Engaging staff and service users in Quality Improvement

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1 Engaging staff and service users in Quality Improvement The presenters have nothing to disclose

2 Objectives for this session 1. Describe a framework for engaging people in quality improvement at all levels of a system 2. Identify locally relevant ideas and tactics to support engagement in quality improvement to support you in your efforts to improve outcomes for your service users, carers and community

3 Mental health services Newham, Tower Hamlets, City & Hackney Forensic services All above & Waltham Forest, Redbridge, Barking & Dagenham, Havering Child & Adolescent services, including tier 4 inpatient service Regional Mother & Baby unit Community health services Newham Urgent care centre Newham IAPT Newham, Richmond and Luton Speech & Language Barnet

4 Cultural diversity Financial stability and strong assurance systems Challenges and opportunities Social deprivation Commissioning arrangements Geographical diversity

5 Engaging a whole organisation in QI Kevin Cleary Medical Director Jonathan Warren Director of Nursing

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8 @ELFT_QI Building the case for change Sentinel event Visits to other organisations Trust board bespoke learning sessions Early small scale tests Developing the strategy through engagement Long-term business case approved Identify strategic partner Assess readiness for change

9 Use of data to guide decisionmaking Executive WalkRounds Stop solving problems at the top Change in Executive behaviours Give people time and space to solve complex problems Paying personal attention Manage the expectations

10 The culture we want to nurture A listening and learning organisation Empowering staff to drive improvement Increasing transparency and openness Patients, carers and families at the heart of all we do Re-balancing quality control, assurance and improvement

11 Key principles in engaging and supporting staff in QI Dr Amar Shah Associate Medical Director for QI

12 Make it feel meaningful Make it feel possible Make it feel valued and permanent Provide skills and support

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18 Continuous improvement Assurance & performance management Research & innovation

19 Our approach to quality improvement at ELFT James Innes Head of QI Tim Gill QI programme manager Jen Taylor-Watt QI lead Auzewell Chitewe QI lead

20 Build the will 1. Newsletters (paper and electronic) 2. Stories from QI projects - at Trust Board, newsletters 3. Annual conference 4. Celebrate successes support submissions for awards 5. Share externally social media, Open mornings, visits, microsite, engage key influencers and stakeholders AIM: To provide the highest quality mental health and community care in England by 2020 Build improvement capability Alignment QI Projects 1. Build and develop central QI team capability 2. Online learning options 3. Pocket QI for those interested in QI 4. Improvement Science in Action waves 5. Develop cohort and pipeline of QI coaches 6. Bespoke learning, including Board sessions & commissioners 1. Embed local directorate structures & processes to support QI 2. Align projects with directorate and Trust-wide priorities 3. Support staff to find time and space for QI work 4. Support deeper service user and carer involvement 5. Support team managers and leaders to champion QI 6. Align research, innovation, improvement and operations Reducing Harm by 30% every year 1. Reduce harm from inpatient violence 2. Reduce harm from pressure ulcers 3. Other harm reduction projects (not priority areas) Right care, right place, right time 1. Improving access to services 2. Improving physical health 3. Other right care projects (not priority areas)

21 AIM: To provide the highest quality mental health and community care in England by 2020 Build the will

22 QI Stories at Trust Board Electronic & paper newsletters QI Visibility Wall

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27 qi.elft.nhs.uk

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30 Visits to see QI at ELFT

31 Influencing national policy and thinking

32 Influencing national policy and thinking

33 Influencing national policy and thinking

34 Influencing national policy and thinking

35 Awards

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37 Score Score Score (%) Score Staff able to contribute towards improvements at work Staff experience and engagement Staff Motivation to Work Staff job satisfaction Overall Engagement Score ELFT Score National Median

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39 AIM: To provide the highest quality mental health and community care in England by 2020 Build improvement capability

40 Pocket QI commenced in October Aim to reach 200 people by Dec All staff receive intro to QI at induction Estimated number needed to train = 5000 Needs = introduction to quality improvement, identifying problems, change ideas, testing and measuring change 480 people have undertaken the ISIA so far. Wave 5 = Luton/Beds (Sept 2016 Feb 2017) 29 QI coaches graduated in January To identify and train second cohort in mid-late 2016 Currently have 4 improvement advisors, with 1.5 wte deployed to QI. To increase to 8 IA s in 2016/17 (6 wte). Estimated number needed to train = 1000 Needs = deeper understanding of improvement methodology, measurement and using data, leading teams in QI Estimated number needed to train = 40 Needs = deeper understanding of improvement methodology, understanding variation, coaching teams and individuals Estimated number needed to train = 11 Needs = deep statistical process control, deep improvement methods, effective plans for implementation & spread Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) Most Executives will have undertaken the ISIA. Annual Board session with IHI & regular Board development discussions on QI Needs = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead Board Bespoke QI learning sessions for service users and carers. Over 40 attended in Build into recovery college syllabus, along with confidence-building, presentation skills etc. Needs = introduction to quality improvement, how to get involved in improving a service, practical skills in confidence-building, presentation, contributing ideas, support structure for service user involvement

41 Improvement Science in Action - 6 month learning path Prework Workshop 9/29-10/1 (3 days) AP-1 Webex Webex #1 1 10/14 AP-2 Webex Learning 2 set 11/21 AP-3 Webex Webex #2 3 11/30 Project Planning Reliability Sustaining Gains AP-4 Webex #3 Supports: Listserve Assignments Learning Set AP-5 2 & graduation Faculty consults Webex calls Coaching calls The two learning sets will be focused on sharing the participants work on their projects and learning from each other. These sessions also will reinforce the content from the Webex calls and the ISIA workshop.

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44 Pocket QI - 2 month learning path Workshop 1 Overview to using QI Workshop 2 Using measurement for improvement Workshop 3 PDSAs and testing Workshop 4 QI Tools All 4 workshops are between 2-3 hours in a classroom format and rotate in location throughout the geography of the Trust.

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46 QI Coaches

47 Intro to QI - for service users & carers

48 So how are we doing so far? Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) Board

49 So how are we doing so far? Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) 134 people trained in Pocket QI 467 people have undertaken the ISIA so far Estimated number needed to train = 800 Board

50 0.31% 1.88% 1.82% 1.82% 2.62% 1.89% 5.85% 2.00% 0.95% 2.71% 2.04% 3.70% 0.00% 0.00% 1.86% 14.63% 33.56% 34.69% 30.03% % of staff trained 51.85% 73.68% 80.95% 90% 80% ISIA % of staff trained across the trust (excluding Luton and Bedfordshire) Pocket QI 70% 60% 50% 40% 30% 20% 10% 0% Band 3 Band 4 Band 5 Band 6 Band 7 Band 8a Band 8b Band 8c Band 8d Band 9 Doctor

51 So how are we doing so far? Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) 134 people trained in Pocket QI 467 people have undertaken the ISIA so far 29 QI coaches graduated Estimated number needed to train = 800 Estimated number needed to train = 30 Board

52 So how are we doing so far? Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) 134 people trained in Pocket QI 467 people have undertaken the ISIA so far 29 QI coaches graduated Currently have 4 improvement advisors Estimated number needed to train = 800 Estimated number needed to train = 30 Estimated number needed to train = 7 Board

53 So how are we doing so far? Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) 134 people trained in Pocket QI 467 people have undertaken the ISIA so far 29 QI coaches graduated Currently have 4 improvement advisors Estimated number needed to train = 800 Estimated number needed to train = 30 Estimated number needed to train = 7 Board 5 Executives have undertaken the ISIA course. Estimated number needed to train = 7

54 So how are we doing so far? Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) 134 people trained in Pocket QI 467 people have undertaken the ISIA so far 29 QI coaches graduated Currently have 4 improvement advisors Estimated number needed to train = 800 Estimated number needed to train = 30 Estimated number needed to train = 7 Board 5 Executives have undertaken the ISIA course. Estimated number needed to train = 7 Annual Board session with IHI & regular Board development discussions on QI Estimated number needed to train = 15

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56 AIM: To provide the highest quality mental health and community care in England by 2020 Alignment

57 Support around every team Project Sponsor QI Coach QI Team QI Forums Service User Input QI Resources

58 See and search for other QI work in the Trust

59 Taking data to the next level Data at Trust, directorate or team level

60 Engaging service users, carers and families in QI Paul Binfield Senior people participation lead Zaffran Jami People participation lead

61 Make it feel meaningful Make it feel possible Make it feel valued and permanent Provide skills and support

62 Engaging SU/ carers Why get service users and carers involved? How do you find service users / carers to get involved with your project? What roles do service users / carers play in the project?

63 Service user involvement in providing governance and assurance Structures and processes Supporting the service user voice Members of our QI Board and steering group Metrics on service user involvement in QI reported to the Board Service user steering group to oversee and support user & carer involvement Stories and experiences within key meetings (eg Board) Service user surveys (qualitative and quantitative) Service user auditors People participation leads across every area of the organisation

64 Service user involvement in improvement Co-design and co-creation Genuine partnership Two service users within the central QI team Co-created service user involvement strategy Co-design the visibility wall and joint newsletters for staff & service users Service users involved in QI projects alongside staff members Service user led QI projects starting to emerge

65 QI Project Involvement Little i Big I Service user forum Regularly consulted during lifetime of the project Surveys Act as a full member of the QI project team Community meetings Focus groups

66 Make it feel meaningful Make it feel possible Make it feel valued and permanent Provide skills and support

67 To achieve % service user/carer involvement in QI across ELFT Communication (in and out) Big I Advertising Access to information Support structure Service user/carer specific role in project team Training Structure/process outlining how service users/carers get involved Payment Service user/carer led or co-led projects Booklet outlining all information about involvement in QI Clear structure outlining different levels of support and outlining responsibilities Service user/carer involvement in QI forum Service user/carer lead in QI central team and each project team Role descriptions and contracts Incorporate QI into recovery syllabus Buddying up Regular support sessions for service users/carers similar to coaches. Training not focused on methodology more focus communication skills and role plays. Service user/carer bespoke group similar to support QI coaches receive. Induction to team and/or trust induction. Little I Overview of service user/carer involvement Service user/carer feedback Partnership working between Quality team and QI Team Monitoring & reporting Regular Reviews A trust wide survey service users/carers can complete about quality of service and/or QI project on that ward/in that team similar to friends and family test. Regular steering group/oversight meeting. Monitoring informatics system that reviews service user/carer involvement at all different stages of the QI project. Dashboards

68 Make it feel meaningful Make it feel possible Make it feel valued and permanent Provide skills and support

69 Role description Reward and recognition

70 Make it feel meaningful Make it feel possible Make it feel valued and permanent Provide skills and support

71 Attend bespoke Learning Events Over 50 service users have attended so far Join QI training with staff For our service user leads Become a Champion within a directorate Support and skills development for service users IHI Open School made available to all Generic skills on confidence, participation, group work Resources on the QI website to support involvement

72 What impact is it having? James Innes Head of QI

73 What impact is it having?

74 Our QI Projects 155 Active Projects

75 Our QI Projects 155 Active Projects 26 REDUCE HARM BY 30% EVERY YEAR 129 RIGHT CARE, RIGHT PLACE, RIGHT TIME

76 Our QI Projects 155 Active Projects 26 REDUCE HARM BY 30% EVERY YEAR 129 RIGHT CARE, RIGHT PLACE, RIGHT TIME VIOLENCE REDUCTION PRESSURE ULCERS PHYSICAL HEALTH ACCESS TO SERVICES

77 No. of new projects Our QI Projects No. of active projects per month

78 Our QI Projects Mar Mar Apr Apr May May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar-16

79 No. of Incidents No. of Incidents 06-Jan Jan Feb Feb Mar Mar Mar Apr Apr May May Jun Jun Jul Jul Aug-14 VIOLENCE REDUCTION 18-Aug Sep Sep Sep Oct Oct Nov Nov Dec Dec Jan-15 No. of Incidents 19-Jan Feb Feb Mar Mar Mar Apr Apr May May Jun Jun Jul Jul Aug Aug Aug Sep Sep Oct Oct Nov Nov Dec Dec Jan Jan Feb UCL Incidents resulting in physical violence (Trust-wide) - C Chart 25% reduction LCL Physical violence to patients (per 100,000 occupied bed days) Physical violence to staff (per 100,000 occupied bed days)

80 57% reduction

81 14% reduction 57% reduction

82 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 No. of Incidents 57% reduction 16 Incidents resulting in physical violence (Clerkenwell ward, Forensics) - C Chart 14% reduction UCL 48% reduction LCL

83 07-Apr Apr Jun Jun Jul Oct Jan Jan Feb- 09-Mar- 30-Mar- 20-Apr Jun Jun Jul Oct Oct Apr May Jun Jun Jul Aug Sep Sep Oct Nov Nov Dec Jan Jan Feb Mar Apr Apr May Jun Jun Jul-15 No. of Pressure Ulcers 10-Aug Aug Sep Oct Nov Jan-16 Completion Rate / % PRESSURE ULCERS Waterlow Completion Rate - P Chart 100% 90% UCL 80% 70% 57.30% 92.01% 60% 50% 73.10% 40% 30% 20% 10% 0% LCL UCL Grade 2 Pressure Ulcers - C Chart LCL 2.5

84 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 No. of Referrals ACCESS TO SERVICES COLLABORATIVE DNA / % Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Average Waiting Time / Days ACCESS TO SERVICES - Baseline data Average waiting time from referral to 1st face to face appt (Collaborative, 9/11 teams) - X-bar Chart UCL % reduction LCL No. of referrals received (Collaborative, 9/11 teams) - I Chart 19% increase 39% 34% UCL % of 1st face to face appts DNAs (Collaborative, 9/11 teams) - P Chart 22% decrease UCL % 24% 32.21% LCL 25.23% LCL 19%

85 41% reduction 80% reduction 85

86 41% reduction 19% reduction 80% reduction 86

87 PHYSICAL HEALTH

88 Improving physical health collaborative; Driver Diagram Overview AIM: Reduce cardiovascular risk for all adults and children for whom we initiate or change psychotropic medication 1. Equipment 2. Assessment & monitoring 3. Intervention Minimum standards & checks Pods for community settings Assessment Monitoring 3. Measuring and Reporting Template development: define scope, data, spec Reports & dashboards Smoking cessation Prescribing Health promotion (exercise, diet, education) Communication between services 4. Service user & staff engagement Leadership Infrastructure Information provision Involvement in all QI areas

89 Improving physical health collaborative; Driver Diagram Overview AIM: Reduce cardiovascular risk for all adults and children for whom we initiate or change psychotropic medication 1. Equipment 2. Assessment & monitoring Minimum standards & checks Pods for community settings Assessment Monitoring 3. Measuring and Reporting Template development: define scope, data, spec Reports & dashboards

90 AOS SCMHT NCMHT EQUIP

91 Intervention Our QI work on Health Promotion Smoking cessation Prescribing Physical activity Diet and nutrition Communication /pathway between services Behavioural interventions, e.g. motivational interviewing Health promotion Informal and formal support; professional and family/peer Education and information

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