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Quality Improvement: Management fundamentals

11 July 2019

“It’s so exciting to see how QI projects are improving our NHS. By applying a QI framework, our colleagues, service users and carers are able to tackle issues in brilliantly creative ways!”
said Simon Edwards, Divisional Medical Director for Diggory, and Quality Improvement Clinical Lead.

Simon has recently returned from the Management Fundamentals Course, which was led by CNWL Chair, Professor Dorothy Griffiths, and CNWL’s Medical Director, Dr Con Kelly.

Delegates on the course had all undertaken a QI project – meaning they had vowed to make an aspect of their service better by thinking about it in a ‘QI’ way. They presented their projects at the Royal Society of Medicine.

Quality Improvement is a scientific framework that allows you to look at a problem from a new angle and develop effective solutions using QI methodology. Essential components include engagement with a wide range of staff and patients, the use of data to monitor changes and understanding the human factors that are needed to support improvements.
“The nineteen projects displayed a wide range of topics that not only improved patient experience but also staff experience,” Simon continues, “They showed that when senior frontline staff work closely with colleagues and service users within their service area then they can make a significant difference. “

“The audience heard some inspiring talks, each one demonstrating how improving healthcare systems and processes had enhanced the lives of patients.”

How can a little QI go a long way? Here are some examples.

Diagnosing Attention deficit hyperactivity disorder (ADHD) in female prisons

ADHD is often being missed, misdiagnosed or inadequately treated. Appropriate treatment and support is likely to reduce symptoms, improve behavioural and emotional control and improve prosocial skills. Dr Catherine Durkin and Marta Pitarch talked about the benefits of identifying women with ADHD in the prison setting and the complexities of delivering care. This project not only increased the number of women diagnosed with ADHD but the team have gone on to be awarded a CNWL starter grant for 2020 to look at the prevalence of ADHD in female prisoners.

Improving medication advice at The Campbell Centre

Receiving expert counselling about medication prior to discharge helps patients to manage their medication at home. The pharmacy team looked at the processes and introduced changes that have significantly increased the proportion of patients who had access to this support with over 90% of patients now receiving counselling from pharmacy staff.

Improving feedback from incidents in The Home First Team in Milton Keynes

Prior to the QI project, only one in 10 members of staff reported that they got feedback from incidents. Now, six months later, the figure has increased to 57%, meaning many more staff are aware of what has happened as a result of their incident report.

Staff have said they ‘feel like (they’re) involved when discussing incidents’ and they ‘feel like (they’re) in this as a team.’

Improving access to third sector support in Kensington and Chelsea Home Treatment Team

Dr Leigh Poyser and the team, care for some very unwell patients in the community. There are lots of local third sector support services around which patients could benefit from and the team wanted to help link patients up with them.

One of the change ideas was to develop an online directory of organisations so that staff and patients/carers had easy access to appropriate information. DirectMe.org was developed and as a result, 100% of services have been made aware of help that’s available.

Delegate receiving certificate

Reducing wasted appointments at ARCH

Missed appointments, also known as ‘did not attend’ (DNAs) cost the NHS thousands of pounds per year. Following a successful QI project, ARCH reduced their DNAs from sixteen a week to less than four. They did this by working with patients to design a patient strategy of managing DNAs and working with themto design letters and posters to tell people of the consequences of failing to show up for their appointments.

Improving the room booking service at MOSAIC

Darren Turze, Camden Mosaic Service Manager (an integrated service supporting children and young people with disabilities) and his colleagues were concerned about the lack of rooms available Camden MOSAIC. This was resulting in cancelled appointments every week and patient complaints. So, they got together and came up with the idea of having a visible shared calendar which made both booking appointments easier but also helped people to cancel their appointments to free up space for others. The project ran for roughly six months after which 100% of people were successfully booking their appointments each week. This meant that where, previously, there had been missed appointments every few days, at the time of the presentation there had been 83 days since the last missed appointment…and counting!