All project work, by its very definition, should have a beginning and an end, with a story to tell about the journey in-between those points in time. But, how do we know that we are ready to end a QI Project and what do you need to think about and do before you ‘complete’ a QI project?
For many of us working on QI projects, we can often find that as we start to see the improvements that we wanted, it can be hard to think how, or even if, we can end a project and return to business as usual. So here, we look at a case study of a mature and successful QI project that has made improvements and been ended; that status drop-down menu on Life QI has been changed from ‘active’ to ‘completed’.
Ellington Ward is a 24 bedded acute assessment unit for older adults with mental health issues, many of whom have co-morbidity of physical health issues. Patient falls on the ward have been a source of anxiety for staff in the service for some while, with some sad experiences of the severe consequences of a patient fall in the past. So, the team were keen to tackle this issue using a QI approach and were eager to benefit from the training offered in the Improvement Science in Action Practicum.
In July 2019, Ellington Ward joined 10 other CNWL services in the Falls QI Programme. The Ellington Team have worked very hard over the course of 2019/2020 to improve their management of falls and as a result, now have much longer times between falls occurring on the unit. But what has led the team to be able to confidently move their project to ‘completed’?
Ellington Ward – Falls QI Poster
There are a number of changes to working practices that Ellington Ward have maintained beyond the end of the Falls QI Project:
- Adhering to falls policy in assessing falls risk on admission
- Handovers about those at risk of falling, using a whiteboard as prompt
- Completing post falls MFRA after each fall
- Adapting care plan following each fall
- Ensuring environmental adaptations are, e.g. lowest bed heights, shower chairs
- All beds on the ward are now hi-low beds.
- Ensuring non-slip socks are available and worn correctly - alerting ward clerk to order more supplies when stocks run low
- ‘Help us reduce falls’ posters in bedrooms and some communal areas
- Call don't fall alerts available to go next to nurse call bells in individuals' rooms when appropriate
- Oxehealth sensors in bedrooms
- Falls QI is part of the induction of new staff
- The team have taken falls reduction on board and it is a shared responsibility across disciplines and grades
Each of these changes are seen across the wider team and are evidence that the ‘system’; both processes and people’s behaviours, have changed as a result of the QI project, even to the level that new staff are inducted into the new way of working. The Team have addressed the question of ‘how do we make this the new and only way of working?’ and written this into their processes, effectively developing a Standard Operating Procedure or SOP document.
The Ellington Team also know that they have a fantastic story to tell about what they have done; not only were they able to produce a QI poster (see above) for the Safety Conversation Day back in November 2020, they also appeared on a QI video talking about their work: https://www.cnwl.nhs.uk/news/ellington-wards-qi-project-interview
Not every QI project has to produce a poster or a video to prove that the project is complete, but if you have put things in place so that everyone in the service works in the new way and have data that shows that your improvement is being sustained, you are probably able to see the end of your improvement project. It is time to complete your project, stand down the project team and move on to the next project!
Contact Information
For support or further information on any aspect of improvement work in CNWL, please contact the QI Team in the Improvement Academy at:
cnw-tr.improvementsupport@nhs.net