10 September 2021
46 active QI projects showing improvement across CNWL
Photo: The Last Rose of Summer, Peter Smith
We move into Autumn with a new QI Website, new QI Clinics, continued learning about developing Driver Diagrams in the CNWL QI Practicum and changes in the QI Team with new faces and colleagues to meet.
We are excited to be launching the new QI Website at https://www.cnwl.nhs.uk/qi and we hope that you will want to take a look and tell us what you think! We hope that a fresh design, new content and navigation that is in keeping with the CNWL Trustnet will all help to improve your experience and make the site more useful to you.
Our lead article this month looks at why data is important to our improvement work, exploring three areas where data supports a QI project, tells a story and helps us learn.
The QI Tip of the month for September might be considered a recommendation, rather than a tip, but we have started to provide a QI Clinic with bookable 20-minute slots to discuss any QI problem or issue with an improvement coach and advisor. And so our tip of the month is to book yourself into an appointment and benefit from an exclusive and focused discussion to support your needs!
Don’t forget that the Virtual Bitesize QI training dates are open for any staff to book via LDZ, so do encourage anyone who wants to start a QI journey to make a booking.
We welcome your feedback and if there is anything you would like to see in future editions of the newsletter, do please get in touch by e-mailing firstname.lastname@example.org.
Why is data so important to Quality Improvement?
Anyone who has received some training on QI methodologies and the model for improvement in particular or who has participated in a QI project will have come across lots of data, both quantitative and qualitative. But do we ever stop to think why we put so much emphasis on collecting, analysing and interpreting data when we are ‘doing’ quality improvement? This article sets out to examine why data means so much and why a QI project relies upon data when we are ‘measuring for improvement’.
William Edwards Deming (1900–1993) was an American engineer, statistician, professor, author, lecturer, and management consultant who is often regarded as the ‘grandfather’ of modern quality improvement thinking. His practices were and remain widely influential in the motor industry and beyond. This often-quoted wisdom sums up much of why data is important; basing our improvement on facts (data) prevents us from falling into the trap of following an opinion or hunch about what is the best course of action.
Essentially data can serve a number of purposes when you are doing work to make improvement happen: tracking and confirming that improvement is taking place, helping to tell a story and aiding learning. Let’s have a closer look at each of them in turn?
First and foremost, you collect data and plot it out over time to answer the second question in the model for improvement: How will you know that a change is an improvement? Without the data, you revert to having an opinion about whether change is causing any good effect on your service.
The second importance of data is that it can help you to tell a story, especially if you make the data visual and therefore accessible to an audience. A chart showing that data has gone up or down easily gets across whether a project is having impact or not. Always remember to define and tell your audience which direction is the ‘direction of goodness’! Data on a story board (as seen above) also helps you to engage more people in your work; the data invites you to have a discussion about it, which can often lead to staff, service users or carers joining a QI project team and new perspectives on your improvement work.
Finally, data plays a key role in helping you learn in two different senses. Gathering data about your system or service before you get in to a QI project is a crucial part of exploring a problem. Pareto charts and audit/survey results can all provide you with information to narrow down what you need to improve. Indeed, you need data to tell you what the baseline output of your system is and hence helps you decide how much you need or want to improve; it answers the ‘by how much?’ question when you are trying to agree a SMART aim statement.
And the other aspect of helping you learn relates to passing on your learning to others. Data that visualises your improvement helps others to quickly learn about your successes. A QI poster such as this example from Specialist CAMHS Services in Milton Keyenes above demonstrates how the data supports the learning from this project.
So, we have seen why data is vitally important in QI, but there is one caveat on all the above and that is to ensure that your data gathering is in proportion to your needs. We often say “as much as you need, but as little as you dare”. Quality Improvement does not have to be an exact science (although there is science behind it!) and so collecting too much data (making an industry out of data) or having a perfect view of your system’s performance can seriously distract you from testing changes to make improvement happen. It is always best to ask yourself “What do we need to know?” before you go about gathering data, so you know why you are collecting it.
News from the Practicum 2021
On 19 August we held our first full Practicum Learning Session, where 24 teams across the four Practicum themes (safety, violence, pressure ulcers and flow) continued to work on defining their aims. We also used breakout rooms for teams to work on steps towards creating their driver diagrams.
Each team used silent brainstorming to get ideas onto a Mural Board (which is ideal for virtual working as a team). From this, each team organised their collective thoughts by creating themes; this is called an affinity diagram, as you gather together the thoughts that have affinity or commonality with one another into groups. Rochester East Ward, who are working on a QI project to reduce harm from Pressure Ulcers created a great brainstorm (below left).
By the end of the session, the team had started to translate the themes on their affinity diagram into the format of a driver diagram. They found that most of their themes were either primary or secondary drivers, but they had also started to identify some of their change ideas as well.
The next step for Practicum teams is to register their projects on Life QI and start to use this work to build their driver diagram in their project pages on the system. The teams are going to be busy in the action periods between the learning session and the next workshops, which will be split into themes, bringing teams working in the same areas together to learn across projects.
We were delighted to hear from Clare Firth in K&C CAMHS, who is leading a project on flow in the Practicum and gave us these comments on using the model for improvement in the Practicum:
QI Tip of the month: Book into the NEW QI Clinic
Have you got something on your mind? Do you have an idea for a QI project; a question or a problem in a project you are working on or any other issue relating to improvement work? What do you do with that? Where should you take this?
The QI Team have been thinking about these kinds of scenarios that staff will often face and are now holding regular short (20 minute) sessions that are bookable in advance to help staff with these sorts of questions and issues.
We call it the QI Clinic and we have already started our PDSA cycles in developing the format. Well yes, of course we have to practice using improvement thinking on our own change ideas!
The QI Clinic runs every Friday with bookable slots at 12.00 noon, 12.20 pm and 12.40 pm and in each slot, you will get the exclusive attention of an improvement advisor and coach to help you think about your issue.
To book, send a request stating your preferred Friday and time to email@example.com and we shall send you a short document to fill in and let us know what you want to talk about, so that we can best help you.
The feedback so far has been very positive, so we look forward to more bookings!
A fresh new website for Quality Improvement
After a lot of thinking about getting it right, the Trust has now launched a refreshed QI Website, which will be your new ‘go-to’ place for information about QI with news, resources and access to book QI training. We have designed the website to follow the same format as the main Trustnet, so navigation around the site is improved, but we have given it a new look so that you can visually identify that you are on the QI website.
We have also reviewed and updated all the site content and, taking into consideration data on which parts of the old website have been most visited, we have clarified the most popular web pages on the availability of QI training (visit the pages behind the ‘Book training’ button). We also heard that a library of tools and resources and a jargon buster are useful, so we have included these and will build more information as we continue to improve the site.
The new QI webpages sit on a new site at https://www.cnwl.nhs.uk/qi so if you have bookmarks at the old site, it would be a good idea to update them now.
We hope you enjoy using the new site; we are happy to hear from you if you have any feedback at firstname.lastname@example.org
Meet the Team
We have two new faces in the QI Team this month, although one of them may not be so unfamiliar and we also say adieu to another colleague.
Hello again to Bridget Browne
Bridget joined the QI Team in August, having been working at CLCH for the past year. She re-joins CNWL as Improvement Advisor working with Jameson Division and is eager to get to know her ‘new patch’. We are glad to have her back! Read the full story here: https://www.cnwl.nhs.uk/news/meet-bridget-browne-jamesons-new-improvement-advisor
Hello to Dr Yasmin Al-Asady
Yasmin has joined CNWL as our new Medical Education & Quality Improvement Fellow, which is a vital role to support trainee doctors as they learn about their role in bringing about quality improvement.
“I’m Yasmin, a child & adolescent psychiatry specialty trainee, with a keen interest in quality improvement. As your new Medical Education & QI Fellow, I hope to use my experience of systemic working to complement the trust’s QI strategy and build on the great QI work already being undertaken in the trust.
I have worked in a number of different trusts, and have experienced the impact of empowering staff and service users to bring about change. I fully believe in the power of continuous improvement driven by the voices of frontline staff, service users, families & carers and am looking forward to working with you all to build on the successes of the recent past, but also learn from things that could have been done differently”
Farewell to Michele Dowling
Michele will be familiar to many staff in Diggory Division, having worked tirelessly to promote QI and improvement thinking in team ranging from Prisons to Mental Health and Community Services across the last two years that she has been an Improvement Advisor in the QI Team. She has also helped develop and improve community housebound vaccinations in Milton Keynes during a period on redeployment during the Covid-9 pandemic response.
So, we are a little sad to see Michele move into a service development role in Milton Keynes community services, although that means that she is not going far and she said that she will certainly be applying improvement methodologies in many aspects of her new role!
Good luck Michele!
Upcoming Training Dates
Dates for the ever-popular monthly 3-hour virtual QI training on the model for improvement and how to set out on a QI project are bookable on LDZ at: https://cnwllearning.org/login/index.php
Search for ‘Bitesize QI’ to find the course, which is available on these dates all starting at 9.30am:
- Tuesday 14 September 2021
- Tuesday 12 October 2021
- Tuesday 14 December 2021
Contact information for Improvement Advisors:
Goodall Division and Corporate
CNWL QI Microsite : www.cnwl.nhs.uk/qi
Life QI: www.lifeqisystem.com/
IHI Open School: www.cnwl.nhs.uk/qi/book-training
If you want to get in touch please contact us here: email@example.com