24 October 2018

Reaping the benefits of Quality Improvement

October has seen the continuation of some glorious autumnal weather, providing perfect harvesting conditions, the theme of this month’s newsletter. In CNWL Quality Improvement has continued to grow, as a consequence of being nurtured and tended to by staff and service users, in collaboration with IHI our QI partners. Consequently we are beginning to reap the benefits as evidenced by projects such as those in Milton Keynes (see article below).

This month our 30 trainee QI Improvement coaches have all been assigned to support new or existing projects, and we wish them well as their training progresses.

Growing in IHI Open School and Life QI users

Here’s an update on numbers of completed IHI Open School courses and amount of live projects on Life QI.

  • 290 staff have registered for training on IHI Open School
  • 516 IHI Open School training modules have been completed
  • We now have 227 active projects on Life QI
  • 686 staff have now registered on Life QI
  • Seven QI projects have been completed on Life QI  

You can see here that more of you have joined our Life QI community online:

 

Diggory: Milton Keynes using QI methodology is yielding returns

The Windsor Intermediate Care Unit (WICU) ward in Milton Keynes is successfully using QI methodology to implement the Red2Green approach

The project team hope to reduce internal and external delays in a patient's journey towards discharge, thereby reducing the overall length of stay on the unit. The project is led by Melissa Cahill (WICU Manager), and supported by Dinah Pressly (QI Improvement Coach trainee).

It is adopting the use of the Red2Green approach which is a visual management system to monitor for wasted time in a patients’ journey. Using QI methodology has enabled local staff working alongside patients to come up with and test change ideas that take into account the local environment.

These changes include:

  • Implementation of a daily handover between all staff.
  • Introduction of shift coordinator role to make sure one member of staff has overall oversight of the unit. Introduction of a structured handover using an SBAR (Situation, Background, Assessment, Recommendation) format.
  • Completion of handover workshops on the unit.
  • Implementation of a whiteboard for all staff to input onto in the unit office to aid the daily Red2Green board rounds

Healthwatch has also got involved and we will be testing the introduction of a bedside booklet for each patient (“My rehab journey”). This is designed to keep the patient engaged in their rehabilitation journey.

Feedback from the team leads is that, “the QI approach has helped the team to focus on a specific aim and undertake tests of change through the supportive structure of Life QI. It has promoted buy-in from the ward team and everyone is excited about reaching our goal of reducing length of stay.”

The graph below shows some promising early results.

Average weekly length of stay on WICU (using SystmOne weekly data on average LOS of discharged patients)

Improvement Coach Development Programme

 

As previously mentioned, 30 CNWL staff embarked on their journey as Improvement coaches by attending the first three of six face-to face days of training late last month. These individuals have now all been assigned to support existing QI projects, initially as trainee QI coaches. QI coaches will in future play a significant part throughout CNWL in supporting QI project teams. We wish them and their projects well.  

Life QI Tip of the month: use a block diagram to assess and narrow project boundaries

Assessing boundaries with a block diagram

  • Choose a process you want to improve
  • Draw an initial block diagram of the process
  • Assess the boundaries of the process- if it’s too big, narrow it down.

It is best to narrow project boundaries to focus on a manageable slice, typically two to four blocks. To narrow boundaries it can be useful to:

  1. List where barriers to flow or problems happen, or opportunities to improve (can use A,B,C.. etc. below for your list)
  2. Assign each barrier/problem/opportunity to the various process segments
  3. If the barriers tend to locate in some small number of segments, consider narrowing project boundaries to those segments.