Posted on: 4 April 2023

April 2023                                                                                   

In this quarterly edition of CNWL Improvement Academy news, we consider how we spread and share improvement at CNWL

Spreading Improvement

One of the common comments made to the Quality Improvement Team is – “this change has made an improvement everyone should adopt it!”

It is useful at this point to ask ourselves the question, when is our change idea ready for spread? And how could we spread this success to other teams within complex systems?

Let’s start with the definition of spread in improvement. Spread is largely referred to as sharing and disseminating ideas that have evidenced sustained improvement across a whole system (such as a service area or organisation).

How do we know a change is an improvement?

Before we start a programme to spread improvement ideas across CNWL, we must be able to evidence the sustainability of this change. Many teams who have embarked on improvement journeys and shown success in their changes will know that enacting a positive change isn’t the end of your improvement work. To sustain improvement, it has to become embedded in the day-to-day working of the team. In CNWL, there are teams who have reached the point in their improvement journeys where their improvement has been sustained for months and in some cases even years. We can see evidence of this in the data and this tells us the change ideas are ready for spread.

So how do we spread improvement within CNWL?

We know that in healthcare we work in complex systems and spreading improvement is unlikely to be a case of lifting and shifting improvement to a new area. Spreading improvement requires a team to take a change idea, test it using Plan, Do, Study, Act (PDSA) cycles and in doing so adapt it to their local context.

To support the spread of change ideas and improvement, CNWL has developed a framework for spread using a CNWL Spreadathon approach.


Figure 1: CNWL Spreadathon Approach

This approach will support teams to consolidate and spread innovations and new ideas across the organisation through a standardised approach. The Institute for Healthcare Improvement encourages teams that want to test change ideas in their service reflect on the following points (Rogers, 1995).

Attributes of Change


Ask yourself …

Relative Advantage

The degree to which an innovation is perceived as better than the idea it supersedes

“Is this idea clearly better than what’s in place? How will this make things better than they are now?”


The degree to which an innovation is perceived as simple to understand and use

“Is this idea going to be easy to learn and use?”


The degree to which an innovation is perceived as being consistent with the existing values, experiences, beliefs and needs of potential adopters.

“Is this idea consistent with the way we currently function?”


The degree to which an innovation can be tested on a small scale

“Will people have a chance to test this idea in a safe setting?”


The degree to which the use of an innovation and the results it produces are visible to those who should consider it

“Will we be able to observe the results of the idea relatively quickly?”

Rogers, E.M., 1995. Diffusion of Innovations

Over the coming year, the QI team will be hosting a number of Spreadathon Events aimed at spreading successful change and encouraging teams to reflect on the opportunity to test these changes within the local context. We look forward to seeing successful improvement spread across the organisation and the systems we work within. If you believe your team has an idea worth spreading and you have data showing sustained improvement, please get in touch with us by emailing

Sharing Improvement

International improvement colleagues from Africa visit CNWL's Sexual Health Team to share learning on HIV

CNWL's Quality Improvement Team and staff from Sexual Health were delighted to host a visit from the Aurum Institute in February 2023.

The team of improvement advisors from the South African organisation visited CNWL's Mortimer Market Centre to understand more about the systems and processes involved in CNWL's HIV treatment and care pathways and discussed how to improve the process of starting Anti-Retroviral Therapy. The Aurum Institute is currently carrying out work to improve HIV care in both metropolitan and rural areas of Africa.

You can read more about this visit here

Trainee’s initiatives celebrated at Inner Borough Trainee Quality Improvement Awards

CNWL recognised some of its staff’s best problem-solving initiatives at the Inner Borough Trainee Quality Improvement Awards in January.

The bi-annual event, which is open to all trainees involved in Quality Improvement (QI) at CNWL, has two main aims:

  • To provide an opportunity to celebrate the fantastic QI work performed by trainees at CNWL.
  • To recognise the importance of organisational learning through QI and to share skills and knowledge across CNWL.

Winners not only got the chance to present their projects, they also received a certificate for their portfolios and the top three presenters were awarded with a gift card prize. Read more here

Introducing the Community Mental Health Podcast

Starting off as a Quality Improvement (QI) project idea, this new podcast series has become a hit.  

Each episode brings a personable human touch to induction and helps support trainees joining Community Mental Health Teams.

Dr Hassan Mallick is joined by a different guest from CNWL to help answer any questions trainees have about working in Community Mental Health Services.

Dr Hassan said, “I hope it can help trainees understand how the Community Mental Health Team or hub works.”

Read more here

Feedback and Complaints Team


Congratulations to CNWL Improvement Collaborative Team, Patient Feedback and Complaints whose project to reduce the number of re-opened complaints is showing early signs of improvement.

The team are working on a project with the aim to increase the number of days between incidents of complaints needing to be reopened by 20% by the end of April 2023.

The team have focussed their change ideas on improving communication regarding complaints. You can read more about the project and their change ideas here: Improving NHS complaints (

Executive QI Conversation - REST

This month, the Rapid Engagement Support Team (REST) team joined Con Kelly, Medical Director at CNWL and Alison Butler, Director of Improvement in a QI Conversation. The REST team have expanded their offer of support to inpatient wards following a successful pilot in Milton Keynes. REST are an addictions team that were setup to help reduce substance misuse and help ease pressure on inpatient wards and Emergency Departments by providing more intensive support in the community or in the inpatient setting to reduce length of stay. The team, who are also part of the CNWL Improvement Collaborative, reflected on their work to increase awareness of the work of the REST team and number of referrals to the team from inpatient wards. Peer Support Worker, Adelia (Dee) Swift shared a service user’s journey of recovery with the support of the REST team. Congratulations to the team on your successes so far, your active service user involvement and good luck with your next tests of change.

Recognition for QI teams’ Quality Coach Development Programme at the HSJ Partnership Awards 2023

CNWL’s Quality Improvement (QI) team, Central London Community Healthcare NHS Trust (CLCH) and Q Community were delighted to be finalists at the HSJ Partnership Awards for their Quality Coach Development Programme. The awards took place on 23 March 2023 and the team were nominated in the category - Best Educational Programme for the NHS. Huge congratulations to everyone involved!

Involving Experts by Experience in your Improvement Work

We have an ambition in CNWL for all QI projects to have involvement as part of their project. Evidence tells us that meaningful involvement of Service Users and Carers is crucial for improving the quality of healthcare services, and projects that involve them are four times more likely to be successful (Shah, A and Course S, 2018; Kostal G and Shah A. 2021).

Currently 47% of active QI projects with formed project team have logged service user and carer involvement on Life QI.

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 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 5 weeks via Zoom and the next forum is scheduled for Thursday, 13th April 2023, from 11am -12:30 pm.

Interested teams can book one of the three available 20-minute slots by contacting the QI team via

Building your QI knowledge

The Improvement Academy have a number of higher level QI courses coming up within the next few months.

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 (Bronze) QI Training: Bitesize QI under the Improvement Academy (Quality Improvement) block.

Level 2: Silver QI Training – How to run a QI Project

Level 2 QI Training is aimed at staff who want to run a quality improvement (QI) project.

Applications are now open for Level 2 QI training, with the next cohort starting in April 2023.  This training is aimed at CNWL staff who wish to use improvement methodologies and tools in their role and need 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. 

Training dates for the course are: 19 April (full day), 17 May, 13 June and 13 July.   The course also forms part of 21CLP.

To book your place go to LDZ and search/look for Level 2 (silver) QI Training: How to run a QI Project under the Improvement Academy (Quality Improvement) block.

All QI training provided by the Improvement Academy can be booked via LDZ here:

For full information and resources relating to QI in CNWL, visit the Improvement Academy website at:

Level 3 Gold Quality Improvement (QI) Training – Leading Improvement for Senior Leaders 

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, which will be held in-person on 11 May 2023. 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 and scroll down to Level 3 Quality Improvement (QI) Gold Training under the Improvement Academy (Quality Improvement) block. The deadline to apply for the course is 5pm on 30 April 2023. If you have any further queries, please email the QI team on 

The QI Clinic is here to support your improvement ideas:

Book time with us today to discuss

Any CNWL teams who would like help with their QI projects can book into a QI clinic.

To book, send a request stating your preferred date and time to 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!