Posted on: 4 October 2023
As we move into Autumn, this edition of the quarterly CNWL Improvement Academy News brings you some thoughts on how Planned Experimentation might be a way to improve and learn as fast as possible, as well as a round up of the latest news and training opportunities.
- What can planned experimentation do for you?
- IA Improvement Badges
- Celebrating Success
- CNWL’s Milton Keynes Community Paediatrics Service shortlisted for HSJ Patient Safety Award
- CNWL celebrates Expert by Experience Involvement in Improvement work
- CRHTT Milton Keynes present their Co-Production practices at an NHS England Event
- QI in the news
- Improving Subject Access Request (SAR) compliance at CNWL
- Quality Improvement Collaborative 2022-23 – Improving Physical Health Monitoring in KCW
- Level 2 QI Training on How to run a QI Project - Peter Smith tells us what is new in cohort 4 and why this training might be for you
- Welcome to Dr Mahmudur Khan, Medical Education & QI Fellow
- Safety Conversation
- Expert by Experience Forum
- Upcoming training opportunities
Planned Experimentation – what can it do for us?
The Model for Improvement may be familiar to us and we often think about and practice the sequential approach to test the effectiveness of a set of change ideas. We may use an effort/impact matrix to think about which of our change ideas to test first and then use ramps of Plan Do Study Act (PDSA) cycles to test each change idea in turn. We often test multiple changes at the same time.
After we have tested a set of change ideas, we may be seeing the effects on our data and it can often be the case that our process measures start to improve before we see the positive affect on our outcome data. At this point in the progress of a QI Project, we may ask ourselves ’which change or combination of changes has brought about this improvement?’. It is usually not possible to draw absolute conclusions about which change in our system has had the most effect. This is where planned experimentation might offer us a way of understanding the nature of the relationship between our changes and the greatest effect on our system performance data.
In essence, a planned experimentation is a deliberate pattern of turning on and off a set of factors (our change ideas) in different combinations and analysis of what overall effect each combination has on response variables (our outcome data).
It is useful to define what we mean by these terms:
Factors are the variables that we are interested in finding out how much effect they will have on our improvement; they are the factors that cause the outcome of our experiment. It can be useful to set out each component as if we are thinking about a Fishbone or Ishikawa Diagram:
Each Factor can have different Levels; in its simplest form, those levels can be just two levels: ‘on’ and ‘off’, but of course there can be more levels.
Our response variables are the outcome of all the factors and background variables; it is the measure that we are trying to improve.
Continuing the thought of the system as a fishbone diagram, the background variables are all the ‘causes’ of the outcome that we know about, but do not wish to study their effects in our planned experiment. Background variables are those that we wish to keep constant as we vary our Factor levels.
Once we have identified the background and response variables, factors and how many levels are needed for each factor, we can plan what is called a design matrix, which sets out how many different tests are needed to cover all of the combinations of factors and levels. The more factors and levels the more complex an experiment will be. If we have three Factors, each with two levels, we would have 23 tests (2x2x2) or 8 different states to test.
One of the difficulties in doing this kind of testing is that turning change ideas on and off can be difficult, for instance if one of your factors is to train staff, you would not be able to ‘turn off’ or ‘un-train’ staff once training is delivered. You would need to order your testing so the training is activated last.
In CNWL, we have yet to try planned experimentation on any scale, so to illustrate what we mean, let us consider a scenario where we wanted to improve assessment process times and we can use some ‘dummy data’ to see how a planned experiment might work?
An example: A planned experiment to reduce waiting times in Children and Adolescent Mental Health Services (CAMHS)
Response variable = Total time taken to complete a patient assessment
Factors (change ideas to be tested):
- Using a new pre-assessment form
- Standardised assessment template
- Digital dictation software for clinicians to write up notes
Levels: For each factor above, either use or do not use (current practice)
If we then went and ran enough tests to work out the average total assessment time for a design matrix, we would get a set of data thus:
Fortunately, software is available to allow us to analyse the outcomes and graphically represent it to be able to decide which is the best or most effective factor or set of factors. Here are two such plots:
We would conclude from these plots that the most effective combination in bringing down assessment times is the digital dictation alone; in the dot diagram we see D for the dictation being on the furthest left (largest reduction in assessment time) and for the cube diagram, the Dictation turned on with the forms both turned off has the least value for average assessment time (the bottom front corner of the cube).
Planned Experimentation is an emerging field and if this article has fired up your curiosity to explore using this approach, please speak to your Divisional Improvement Advisor (contact details at the end of this newsletter).
Further reading:
An example of an academic paper based on using Planned experimentation approaches, see this article, which discusses work to improve the management of acute kidney injury in primary care: Click here.
Reference:
Quality Improvement through Planned Experimentation, Third Edition (2012, Moen, Nolan, Provost) ISBN 978-0-07-175966-3
Improvement Academy Email Badges
Are you proud of your QI training? At the Improvement Academy, we want everyone in CNWL to be proud of their knowledge about how to methodically improve our services, so we have developed a set of Improvement badges relevant to each level of training.
We invite everyone who is trained by the Improvement Academy to place the relevant badge on their email signature. So, this is for staff, service users and carers that have concluded any level of training!
Are you an Improvement Sponsor, an Improvement Coach or have you completed Level 1 Bitesize QI Training?
Here is the full range of badges:
To get your badge, please email the central QI Team at cnw-tr.improvementsupport@nhs.net letting us know which badge is the one for you and we shall send you the file to add to your email signature.
Celebrating Success
CNWL’s Milton Keynes Community Paediatrics Service shortlisted for HSJ Patient Safety Award
CNWL’s Community Paediatrics Service in Milton Keynes has been shortlisted for an HSJ Patient Safety Award in the categories of ‘Quality Improvement Initiative of the Year’ and ‘Improving Care for Children and Young People Initiative of the Year’.
Erika Lamb, Community Paediatrics Manager, said: “This project has involved a lot of time and effort for all the staff involved and has been tackled with real enthusiasm, always with the aim of improving the service provided to the young people and their families in Milton Keynes.
“To receive the wonderful news that we have been short-listed for an HSJ Patient Safety Award is so exciting and a real reward for the whole team, whether we win or not, for all the hard work involved.”
Read the full story here.
CNWL celebrates Expert by Experience Involvement in Improvement work
The inaugural Expert by Experience (EbE) celebration event, organised by the CNWL Improvement Academy and Involvement team, in collaboration with EbE colleagues, took place on Thursday, 8 June 2023 in the Bevans at Trust Headquarters. The theme of the event was 'Collaborating for Success: A Celebration of EbE Involvement in CNWL Improvement Work'. Fifty-seven individuals attended this event, including service users, carers, CNWL staff and a representative from NHS England and NHS Improvement (NHSEI).
The event commenced with the opening remarks delivered by Janet Seale and Sandra Jayacodi, setting the tone for the celebration. They highlighted that the event was aimed at celebrating the outstanding efforts of CNWL staff, service users and carers, who have worked together to improve the Trust’s services. Following the introduction, the Chief Medical Officer, Dr Con Kelly, took the stage to share insights from his own improvement journey. He is a big advocate of EbE involvement in improvement work and made sure to stress how crucial it is.
During the event, two improvement teams—the Crisis Resolution and Home Treatment Team and the Information Governance team—presented their improvement work, shining a spotlight on the invaluable contributions made by their respective EbE colleagues, Paul Jones and Sandra Jayacodi. The subsequent Q&A sessions that followed each presentation sparked interesting discussions and showed overwhelming support for EbE involvement in improvement work.
Sandra, then facilitated a panel discussion featuring three panel members. Their discussion revolved around ways of ensuring meaningful engagement of EbE colleagues in improvement work. One key takeaway? EbE involvement is like the secret ingredient in a delicious meal – absolutely essential.
To wrap things up, Trust Chair, Tom Kibasi gave his closing remarks, reminiscing about past experiences that strengthened his resolve to be a strong advocate for the involvement of EbE colleagues in improvement work. As a token of appreciation, awards were presented to twenty-two EbE colleagues, recognising their invaluable contributions towards enhancing the Trust's services.
The event was a success, with 100% of respondents rating it as good or excellent. People also called for more EbE celebration events in the future, suggesting that they be integrated with existing Trust-wide celebrations.
Read the full story here.
CRHTT Milton Keynes present their Co-Production practices at an NHS England Event
The Crisis Resolution and Home Treatment Team (CRHTT) from Milton Keynes presented their success story at the "Shine a Light on Co-production" event hosted by NHS England on 15 August 2023. Their presentation, titled "Co-producing Improvements in Patient Flow: Our Success Story," highlighted the benefits of meaningful Expert-by-Experience (EbE) involvement in improvement work. The presentation was delivered by Claudette Wrake, the QI project lead, and Paul Jones, the EbE Representative.
In their presentation, Claudette discussed how they recruited Paul locally to join their QI project team. She highlighted the inclusive nature of their QI project meetings, which genuinely incorporated Paul's perspective. She further underscored the importance of engaging EbE colleagues as equal partners in any improvement work.
The insight informed by Paul’s lived experience regarding the importance of maintaining consistent patient contact served as the foundation for the team’s lone working change idea. This change idea was then tested through three Plan-Do-Study-Act (PDSA) cycles showing measurable improvements in patient flow and care quality. The CRHTT team achieved a 36% improvement in lone working visits, while also showing improvements in staff workloads and resource utilisation.
Read the full story here.
QI in the News
Improving Subject Access Request (SAR) compliance at CNWL
CNWL’s Information Governance Team led a Quality Improvement (QI) project to improve Subject Access Requests Compliance to 95%.
But what is a SAR and why is it important?
SARs are a statutory requirement under the Data Protection Act 2018, and the UK General Data Protection Regulation (GDPR) that allow individuals to view and receive a copy of their personal data that is being 'processed.' This applies to both patients and employees.
Complying with a SAR within the allocated one calendar month demonstrates that CNWL is fulfilling its commitment to being compliant with the GDPR’s accountability and transparency principles. Non-compliance with this statutory right could lead to reputational damage to the organisation and regulatory action by the Information Commissioners Office (ICO).
To read the full article on how the team successfully improved compliance to 98%, click here.
Quality Improvement Collaborative 2022-23 – Improving Physical Health Monitoring in KCW
The ReFoCuS Community Forensic Service for Kensington & Chelsea and Westminster (KCW) have succeeded in their aim to improve annual physical health assessment rates for patients living with severe mental illnesses (SMI).
The project, which was part of CNWL’s 2022/23 Quality Improvement Collaborative, will increase their service’s average percentage of completed physical health assessments by 20%. The Community Forensic Service also aspired to help improve their patients’ engagement with physical health clinics, and to improve communication between their team and primary healthcare colleagues.
Read the full article here.
Level 2 QI Training on How to run a QI Project
Peter Smith tells us what is new in cohort 4 and why this training might be for you
To date, 38 staff have been trained in Level 2 QI Training and 77% of staff who attend the course are able to graduate and demonstrate their learning from their QI project.
54% of participants remain active on Life QI after the course and 78% of projects have meaningful Expert by Experience involvement
Peter Smith, Course Leader and Improvement Advisor, Goodall and Corporate Divisions, said that “every cohort of the training that we deliver is a chance to learn about what works and what can be improved; each one is a Plan Do Study Act cycle and we learn something every time. We have focused on creating an experience in a learning community and provide trainees with a sense of their QI learning journey, so that they stay motivated and enthusiastic!”
Here are some of the comments received from staff feedback:
The full article is here.
Welcome to Dr Mahmudar Khan, Medical Education & QI Fellow
We are excited to welcome our new Medical Education and Quality Improvement Fellow, Dr Mahmudur Khan, who has taken up his new role this Autumn. Here is what Mahmud wrote to introduce himself:
“Hello I’m Mahmud, and I recently joined the trust as the Medical Education and Quality Improvement Fellow. I am a medical trainee by background, and I have just completed Internal Medicine Training in North West London. I am currently taking a break before continuing with higher training, and I chose to pursue this role due to my interest in QI and medical education.
I have dual role and work with both the QI and postgraduate medical education team. On the QI side I hope to encourage fellow doctors to pursue QI projects they are interested in and to support them to deliver successful and worthwhile projects. On the other side of my role, I aim to improve the quality of the trainees’ experience at CNWL as they rotate between different roles.
I am really excited to share my genuine enthusiasm and interest for QI work with fellow doctors, with the hope that they can take the knowledge gained at CNWL to deliver numerous successful projects in the longer term”
We wish Mahmud every success in his time working in QI at CNWL!
Safety Conversation 2023
This year’s all-day virtual Safety Conversation Day will be held on Thursday 9 November 2023.
Please register on Eventbrite here to get the date in your diary.
Applications are now open to submit a poster. This year you would have the opportunity to participate in two different poster submission competitions. If you would like your poster to be judged:
- Submit your poster by 2 October at 5:00pm to be considered for presentation on the day* or
- Submit your poster by 25 October at 5:00pm to be considered for an improvement award
* Posters submitted for oral presentation do not need to resubmit to be considered for an award. They will automatically be added for judging.
Please submit your poster using this link: https://forms.office.com/e/jY3NeUMGJ9
A poster template is available here.
Expert by Experience Forum
We are proud that across CNWL, we are maintaining an extremely high proportion of active QI projects with a formed project team having logged service user and carer involvement on Life QI. The latest data for September 2023 shows a rate of 86% of projects having meaningful Expert by Experience involvement.
Experts-by-Experience Forum - Would you like support to involve Service Users and Carers in your improvement work?
The Quality Improvement and Involvement Teams facilitate a collaborative working group called the Expert-by-Experience (EbE) Improvement Forum. This group comprises of service users and carers who have used CNWL services and are passionate about improving services.
Our EbE forum members bring unique perspectives and insights to your improvement work which help ensure that your improvement work is going to be meaningful and have the best impact for those who use your service.
These forums are held every five weeks via Zoom. The three available slots for each forum are allocated on a first-come, first-served basis and are as follows:
- 6 November 2023 from 1:30-3pm (20 mins slot per team)
- 11 December 2023 from 1:30-3pm (20 mins slot per team)
Interested teams can book one of the three available 20-minute slots by contacting the QI team via cnw-tr.improvementsupport@nhs.net.
Upcoming Training Opportunities - building your QI knowledge
The Improvement Academy offers a full education programme open to anyone in CNWL and any service user or carer who is actively working with a QI project team in CNWL.
Level 1 Bronze QI Training - Bitesize QI
Continues monthly as a half day virtual session to explore the Model for Improvement. We wish to encourage staff at Band 3/4 to take up this training as these colleagues are less represented in staff who access Bitesize QI.
To book your place go to LDZ and search/look for Level 1 Bitesize QI Training to enrol and book a training date suitable for you.
The next available training days are: 11 October; 15 November and 14 December, with each training sessions runs 9.30am to 1.00pm.
Level 2: Silver QI Training – How to run a QI Project
Level 2 QI Training is a 4-month training programme that is aimed at staff who want to run a quality improvement (QI) project. The course will deepen understanding of using improvement methodologies and tools and help staff to develop skills to successfully run a QI project. The course is a virtual workshop-based programme, delivered over 4 months with formal training and access to QI coaching.
The next cohort will commence in October and applications are now closed.
Dates for the next cohort will be released during Autumn 2023 and will be bookable via LDZ.
Read about what is new for cohort 4 here.
Level 3 Leading Improvement for Senior Leaders – Limited spaces available
Are you a Senior Leader who wants to lead improvement of your services and adopt an improvement approach to your role? Do you want to know how to sponsor teams doing QI projects? If so, then this is the course for you.
We are pleased to be re-opening applications for the CPD accredited CNWL Level 3 Gold QI Training, which will be held in-person on 16 November 2023 at Hamilton House, London, WC1H 9BD. This workshop-based training is aimed at Senior Leaders (Band 8a and above). This course offers training and tools to help Senior Leaders to; adopt an improvement approach to their day to day work, sponsor an improvement project and support teams to use an improvement approach.
To book your place or for more information, go to LDZ (click here) and scroll down to Level 3 Quality Improvement (QI) Gold Training under Leadership and Management block. The deadline to apply for the course is 5pm on 30 October 2023. If you have any further queries, please email the QI team on cnw-tr.improvementsupport@nhs.net
All QI training provided by the Improvement Academy can be booked via LDZ here: https://cnwllearning.org/login/index.php
For full information and resources relating to QI in CNWL, visit the Improvement Academy website at: https://www.cnwl.nhs.uk/ia
The QI clinic is here to support your improvement ideas
Book time with us today to discuss
Any CNWL team who would like help with any aspect of their QI project can book into a QI clinic.
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
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Head of QI |
Geetika Singh |
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 |