Posted on: 18 July 2023

In this quarterly edition of CNWL Improvement Academy News, we consider how CNWL have embedded QI and the NHS Impact Framework.


NHS Impact


  NHS Impact logo in black and teal. NHS IMPACT, Improving Patient Care Together with 5 cogs. Words around the cogs are Leadership, Collaboration, Capability, Delivery, People and Culture.

Underneath the logo, with a teal background and white text, words read the 5 key components which are:
Building a shared purpose and vision
Investing in people and culture 
Developing leadership behaviours 
Building improvement capability and capacity 
Embedding improvement into management systems and processes

NHS Impact is the new, single, shared NHS improvement approach launched in early 2023. NHS Impact recognises the NHS commitment to create the right conditions for continuous improvement and high performance, systems and organisations that can respond to today’s challenges, deliver better care for patients and give better outcomes for communities.

It includes the five components which form the ‘DNA’ of all evidence-based improvement methods, which underpin a systematic approach to continuous improvement:

It is recognised that when these 5 components are consistently used, systems and organisations create the right conditions for continuous improvement and high performance, responding to today’s challenges, and delivering better care for patients and better outcomes for communities.

Let’s look at examples of these elements in practice within CNWL:

Building a shared purpose and vision - since 2017 CNWL has partnered with the Institute for Healthcare Improvement (IHI) to develop a shared purpose and vision for QI using the Model for Improvement as our core methodology. Examples of where this has happened in practice are our improvement collaboratives with 100 staff coming together to collectively learn about the science of improvement. From these collaboratives, we have seen improvements such as 50% reduction of violent incidents on Nile Psychiatric Intensive Care (PICU) Ward, work that continues to this day three years after they started their QI journey.

Investing in people and culture – one of the central elements of our improvement work is to involve people who use our services in designing and delivering improvement (often referred to as Experts by Experience or EbE).  We are proud to have achieved 80% of active improvement projects with a formed team reporting EbE involvement. Centrally, within the QI team we work alongside involvement colleagues and have:

  • Co-produced a toolkit to involvement to support teams to involve EbE in their improvement work
  • Established EbE forum where staff can book in to discuss their improvement work with EbE colleagues who have been trained in our improvement approach.
  • Worked with teams to develop their projects in conjunction with EbE
  • EbE are member of our Improvement Academy Board and contribute to the design and governance of our improvement programme

To celebrate the collaborative work our EbE and staff have done to support and improve our services, we recently held an EbE Celebration Event.

The inaugural EbE celebration event took place on Thursday, 8 June 2023 at Bevans, Trust Head Quarters. 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).

Developing leadership behaviours – In 2022, the Improvement Academy launched our Level 3 Gold QI training - Leading improvement for senior leaders. This training is aimed at Senior Leaders who want to facilitate or sponsor teams doing QI projects. This course offers training and tools to help Sponsor an improvement project and support teams to either adopt an improvement approach or to undertake QI projects. Feedback from the first two cohorts have been positive and we look forward to developing this training further with accreditation over the next few months. More information is available on our website.

Building improvement capability and capacity – CNWL has a number of courses available within the Trust to develop improvement knowledge. These can be accessed via our website. Our courses range from entry level to advanced training and is supported by a central QI team of Improvement Coaches and Improvement Advisors.

Embedding improvement into management systems and processes – across the Trust we have moved away from RAG rated reporting and within our management systems we view data with an improvement lens using Statistical Process Control (SPC) charts for key quality and performance measures.  Using time series data helps us predict when a system or process needs to move into quality improvement. This is an area we continue to develop.

More information regarding the NHS Impact Framework is available at: NHS England » NHS Impact

You can read more about the work to develop CNWL’s improvement capability and capacity in the Improvement Academy’s annual report for 2022. You can access the full report here

Celebrating Success

CNWL’s Head of Improvement presents at IHI BMJ International Quality Forum in Copenhagen

CNWL’s Head of Improvement, Geetika Singh, presented at the International Forum on Quality and Safety in Healthcare in Copenhagen on 15 to 17 May 2023.

Hosted by the Institute for Healthcare Improvement (IHI) and BMJ, the event focussed on improving outcomes for patients and communities through quality improvement. The theme this year was adapting to a changing world: equity, sustainability and wellbeing for all.

You can read more about the presentation here

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.”

You can read more about team’s work and submission here

CNWL’s Sexual Health Service PrEP programme in North Central London shortlisted for HSJ Patient Safety Awards

CNWL’s Sexual Health Service in North Central London has been shortlisted for a HSJ Patient Safety Award for its Pre-exposure Prophylaxis (PrEP) Programme. The award falls under the category of Early-Stage Patient Safety Innovation of the Year.

You can read more about the team’s work and submission here

Sharing Improvement

Psychosocial Waiting times Spreadathon event

On 18 April 2023, building on our ambition to share and spread improvement across CNWL Team’s using our Framework for Spread, CNWL held an Adult Psychosocial Spreadathon.

The event aimed at spreading successful changes and encouraging all six teams to reflect on the opportunity to test these changes within the local context. 

The day consisted of a presentation on CNWL’s spread approach, a presentation from each of the six CNWL boroughs about their current Quality Improvement informed changed idea, and break out discussions in the afternoon.

You can read more about the event and the change ideas shared here.

Recognition for CNWL Teams Improvement Work

Four CNWL improvement projects and their learnings were presented at the Bristol Patient Safety Conference on 17 May 2023. All teams either won or were runner up in their categories.

The projects were:

  • Planning for transition for Children with Complex Needs –  a work in progress using QI for better outcomes for patients and families (Elly Kerr – Specialist Nurse for Children with Complex Needs, Transitions Nurse)
  • Maximising our ‘peak flow’: how QI supported a redesign of community pulmonary rehab services in Milton Keynes (Alison Stirton-Croft, Lisa Pitam, Kiaya Watson, Jennifer Hammond, Susan Gaynard, Home 1st Therapies, Community Health Services Milton Keynes)
  • Humanistic CMHT Induction for Trainees using podcasts (Dr.Hassan Mallick, ST4 Psychiatry and Dr.Isaac Obeng, QI Coach)
  • Evaluation of Improvement Collaborative (Geetika Singh, Alison Butler and Dr Simon Edwards)

You can read more about the projects and see their submissions here

From Tenerife to London: Sam’s journey into Quality Improvement

QI Team Improvement Coach, Samuel Diaz-Hernandez shared his journey from Social Worker to Improvement Coach.

Sam says of his QI journey “It was the idea of learning something new that appealed to me in particular,” Sam said. “As a social worker, this is not part of our usual learning.

“There was an element of innovation with an emphasis on improving the way we work and, ultimately, the care we provide.

“So, it definitely seemed like something in line with my values, aspirations and personal and professional interest.”

Read more here


Milton Keynes Crisis Resolution and Home Treatment Team celebrates service user, Paul Jones