Work.aspx
Ross, S. & Naylor, C. (2017) Quality improvement in mental health. London, The King’s Fund.
Shah, A. & Course, S. (2018) ‘QUALITY IMPROVEMENT Building the business case for quality improvement: a framework for evaluating return on investment’, Future Healthcare Journal, Vol.5, No.2, pp.132-7.
West, M. & Dawson, J. (2012) Employee engagement and NHS Performance. London, The King’s Fund.
Improvement Practicum Celebration event
Wednesday 29 June 2022
This year’s improvement practicum celebration event was an exciting in-person event that gave participating teams the opportunity to share their success and learning as part of their improvement journey while being together on the 2021-2022 Improvement practicum. Click here to read more and see photos from the event.
International What matters to you? Day @ CNWL
One Community @ Bay 20 community centre
On International ‘What Matters to you?’ Day, Improvement Advisor, Bridget Browne and Improvement Coach, Vernanda Julien joined One Community at Bay 20 to experience the uplifting and relaxed atmosphere. Please click here if you would like to read more.
For more information on One Community, follow them on twitter @1CommunityCNWL.
If the idea of holding a WMTY event in your local area and would like to explore this further with a member or our team please do not hesitate to get in touch with Geetika Singh, our Head of Quality Improvement at geetika.singh@nhs.net and we will be more than happy to help you.
Additional ways of gaining support are at our QI Clinic by contacting us at cnw-tr.improvementsupport@nhs.net and other educational opportunities here.
Image Source : https://wmty.world/
Executive QI Conversations with Hannah Witty, Chief Financial Officer & HMP High Down
The latest in the monthly series of improvement conversations with our Executive Directors took place in July with Hannah Witty, Chief Financial Officer, hearing about improvement work in medication safety in HMP High Down.
Verity Mills, Head of Healthcare & Kerry Panter, Pharmacy Technician, presented their improvement work on reducing the incidence of missed medications on House block 6. The team also spoke to the positive impact of multidisciplinary team and cross partnership working with Prison governors has had on team morale, motivation and buy-in. This project has really encouraged members of the team to want to improve together. Working with service user representatives ‘Uservoice’ also brought service user views to the heart of the project and helped shape improvement efforts.
This team have really valued being part of this year’s Improvement Practicum and would highly recommend it to other teams as they really appreciated the collaborative learning from other teams and the bespoke support that they received from their QI Coach and Improvement Advisor to share their improvement journey with others.
“We are very proud as a team to have won an Improvement Academy Award for our improvement poster and very much appreciated our achievements being acknowledged by the CQC during their last site visit.”
Verity Miles, Head of Healthcare – HMP High Down
The data also shows that the results of the project are truly impressive and demonstrate that this improvement has been able to be sustained with greater stability in the system.
Well done team!
Gold QI Training – Senior Leaders
Applications are now open for Level 3 Gold QI Training, starting September 2022. This training is aimed at Senior Leaders (Band 8a and above) who want to facilitate or sponsor teams doing QI projects. This workshop based programme is delivered over a three month period with attendance at three half day sessions. This course offers training and tools to help Sponsor an improvement project and support teams to either adopt an improvement approach or to undertake QI projects.
To book your place or for more information, go to LDZ and scroll down to Level 3 Quality Improvement (QI) Gold Training under the Improvement Academy (Quality Improvement) block. The deadline to apply for the course is 5pm on 5 August 2022. If you have any further queries, please email QI team on cnw-tr.improvementsupport@nhs.net
Bronze QI Training – Bitesize – Now CPD accredited!
We are pleased to announce that the Continuing Professional Development (CPD) Service has now accredited the Improvement Academy’s level 1 Bronze QI training from July 2022. If learning more about quality improvement and how you could gain skills to commence your improvement journey to address your messy problems then please click here. We look forward to providing more CPD accredited courses for 2022 and beyond and will update you in future newsletters.
The QI Clinic is here to support your improvement ideas:
Book time with us today to discuss
We are excited to announce that we have listened to your feedback and have increased our QI Clinic time slots from 20 to 30 minutes. So take the opportunity today to book a QI Clinic slot while they are still available!
To book, send a request stating your preferred date and time to cnw-tr.improvementsupport@nhs.net and we shall confirm back to you with a diary invite and link to your QI clinic slot.
We look forward to speaking with you!
Useful Links
Contact information for Improvement Advisors:
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Diggory Division |
Peter Toohey |
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Goodall Division and Corporate |
Peter Smith |
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Jameson Division |
Bridget Browne |
CNWL Improvement Academy Microsite: https://www.cnwl.nhs.uk/ia
Life QI: www.lifeqisystem.com/
If you want to get in touch please contact us here:
cnw-tr.improvementsupport@nhs.net
Follow us on twitter by clicking @CNWLImprovement.