Improvement Academy Newsletter - May 2022

In this edition, our feature article will be an introduction to the What matters to you? (WMTY) Movement in the lead up to International #WMTY2022 Day on Thursday 9 June 2022.

Our improvement story this month is from Elshadai Markin on Willow ward at the Campbell centre in Milton Keynes. We also have an update on this month’s Exec QI conversation with Westminster North Hub CMHH and Con Kelly.

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. We also have exciting news from the Improvement Academy Awards in-person and Live streamed event last Friday 6 May 2022. In addition, we also have links to great educational opportunities that are coming up.

Image Source : https://wmty.world/

An introduction to the What matters to you? movement

In the lead up to International #WMTY2022 Day on Thursday 9 June 2022, we would like to build on last month’s newsletter where we explored the IHI Quadruple aim and introduce you to the What matters to you? Movement, it’s origins and how it has evolved to what it is today.

The ‘Crossing the Quality Chasm’ report (IOM, 2001), first introduced the concept of ‘patient-centred’ care as a fundamental cornerstone to improving the quality of healthcare and defined it as “care that is respectful of and responsive to individual patient preferences, needs and values” and that ensures “that patient values guide all clinical decisions” (IOM,2001). Fast forward a decade or so and Barry & Edgman-Levitan (2012) found that although talking about patient-centred care was ubiquitous in modern healthcare, one of the greatest challenges of turning rhetoric into reality continued to be routinely engaging patients in decision making.

Barry & Edgman-Levitan (2012) identified that to successfully address this critical component of quality and safety, we must break down critical barriers between clinicians and service users & carers. Barry & Edgman-Levitan (2012) continued, stating that service users & carers should be educated about the essential role they play in decision making and be given effective tools to help them understand their options and the consequences of their decisions. They should also receive the emotional support they need to express their values and preferences and be able to ask questions of their healthcare professional (Barry & Edgman-Levitan, 2012).

Barry & Edgman-Levitan (2012) identified that Healthcare professionals, in turn, needed to relinquish their role as the single paternalistic authority through ‘shared decision making’ and train to become more effective coaches or partners - learning, in other words, how to progress beyond asking ‘What is the matter?’ to a more humanistic ‘What matters to you?’.

Several years later, on the backdrop of this paper, Maureen Bisognano, former Institute for Healthcare Improvement (IHI) President and CEO was inspired to throw down a challenge at the IHI/BMJ International forum in Paris, in front of thousands of Health and Social care leaders from across the globe, to ask that very question...and the beginning of a movement was born.

The first to take up this challenge was Anders Vege, Nurse and Head of a Department of Quality Improvement, and a team of Norwegian healthcare professionals who organised a system for older people to support them to live by their preferences. So, it was then that 6 June 2014 was instituted as being the first official date of the What matter to you? campaign.

This spread to Professor Jason Leitch and Shaun Maher in Scotland and Kris Vanhaecht in Belgium and Isabela Castro in Brazil and so many more.

These health and social care leaders found that asking service users & carers and their team members “what matters to you?” changed the way they designed care with service users & carers and gave them new meaning in their work each day. These teams found each other and began to share their experiences and enthusiasm as they built this question into their daily work. In 2015, the WMTY movement became recognised internationally.

The underlying principle is to encourage and support more meaningful conversations between people who provide health and social care and the people, families and carers who receive health and social care to understand what is ‘most important’ to service users & carers, leading to better care partnerships and improved patient experience. Asking staff WMTY is also a fundamental element of the IHI’s Framework for Improving “Joy in Work” (Perlo, 2017), where staff are asked what matters to you? The WMTY movement has now spread to over 49 countries and has been integrated into workflows at diverse care settings including hospitals, primary care, behavioural health, substance use treatment programs and community based social service organisations.

Many trusts across the NHS are beginning to get involved and generating a lot of engagement while sharing their learning with others along the way with over 15 million impressions on Twitter last year. This year you will be able to follow what teams are doing both locally and abroad by searching Twitter for the hashtag #WMTY22. You can also access many resources, gain inspiration and ideas at:

https://wmty.world/

http://www.ihi.org/Topics/WhatMatters/Pages/default.aspx

Anders Vege’s improvement story click here

Professor Jason Leitch’s TED talk @ TEDx Glasgow “What Matters to Me”

If you are interested in holding a WMTY event during the month of June 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/

References:

Barry, M.J. & Edgman-Levitan, S. (2012) ‘Shared decision making – Pinnacle of patient-centered care’, New England Journal of Medicine, March 1;366(9), pp.780-1. doi: https://www.nejm.org/doi/10.1056/NEJMp1109283

Institute of Medicine (U.S.). (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, D.C., National Academy Press.

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

Improvement Stories: Willow Ward In-patient Mental Health Unit

This month’s improvement story focuses on the reduction of incidents of self-harm on Willow ward. Elshadai Markin, a QI champion and Willow project lead, shares a story of his and his team’s improvement journey that speaks strongly to the power of co-production to achieve better outcomes for their patients.

Reducing Self-Harm on Willow ward through co-production

Our team wasn’t ready to submit a poster for the Safety Conversation in November 2021, but we’ve come a long way in the short time since then.  Now is the time to start sharing some of our story with our colleagues across CNWL.

Willow Ward is a 19 bed In-patient mental health unit for women, located in Milton Keynes.  The team has been part of the CNWL Practicum that started in June 2021.  Our focus has been in reducing self-harm on the ward – something the team has wanted to work on since 2019.  It took us a while to get going, but we are now seeing real improvements in data relating to self-harm, rapid tranquillisation and feedback from both patients and staff on the atmosphere on the ward. 

Over the past year we have focused on 2 change ideas:

• Introducing evening activities on the ward;

• Providing 1:1 support for patients before and after ward round

We have now moved from testing these ideas into making them business as usual within our ward. 

This has felt like a long journey.  Like everyone else in CNWL, we’ve had challenges over the year – Covid outbreaks, challenges with staffing.  We’ve also had to do our work while dealing with the challenges that are part of working on an in-patient mental health ward.  At times it felt like we were taking a step backwards, or fighting just to stand still.  However, we are now starting to see the benefits of our work.  Reflecting on this, we feel that there have been two really important factors for this:

• Listening to our patients, and involving them in the changes we made and how we made them;
• Listening to each other, going beyond the core nursing team to involve all of the MDT that support our patients.

When we started our evening activities work, we introduced the idea to patients on the ward, to see if they’d like to ‘do something’ that evening.  Over time, this ad hoc approach has become more formal, with regular conversations with patients on the ward as well as discussions at the weekly community meeting.  This has helped us to develop a programme of activities that we can deliver several evenings a week.  Patient involvement and feedback into whether they’ve enjoyed activities and what they might like to do in the future will continue as we scale up and make this part of normal life on Willow.  Our peer support worker is now involved in the project team, and will lead on this aspect of the work.  Patient feedback on the 1:1 support, including experience of ward round, has been central from the start of this work.  We’re still scaling up our tests with this idea and we’re making progress and starting to normalise the approach across the team.

Over time, we’ve also extended membership of our improvement project team.  At first it was made up of nurses and HCAs who were ward based.  It now includes colleagues from psychology and occupational therapy.  This has made a massive difference to the resources available to us as a team, giving us different perspectives on change ideas, and helping to provide time to test things and feedback even when we are busy.  We’ve made a point of meeting together, with our coach, every week as much as we can.  Even when we’ve not managed to do very much between meetings, it has allowed us to review progress, chase up missing information and get us going again.  Watch out for our poster at the Improvement Academy Awards this month.

Since Elshadai wrote this story, The Improvement Academy is very excited to announce that the Willow ward Practicum project team won best ‘Runner up’ poster at the Improvement Academy awards last Friday. If you would like to know more see their poster submission here.

If you would like to know more specific details about this project then please email us at cnw-tr.improvementsupport@nhs.net and we will be very happy to connect you with Elshadai or someone from the improvement team on Willow ward at the Campbell centre.

Executive QI Conversation with Con Kelly, Chief Medical Officer

This month the Westminster North Hub CMHH shared their improvement work with our Chief Medical Officer, Con Kelly and Trust QI Leads. As part of the Safety Theme on the CNWL Practicum 2021, the team has been working to reduce the number of patients on the caseload who haven’t had a contact for 45 days or more. The team shared how using the QI approach has helped to structure and focus their work and celebrated a fantastic improvement of over 54% reduction in the number of patients who have not been contacted for 45 days or more. It was wonderful to see how a whole team approach to improvement helped move their project forward and the team are already developing their next improvement idea. They are also runners up in the Improvement Awards and we look forward to hearing more from the team as their improvement work develops.

Congratulations Westminster North Hub CMHH team!

Simon Edwards, Clinical Lead for QI and Diggory Division Medical Director said of this work, ”Fabulous effort showing that engaging everyone in the team in coming up with solutions really works and makes people happy”

Improvement Awards 

CNWL’s first annual Improvement Awards was held today (Friday 6 May) to celebrate new initiatives that make practical improvements to healthcare services.  

28 teams from across the Trust entered the awards competition, each submitting a poster to showcase their improvement work. The top five entries received an Improvement Award and trophy presented by Dr Cornelius Kelly, CNWL’s Chief Medical Officer and Executive Sponsor for the Improvement Academy.

The winning teams joined us at the celebration event to present their improvement projects and demonstrate their criteria for success.

Read more and see the winners' posters here.

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!

Level 1: Bronze - Bitesize (Intro to QI) New dates for 2022!

Dates for the ever-popular monthly 3-hour virtual QI training on the model for improvement and how to set out on a QI project are bookable here direct on the Improvement Academy website.

Useful Links

Contact information for Improvement Advisors:

Life QI:  www.lifeqisystem.com/

If you want to get in touch please contact us here:

cnw-tr.improvementsupport@nhs.net

and follow us on twitter by clicking @CNWLImprovement.