Posted on: 22 April 2024
Editor: John Francis William Apted
If you want to get in touch please contact us on cnw-tr.improvementsupport@nhs.net
Welcome to the first edition of our Expert by Experience (EbE) newsletter. This edition of the newsletter shares insights on how to recruit an EbE colleague to support your improvement work and features two case studies celebrating successful partnership working within two teams in the Trust.
- Key takeaways on how to recruit an Expert by Experience colleague to support your improvement work
- Case study 1: Co-producing violence reduction at St Charles Hospital
- Case study 2: Healthcare Workers understanding of the 5 moments of hand hygiene
Key takeaways on how to recruit an Expert by Experience colleague to support your improvement work
It is very important to involve Experts by Experience (EbE) colleagues in your improvement work. This is particularly because, our EbE colleagues 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.
While many project teams recognise the importance of EbE involvement, our analysis of the involvement behaviours of project teams across the Trust revealed a gap in the capability or confidence for teams around involvement. Hence, this article focuses on building knowledge on the basic processes involved in recruiting an EbE colleague. The first step you may want to consider is to decide how you want to involve EbE colleagues in your improvement work: Do you want to recruit the EbE colleague to be part of your project team or do you want to periodically ask EbE colleagues for their thoughts, suggestions and feedback for improvement?
You can then build on this to work through the steps below that provides some key insights on best practices on effective EbE recruitment.
- Clarify your EbE recruitment plan
- Decide on your recruitment approach based on the needs of your team. Hearing the views of patients and carers in your service is a great start and you can do this via discussion (group discussion or 1:1) or surveys. It’s also good to bring someone with lived experience onto your QI project team. If so, consider who is best placed to join you. For ad hoc, time limited projects requiring specific skills, consider inviting someone you know directly onto the team. For more substantial roles, you may want to open the opportunity to a broader audience to gain diverse perspectives.
- Advertisement and promotion
- Provide opportunities for EbE colleagues to apply or express interest in supporting your improvement work. Consider the diversity of EbE colleagues and identify groups or networks that could tap into.
- You can use the template on page 13 of the EbE involvement toolkit provided below to promote opportunities through your local services, charities, community groups, patient and carer associations. You can also book unto the Improvement Academy’s EbE Improvement Forum by contacting us via cnw-tr.improvementsupport@nhs.net to advertise your improvement work to our EbE forum members
- Consider your plan for reimbursing EbE colleagues for the time spent supporting you (for more details, see page 10 of the EbE toolkit)
- Shortlisting of interested EbE colleagues
- If you are interviewing people, shortlist interested EbE colleagues and schedule a short, informal discussion via phone, Zoom or Teams or face-to-face to discuss their interests, preferably with an EbE colleague who already supports your services/team
- Feedback and communication
- Provide sensitive and constructive feedback to unsuccessful candidates
- Maintain a reserve list for potential replacements or future projects
- Offer applicants the opportunity to be added to the central involvement register for future opportunities by contacting the involvement team via involvement.cnwl@nhs.net
See detailed guidance on how to involve EbE colleagues.
Case study 1: Co-producing violence reduction at St Charles Hospital
Incidents of aggression against staff and service users were increasing across different wards at St Charles Hospital. This necessitated an improvement work focused on violence reduction on the wards. The underlying principle behind this work was that the reduction of violent incidents will improve the quality of life of the people who use services at St Charles and the staff who care for them. The aim for this improvement work was to reduce rapid tranquilisation and physical interventions by 30%.
John, an EbE colleague, was involved at the programme level and his role included defining the scope of the improvement programme that included different wards at St Charles. Other EbE colleagues were also involved in supporting this improvement work at the project level. It was important for John and other EbE colleagues to be involved because they could leverage their varied lived experiences to support the QI project team identify change ideas that would make a meaningful impact on their improvement work.
Some of the change ideas tested in this work included the standardisation of handovers, introducing a de-escalation room, employing full time activities coordinators and many others. Through this co-produced improvement work, staff became consciously more proactive with de-escalation and medicating patients before it reached the point of violence on the ward. They attributed this to the raising awareness work they carried out as part of the project. This helped ensure that the aim achieved was achieved at the end of the improvement work.
At Shannon ward for instance, the ward previously reported an average of 52.6 violent incidents, which then reduced to 29.3 (a 44% reduction) over the five months during which this improvement work was done. Data from the ward even identified a period of five weeks where there was no violent incident. Staff on the ward therefore reported Shannon Ward felt safer and this shines a light on the many benefits that can come with meaningfully co-producing improvement work.
Quote from John:
“Being left alone on the ward for too long can be intimidating and sharing this experience helped in the identification of change ideas that had a meaningful impact on this improvement work. It is also important to add that as we did in our improvement work, improvement projects similar to this should focus on reducing violence incidents against both staff and service users alike. Violence reduction improvement projects should not focus solely on the violence experience by staff while disregarding the violence experienced by service users, parents or carers on the ward”
Case study 2: Healthcare Workers understanding of the 5 moments of hand hygiene
In November 2022, Cady was involved in a Quality Improvement Hand Hygiene project with the Infection Prevention and Control team at St Pancras Rehabilitation Unit (SPRU). The aim for this project was to reduce the amount of missed opportunities for hand hygiene according to the World Health Organisation “my five moments for hand hygiene” among healthcare staff in the intermediate care unit by 50% by the end of April 2023. Thus, this project focused on increasing the application of good hand hygiene practice particularly because it is recognised as the most effective method of preventing the spread of Healthcare-Associated Infections (HCAI).
There was a 48.8% reduction in the average number of missed moments of hand hygiene for all SPRU wards, that is, from an average of 56.5 to 29. The breakthrough tests of change that led to this include:
• Standardising availability of hand sterilisation gels across the 3 units and introducing localised checking
• Scenario-based hand hygiene training for all SPRU staff on each of the 5 hand hygiene moments
• Training of local nominated hand hygiene auditors
• Development of co-produced poster campaign
Cady was involved in co-producing the poster designs for the awareness campaign. The posters were to remind people to use a hand sanitizer more frequently than they would normally do. Cady was shown around the ward to get inspiration that would inform the tag lines and catchphrases that were to underpin the poster campaign. The plan was for the posters to be placed by hospital beds and in the corridor where they would be easy to read. The concept was for Cady to represent the patient voice, thereby prompting the theme "clean your hands before you care for me".
Cady’s involvement in this project meant that he attended a bitesize QI training course delivered by the Improvement Academy. With this training, he was introduced to the Trust’s improvement methodology and this made him well-placed to make meaningful contributions to the QI project team. He also helped deliver hand hygiene training where he had the opportunity to play the role of a patient as nurses engaged in the care of the patient.
Quote from Cady:
“I was recruited for this project, with the assistance of hospital staff. My experience of being part of a team was amazing and exciting. I was supported throughout the project with regular meetups face to face and online. My personal achievement in this project was the ability to show my artistic input to poster design and creating seven images in colour that really impressed the team! I felt that my contribution in this project helped increase the use of the five moments of hand hygiene. My personal benefit that came with supporting the work was that it helped me with my own mental health in many ways. I felt connected with healthcare professionals which empowered my personal recovery for better mental health”
Quote from Miriam (QI project team lead):
“It was a great pleasure working with Cady on the hand hygiene QI project. It was important to us as a team to have the patient’s voice represented in our QI project. He took time to understand the brief for the posters and also attend some of our training sessions as well as going on ward visits with us at SPRU to get the feel of the place so it can be translated in the hand hygiene posters.
He is a talented artist and his input was truly valued by the team. His work ethic was also impeccable. He was always punctual, whether face to face or on MS teams. We really enjoyed working with Cady on this QI project”
This co-produced improvement work not only highlights the benefits of partnering with Service Users and/carers to make meaningful improvement at the healthcare service level, but also emphasises the personal benefits that this can bring to Service Users. This partnership fostered a sense of ownership and empowerment for Cady. It is crucial to recognize that Service Users and/or Carers are experts in their own health journeys, and by valuing their input, healthcare professionals empower them to help co-produce more effective and tailored improvements. Together, through collaboration and shared decision-making, we can drive positive change and enhance the quality of healthcare services for the benefit of all.