Posted on: 24 May 2024
It’s been a great year so far and below we are sharing some of the Quality Improvement (QI) work going on and around CNWL, including an international visit.
As we head into the summer of 2024, the QI Team are reflecting on their time at the IHI/BMJ International Forum for Safety & Quality 2024 and would like to introduce some new team members.
We have an exciting update within our training opportunities – the next cohort for Level 2 starts in July and Level 3 still has some places available. Read on for further information on both of these and how you can book a place via LDZ.
In this issue, you will find a roundup of the latest news and training opportunities:
- Using QI to establish (and improve!) Patient Reported Measures (PRMs)
- Celebrating Success
- Improving Flow Spreadathon Celebration Event
- Improving the management of peripheral arterial disease at Camden Podiatry
- CNWL Improvement Academy publishes 2023 annual report
- Kensington and Chelsea Home Treatment Team lead education initiative to improve team skills and expertise
- International Chief Quality Officers visit CNWL Improvement Academy
- Introducing new members to the QI Team
- Expert by Experience Forum
- Upcoming Training Opportunities - building your QI knowledge
- Useful Links
Using Quality Improvement (QI) to establish (and improve!) Patient Reported Measures (PRMs)
- Do you ask your service users (SU)/ patients/carers about their treatment?
- Do you act upon their feedback to improve future SU experience and/or outcomes?
- Can you capture any data before and after their intervention?
- Is there an existing conversation that takes place where the service users/patients tell you how they are finding things?
- Are you certain you are asking the right questions of your service users?
These questions are initial prompts to help you to start thinking about the information below.
There are two umbrella terms: Patient Reported Outcome Measures and Patient Reported Experience Measures. These should both be at the core of any QI work we do at CNWL.
What are PROMs and PREMs?
PROMs = Patient Reported Outcomes Measures
PREMs = Patient Reported Experience Measures
PROMs are the tools we use to capture the Patient Reported Outcomes information directly. They are best used in clinical practice, facilitating clinician-patient communication, but have over the years been bought into clinical trials. They enable the patient to input into their own care and treatment and can aid in informing commissioners (such as the NHS Integrated Care Boards - ICBs) why any future service design, or redesign, may be necessary.
PROMs have been collected by all providers of NHS-funded care since April 2009. The first ever PROMs were trialled within an elective surgical environment, where patients completed the same questions before and after their surgery. Reporting of these was made mandatory so they could measure the effectiveness of the intervention.
There are two types of PROMs:
- Generic (these are usually measures of wellbeing / quality of life) and they can help with looking across different disease states
- Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)
- Asking questions such as I’ve been feeling useful, I’ve had energy to spare, I’ve been feeling close to other people etc. where results are plotted
- Condition-Specific
- Disease specific – such as Oxford Hip score
- Cannot be used to compare against different conditions or diseases, unlike Generic
PREMs can be considered to be a quality measure in terms of the care we deliver to our service users; how they think, feel, and reflect on the care or treatment they have received. How a patient experiences the care we provide is inextricably linked to the outcomes of their care and treatment. It also has a profound effect on the staff providing the care.
The friends and family test (FFT) that service users, carers, relatives etc. take part in to tell us how we’re doing as a Trust is a great example of a PREM that is used consistently across the whole of the NHS and CNWL.
Alongside the FFT, each service may also have a feedback survey for their service users and relatives to answer. Ideas for questions to measure service impact can be found on the CARE Measure Website.
There is a great opportunity to consider embracing the concept of PROMs and PREMs where possible. Over time, they have been used in many different contexts throughout the NHS, in both acute and MH settings, to improve processes, outcomes and experiences of our service users.
What is the added value?
There are benefits in having these metrics in place for different reasons, depending on whether you are focusing on the micro, meso or macro levels of the system:
- Individual Patient/Service user level
- Service level
- Organisation / System level
How does this link to other strategies and objectives at CNWL?
As the NHS as a whole move towards patient centred care, and patient choice initiatives, we at CNWL are aspiring to measure what matters to our service users, their families/carers, and our staff, to ensure the work and care we provide is effective and meets (if not exceeds) their expectations.
As part of the Trust Strategy, one of our Strategic Principles is ‘Digitally-enabled; data driven’ meaning we need to be data informed and this plays into PROMs and PREMs. We need to work with clear and aligned information about our services and service users, patients and carers, and using this to inform effective decision making. Your PROM or PREM would form part of this. You would be able to capture data, identify areas for improvement and act upon it. Experience measures and feedback from our service users, and people, are monitored by the Board.
Outcome and experiences form a large section of the draft Clinical Strategy too.
Still in its finalising stage before publishing, there is a section specifically looking at Outcome Focused Care and a golden thread throughout the clinical strategy is Service Users, Families & Carers Voice. Both of these would ensure we have PROMs and PREMs in place at CNWL to improve and better our services for everybody who accesses and works within them.
Where and how to use PROMs and PREMs in improvement work
You are likely already using these if you work in a community adult mental health setting as CNWL launched DIALOG+ back in 2022.
It is best practice to coproduce/develop any new PRMs with service users/EbE to ensure it covers the most important domains of a specific condition, or a generic PROM where there is no specificity to a specific disease or condition. It is also important the PROM is sensitive enough to detect meaningful change, otherwise an improvement cannot be seen.
Usually PROMs will be introduced into clinician-service user consultations for specific measurements, or can inform QI work at the service level or across an entire Trust for a more generic view.
We hope this article has inspired you to consider how you could use PREMs and PROMs within your quality improvement work to directly improve the care we provide to the communities we serve.
If you would like to talk this through further with the QI team, please reach out to us via our team email address: cnw-tr.improvementsupport@nhs.net, where we’d be happy to help answer any queries or explore improvement ideas with you.
Further resources
If you’d like to explore this topic more, we’ve included some videos and articles below.
- PROMs, PREMs and Patient-Centred Care (PCC): How PROMs and PREMs can contribute to PCC in a LHS
- What are patient reported outcomes measures (PROMs)?
- BMJ Open Quality article - Measure what we want: A taxonomy of short generic person-reported outcome and experience measures (page 10)
- How subjective well-being, patient-reported clinical improvement (PROMs) and experience of care (PREMs) relate in an acute psychiatric care setting?
Celebrating Success – articles from around CNWL
Improving Flow Spreadathon Celebration Event
On Thursday 9 May 2024, CNWL held its first Improving Flow Spreadathon celebration event. The Spreadathon involved eight teams, from five acute in-patient mental health sites, working towards a common goal of improving their length of stay by at least 10%.
The energy and enthusiasm in the room was infectious, a special thank you to everybody who was involved in attending, those covering teams back at base, and those involved in preparation or speaking at the event. Presentations and stories were shared throughout the day, including:
- Looking at how the Improving Flow Spreadathon teams have come so far
- Each team presenting their biggest breakthrough PDSA
- Table discussions looking at how to sustain and maintain their project successes beyond the programme
Read the full story and see photos from the event here.
Improving the management of peripheral arterial disease (PAD) at Camden Podiatry
Camden Podiatry service has been able to improve the detection, diagnosis and management of peripheral arterial disease.
The improvement work included:
- A weekly clinic session to provide vascular assessments
- A new referral pathway, which was approved by a Vascular Consultant at University College London
- Upskilling clinicians in vascular assessments to use in daily patient care
- Working more closely with vascular teams and GPs
- Providing education materials to patients for diagnosis of PAD as well as cardiovascular risks, including healthy lifestyle changes (smoking and exercise)
This new approach has led to:
- A reduction in unnecessary outpatient referrals
- An increase in staff motivation and confidence
- Improved patient experience and more personalised care because care is given quicker and closer to home
Read the full story here or view their poster here (opens PDF).
CNWL Improvement Academy publishes its 2023 Annual Report
The report highlights the successes and challenges of the past 12 months, exploring key case studies, and looking at next steps for the future.
Read the full story, including primary aims for the year 2024, and report here.
Kensington and Chelsea Home Treatment Team lead education initiative to improve team skills and expertise
Senior staff and team members, part of the Kensington and Chelsea Home Treatment Team (HTT), identified a lack of confidence in certain key areas of their work during their regular supervision sessions, team meetings, and handovers.
In order to address these areas, they developed a programme to build up the team’s skillset and improve the standard of patient care through a 'bitesize' teaching programme. Post-teaching assessments revealed an average 41% surge in confidence.
Read the full story here.
International Chief Quality Officers visit CNWL Improvement Academy
A total of nine senior leaders from Canada, Brazil, Jordan and Australia visited us to hear about our Improvement Academy and how we have embedded and sustained improvement across the organisation.
Read the full story here
Check out other success stories on our Improvement Stories tab of our website.
If you’d like to share your good news story or something you have been working on, get in touch with us!
Introducing new members to the QI Team
The QI Team would like to welcome three new team members: Laura, Sam and Abigail.
Laura Lubimbi, Improvement Support Officer
Laura's career journey within the NHS commenced in 2020 at the Central and North West London NHS Foundation Trust. Throughout her time, she has held a variety of roles encompassing both clinical and administrative capacities, ranging from Assistant Health Care/Support Worker positions to Senior Administration roles within Mental Health Wards. Her primary interest lies in elevating the standard of care and quality of life for both patients/relatives and staff members alike. This dedication has seen her actively involved in assisting Quality Improvement initiatives on the wards, ensuring that the diverse needs of patients/relatives and staff are met effectively.
Since joining the QI Team in January 2024, Laura seeks to leverage her adaptable skill set, developed through her multifaceted clinical and administrative roles, by transitioning to the Quality Improvement Team at CNWL. This move reflects her desire to further contribute to enhancing care standards within the Trust.
Sam Heritage, Improvement Coach
Sam began his NHS career at Bolton NHS Foundation Trust working as a Quality Improvement Project Manager. In his time there, the principle share of his portfolio concerned the reduction of Clostridium Difficile. It offered a unique perspective and challenge working in an acute setting such as Bolton. Moving to CNWL, a new challenge presented itself having never worked with community services before. Joining CNWL in March 2024 has been a real privilege and the team couldn’t have been more welcoming.
Sam’s interest in healthcare began during the final year of his undergraduate at the University of Sheffield, the history of medicine in India during the 18-20th centuries was a key focus. Following this, during his time at the University of Manchester, Sam wrote his MSc thesis on the history and pathology of Cystic Fibrosis. This work focused principally on the relationship between patient and practitioner in the context of a chronic condition. This awareness is something that has been really valuable working in QI. Sam thrives when meeting new people and working with both clinical and corporate teams.
Abigail Peck, Improvement Coach
Abigail has worked for the NHS for 7 years, advancing through different Corporate roles including within Leadership & OD and strategic Project Management positions. Abigail’s enthusiasm and interest into QI began when she worked through her Level 4 Apprenticeship and qualified as an Improvement Practitioner.
Abigail has a keen eye for detail and enjoys challenging how things have always been done, identifying where there may be room for improvements. Abigail loves to support teams to work towards a common goal and achieve a successful improvement within their own areas, of which they can be proud of and sustain after the QI project has officially closed. Abigail is approachable and always willing to support, whether that’s assistance with getting a QI project started, analysing data, or discussing ideas how to engage your team better.
Expert by Experience (EbE) 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 EbE involvement on Life QI. We have consistently remained at 86% of projects having meaningful EbE involvement, with an increase to 87% in April 2024.
Would you like support to involve EbEs in your improvement work?
The QI and Involvement Teams facilitate a collaborative working group called the EbE Improvement Forum. This group comprises of EbEs 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 the next available date is:
- Monday 1 July 2024, 1.30-3pm (20 mins slot per team)
- Monday 5 August 2024, 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.
EbE Newsletter
Our EbE newsletters celebrate collaborative working between CNWL staff and Expert by Experience colleagues across various improvement projects in the Trust.
The April edition of the EbE newsletter features 2 case studies and summarises the processes involved in recruiting an EbE colleague to support your improvement work.
The next edition is planned for July, where we’re asking to hear from any project teams who have had meaningful involvement from EbE(s) and would like to share your story. Please get in touch!
Upcoming Training Opportunities - building your QI knowledge
The Improvement Academy offers a full education programme open to anyone in CNWL and any EbE who is actively working with a QI project team in CNWL.
Level 1 (Bronze) QI Training - Bitesize QI (CPD Accredited Training)
This half day session (9.30am - 1.00pm) will provide a brief introduction to QI for all staff who are either already involved in QI projects or thinking about being involved and want to learn more. During this CPD accredited training you will learn about the Model for Improvement, driver diagrams and PDSA cycles. We will also start to explore the use of data to capture improvements.
All levels of staff are welcome. You do not need to be leading or involved in a pre-existing QI project to attend. Band 3 and 4 staff are especially encouraged to book this training as they are underrepresented in previous cohorts.
The next sessions are 12 June and 9 July; these are currently fully booked! Please search LDZ for Level 1 Bitesize QI Training to enrol onto dates later in the year or watch out for any cancellation places before the summer holidays.
It was great to see colleagues for a face-to-face session (see photo below of colleagues practicing PDSA using Mr Potato Head!) for the first time since before the pandemic. If you would prefer to attend in person, our next f2f session is 10 September 2024.
Level 2 (Silver) QI Training – How to run a QI Project (CPD Accredited Training)
This training is designed to provide staff with the skills and experience to run a QI project; it picks up where the Bitesize training left off. The course is a virtual workshop-based programme and is CPD accredited. This would be delivered over 4 months and will help anyone in a QI project team and is especially useful if a member of staff wishes to take on the role of Project Team Leader.
We are pleased to announce that dates for the next cohort are below, starting in July 2024. The structure of the course is as follows:
- Learning session 1: Thursday 11 July 2024
- QI coaching clinic 1 (30 mins per project): Tuesday 3 September 2024
- QI coaching clinic 2 (30 mins per project): Thursday 17 October 2024
- Learning session 2 (Graduation): Tuesday 26 November 2024
Satisfaction with the course is consistently high and we encourage you to consider the training for yourself and pass on this information to colleagues who would benefit from this training.
You have until Tuesday 25 June 2024 to book your place via LDZ. Please search/look for Level 2 (silver) QI Training: How to run a QI Project under the Improvement Academy (Quality Improvement) tab. You’ll be required to answer a few questions around a real project you are working/planning to work on as part of the course.
Please contact the QI Team on cnw-tr.improvementsupport@nhs.net if you would like to talk to someone about the course, and the team will be eager to help you decide if this course is for you!
Level 3 (Gold) QI training: Leading Improvement for Senior Leaders (CPD Accredited Training)
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 opening applications for the next CNWL Level 3 (Gold) QI training: Leading Improvement for Senior Leaders, which will be held in-person on Thursday 20 June 2024.
This CPD Accredited full day 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 and search for Level 3 (Gold) QI Training: Leading improvement for senior leaders under the Leadership and Management and Improvement Academy (Quality Improvement) tabs.
The deadline to apply for the course is 5pm on 10 June 2024. 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. For full information and resources relating to QI in CNWL, visit the Improvement Academy Microsite.
Book time with us to discuss everything QI!
The QI Clinic is here to support your improvement ideas. Any CNWL team who would like help with any aspect of their QI project can book into a QI clinic. We have two slots every Friday, 12 and 12.30pm.
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
- Head of Quality Improvement: Geetika Singh (Geetika.singh@nhs.net)
- QI team email address: cnw-tr.improvementsupport@nhs.net
- Improvement Advisor divisional support:
- Corporate and Goodall – Geetika Singh (Geetika.singh@nhs.net)
- Diggory – Peter Toohey (peter.toohey@nhs.net)
- Jameson – Isaac Obeng (isaac.obeng1@nhs.net)
If you have any feedback about this newsletter, or you would like anything including in the next edition, please get in touch as we would love to hear from you!