Posted on: 10 February 2021


102 QI projects showing improvement across CNWL


Snowdrops in Kew Gardens, Peter Smith


Winter is passing

As we move through February and the dark Winter nights begin to shorten once more, we can start to find hope that 2021 shall bring better times and the potential for lockdown to be eased.

The past year has seen unprecedented changes in our lives and how we deliver clinical services to our patients.  Everyone of us in the NHS has needed to adapt our ways of working; how we provide care, how we communicate and how we feel, have all needed to evolve to keep us going.  Such change is at the heart of making improvements in our work, even in the face of difficult times.

So this month, we are focussing on how improvement thinking and elements of the model for improvement can help us to get through the greatest of challenges by actively thinking about how we make changes.  This may not involve setting up a full QI project, but employing the principles of thoughtful testing of changes to rapidly improve how our system or service is performing.  We think that this can help everyone when rapid change is both necessary and inevitable.

In this issue we also meet Dr Emily Duncan, Medical Education and Quality Improvement Fellow and hear how QI training has been successfully helping medical staff to get started on their QI journey.

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


Rapid Tests of Change

Many of us are facing new ways of working as we respond to the ongoing Covid-19 pandemic and it is tempting to change without thinking; to forge ahead to ‘get the job done’.  But it can be useful to add some structure to how we make these changes.  Learning as we go can help maximise the positive impact of change for both staff and service users.

Five principles of improvement


To help us think through our changes, it is useful to consider the 5 principles of improvement and how we apply each of these steps as we make changes.

These principles may be familiar to you if you know about the QI model for improvement and it might be assumed that to ‘do change rapidly’ and follow the principles, we need to set up a QI project.  But this isn’t necessarily so! 

Actively thinking about the change and seeking feedback in real time, then acting on what you find is a powerful way of making sure that your change is making things better. 

And remembering that feedback can be as simple as a daily check in conversation, along the lines of ‘how did that go yesterday?’, may be all that is needed to help you adapt, adopt or abandon your change.  There isn’t necessarily a need to collect data whilst we do this kind of day to day improvement, it is more about a way of working.


Remembering the Plan Do Study Act (PDSA) cycle

So how do we make our change ‘real’?  To do this, we need to apply the PDSA cycle as a way of thinking through the change.  If we have introduced a change, we need to take a little time (sometimes only 5 minutes) to reflect about whether the change has worked; we study the effects of the change and decide whether it has been beneficial or not.  Often you can get to know this simply by hearing how it went from staff around you. 

You can then decide whether to adopt (do more of), adapt (keep the change but alter it in light of how it worked) or abandon (do less of the change because it did not work).  You have then completed a PDSA cycle!

It may be helpful to very briefly capture what you have learnt.  Using a discussion huddle around a whiteboard can be a very good way of making sure everyone in your team knows what changes have happened and what you are going to test next.

The following diagram illustrates what we mean.


An example: Personal Protective Equipment (PPE) Distribution

A good example of how using the five principles of improvement and PDSA cycles is captured in the infographic below.  In March 2020, the QI Team were redeployed to set up and run the process of distributing PPE to clinical services across CNWL.  This was highly important to keep our staff safe and the team needed to get the process up and running as fast as possible.

You can see that via a set of PDSA cycles, the team went from commencing supplies to a streamlined ordering and delivery process, with stock level management and standardised PPE distribution boxes, all within 4 weeks.  The team achieved this by using daily feedback from managers ordering the PPE and a regular testing huddle to ensure that everyone in the team was kept up to date with changes.


Knowing that many staff in CNWL are facing such rapid change, similar to the example above, the QI Team have temporarily changed the training that is on offer.  For the month of February (and probably through March) we are delivering 1.5 hour sessions on rapid test of change.  See the training dates section below to book a place on the next session.

“Thanks for this brilliant and really pragmatic session”

Feedback from rapid test of change attendee


Meet our Quality Improvement Fellow and QI Training - support for Medical Staff  


Dr Emily Duncan has been in the role of Quality Improvement and Medical Education Fellow at CNWL since May 2020. She has been working with the QI and Medical Education teams to design and implement bespoke QI teaching for trainees and supervisors, and using QI methodology to improve other areas of the trainee experience at CNWL. 

The bespoke teaching has been very successful in encouraging doctors to get more involved in QI work. The first session specifically for trainees in August had 50 attendees, and excellent feedback – with one attendee saying “…this is one of my favourite presentations since joining CNWL thus far. I’m sure it’s going to be greatly beneficial!”.

The bespoke session for Consultant Supervisors on QI methodology and supervising trainees in QI had 30 attendees, and again received very positive feedback. On the back of this Emily has been requested to present at the CNWL New Consultant Forum.   

Another innovation, the monthly ‘QI Clinic’, has also proved very popular, with 40 people having attended over the 3 clinics run so far and 9 trainee projects have been supported through this format. In the clinic, trainees book in to discuss their projects and receive advice and guidance from the QI Team. This has also been an excellent regular QI teaching opportunity. Emily has also been providing 1:1 support for trainees on projects and ideas they would like to develop and has supported 25 projects in this way.

The hard work of trainees came to fruition in November, when over 25 posters were presented by trainees at the CNWL Safety Conversation. The quality and quantity of the posters inspired a whole prize category for Medical Trainee Initiatives, which was won by a Core Psychiatry and GP trainee for their work on physical health recording on an adult inpatient mental health ward. Special commendations were given to teams presenting posters on: reducing violence on an adult inpatient ward; improving the out of hours handover at a mental health hospital; and improving contraceptive planning on a mother and baby unit.

We look forward to continuing helping trainees develop their QI skills and harnessing their enthusiasm for improvement.  

Upcoming Training Dates

Rapid test of change QI training is bookable on LDZ at:

Search for ‘rapid tests of change’ to find the course.

  • Thursday 25 February 2021 at 11:30 AM - 1:00 PM
  • More dates in March to be announced

Useful links

Contact information for Improvement Advisors:

Diggory Division

Michele Dowling

Goodall Division

Peter Smith

Jameson Division

Marcus Maguire

CNWL QI Microsite:

Life QI: ​​​​​​​

IHI Open School: ​​​​​​​

If you want to get in touch please contact us here: