Posted on: 20 January 2023
January 2023 Happy New Year! 
In this quarterly edition of CNWL Improvement Academy news, we reflect on the past five years of Quality Improvement at CNWL and celebrate the successes of Improvement Teams
- Reflecting on five years of QI with Alison Butler, Director of Improvement
- Safety Conversation and Award Winners Reducing Wait Times in Autistic Spectrum Conditions
- #iCollab & IPC improvement story
- Introducing our new Improvement Coaches
- IA prospectus – upcoming training opportunities
- Improvement Coach Programme Shortlisted for HSJ Partnership Award
Reflecting on five years of QI at CNWL with Alison Butler, Director of Improvement
In November 2022, we celebrated five years since the QI Programme launched in CNWL. We caught up with Alison Butler, Director of Improvement to reflect on the past five years.
If you were to describe five years of QI in five words what would they be?
Exciting, rewarding, inspiring, a privilege and connectivity.
I’ve chosen connectivity because QI has helped to enable connectivity across the organisation. QI has created opportunities for teams to network and share learning and experiences. We link staff in training programmes and we connect them to other projects similar to their own. Recently, we invited an early adopter of QI to talk at one of our training courses; they shared how QI has opened doors and conversations with others working in different teams and divisions. Their reflection was that QI has made the Trust feel smaller and supported them to feel part of the whole organisation. QI really is about creating connectivity.
Rewarding and a privilege is because QI provides a platform for staff to do what’s important to them and it is very rewarding in that respect. It is a privilege to see how teams and individuals succeed using QI methodology. Which is also inspiring and exciting.
What is your biggest highlight of QI in CNWL over the past five years?
There have been so many highlights over the past five years.
The most recent highlight has been the development of the Improvement Academy in January 2022. This was something we hadn’t anticipated developing and shows the organisations commitment to QI and Improvement.
A very early highlight that stands out for me is the first wave of Improvement Science in Action QI training. It was a matter of months, since we formally launched the QI Programme and we had over 90 staff together in a room. This group was pivotal in building momentum for the organisation and it was incredible to see the energy and enthusiasm in the room. That programme saw the launch of over 70 improvement projects and many staff who attended that first session continue to work in improvement and improve care within CNWL. It was also the test to see if there was a place for QI in CNWL. Clearly there was as staff who attended that first course are still continuously improving, and many have gone on to train as Improvement Coaches and win Improvement Awards.
If you could turn back time, what would you have done differently?
In the ethos of improvement, we know that it is all about testing and learning. From the start we knew that enabling staff to make improvements and suggest change (sometimes called bottom-up improvement) and involving Expert by Experience (EbE) was important. We also knew that it wasn’t always easy. It was important for us to understand the barriers and levers and work to improve this.
We have, through our own tests of change, worked to increase EbE involvement over the five years of QI. We have learnt that when staff develop improvement alongside people who use our services the outcome is far more effective and the gains are sustained.
We are pleased to have achieved 46% EbE involvement in projects registered on Life QI and we are still aiming to do better. My other learning is when in doubt use data. No one can argue with the data. Data is core to our improvement efforts and we have made great strides towards using time series data across the organisation. This took time and energy and within QI we still remind each other “What does the data tell us?”
What does the future of QI look like at CNWL?
The Improvement Academy and QI are definitely here to stay. QI is now in the DNA of the organisation. There is a lot of QI work happening that the central QI team are not even aware of because it’s become “the way we do things around here”. We have shifted to a common language of improvement in CNWL and this will continue this as we move into year six.
A large part of QI is developing QI capacity and capability, we will continue to develop and deliver our training programmes. We are working to offer more accredited courses within the Improvement Academy in 2023. We have improved the training we provide and now offer different levels allowing progression through our training and development opportunities for staff.
We have aligned our Improvement Collaborative to the CNWL Strategy 2022-25 and we will be focussing on spreading this learning across the Trust.In 2023, there will be more opportunities for staff to celebrate their achievements and receive Improvement Awards and we look forward to seeing what you achieve.
CNWL celebrates third Safety Conversation
On 10 November 2022, CNWL’s Improvement Academy, hosted it’s third Safety Conversation Day for staff.
This virtual event, hosted by Dr Cornelius Kelly, CNWL’s Chief Medical Officer, and Maria O’Brien, Chief Nurse, brings together staff to discuss a range of safety topics including learning from incidents, sharing best practice, managing medication and reducing health inequalities. 400 staff attended throughout the day.
The day ended with our annual CNWL Improvement Academy Awards. This year we had 116 poster entries to the awards. You can view all the entries here
Congratulations to all the teams who won Awards, it was fantastic to celebrate your improvement success. You can read more about the Safety Conversation and Award winning teams here.
The winner of the Chief Executive’s Improvement Award, was the Community Paediatrics Team in Community Health Services, Milton Keynes. Congratulations to the team who won an Improvement Award for their work to Improve Time Taken for Autism Spectrum Conditions (ASC) assessment in Milton Keynes.
Reducing waiting time for autistic spectrum conditions assessment in Milton Keynes – how QI helped us on our journey.
The Community Paediatrics Service in Milton Keynes is a consultant led service that provides a range of assessment and support for children registered with a Milton Keynes GP. This includes assessment for autism and autistic spectrum conditions (ASC). During the pandemic the service experienced significant disruption to core processes and ways of working, and these continued to have an impact after the return to ‘normal’ service in 2021. Referrals to the service rose as schools returned to face to face teaching, and these have remained higher than pre-2020 levels. Towards the end of 2021 the service wasn’t meeting it’s 18 week Referral to Treatment target, waiting lists were rising and a number of complaints about length of waiting times were received.
The service explored the issues being raised, speaking to parents and staff and looking at the range of data that could be extracted on service performance. This identified a number of bottle necks at different points in the child’s journey. The team agreed that they needed to take a whole system approach to ensuring that long term improvements were made to their processes to ensure that children moved through their diagnostic pathway quickly and efficiently. A QI project involving both clinical and administrative staff was setup to test a new pathway.
As a result of this work, the team have been able to cut the time children spend from ADOS to Feedback from an average of 25 weeks to an average of 2.5 weeks.
Length of time in weeks from ADOS to Feedback by child
The team’s key learning points are:
- It’s important to consider the whole system – for us this was the child’s journey through the whole service. Our KPIs only focused on the very first part of the journey. Our improvement work enabled us to widen our focus across the entire patient’s journey;
- We protected time for the team to meet every 4-6 weeks which allowed us to come together as a team and take stock.
- Listening to each other, respecting that each of us (including our service user representatives) have a valuable contribution to make to the process was critical;
- We have a new understanding of how important data is in allowing us to see if our actions have the impact we want.
- Change is hard and sometimes you want to walk away. Stick with it, watch the data change and listen to your staff and patients. If you can see you are making a difference it will help to keep you going through the tough times.
- QI methodology gave us the freedom to try new things as well as a structure for the work. We are now using this learning to look at how we reduce waiting times for the full autism pathway, from referral through to feedback and report being issued to families.
Improvement Collaborative 2022/23
Full steam ahead on the Improvement Collaborative!
Our latest Improvement Collaborative is already 3 months into the 6 month programme with 23 active project teams benefitting from an educational environment that provides training and practical exchange of shared learning.
The full set of project teams set out here include projects on wide-ranging subjects from; reducing waiting times from referral to commencement of treatment in K&C CAMHS, reducing the number of re-opened complaints in the Patient Feedback and Complaints Service, and improving ECG screening in Brent OPHA.
Project teams have received two full days of training looking at the model for improvement in depth and dedicated time in breakout rooms to work on their project. Action periods with weekly protected time to develop aim statements, driver diagrams and collect baseline data have progressed each project and will continue throughout the programme. Most teams are now starting to test their change ideas using Plan Do Study Act (PDSA) cycles, with some very encouraging early results.
Goodall Infection Prevention and Control Team
The Goodall Infection Prevention and Control (IPC) Team are a small unit of dedicated IPC nurses who are passionate about supporting IPC in the Division. When the chance to get involved in the Improvement Collaborative came along, they jumped at the opportunity!
Miriam Chibamu, IPC Nurse, who is leading the project team, asked the team ‘How did it feel at the beginning of the improvement collaborative?’ The results are a mixture of thoughts and emotions that we may expect at the start of a new journey…
Aim : Following work to refine their aim the team decided to reduce the scope of their project for a project across the division to focus on St Pancras Rehabilitation Unit (SPRU) to start their work to improve hand hygiene and develop learning that could spread wider within division.
To increase SPRU HCW compliance of when to apply the five moments of hand hygiene by 80% by April 2023.
Understanding the problem: The IPC team set about thinking around the system of good hand hygiene by using a Fishbone or Ishikawa diagram1.
Fishbone Diagrams are one of many QI Tools available on the CNWL Improvement Academy webpages2.
And after considering their diagram, the IPC Project Team translated the most relevant parts of the fishbone to populate the drivers on their project Driver Diagram. A team brainstorming session helped them to develop change ideas that were specific to the area in which the system is operating, thinking about what might be changed in the wards of the SPRU.
Engaging Stakeholders and Experts by Experience: Stakeholder mapping enabled the project team to understand which staff and service users/carers would be important to engage with over the time of the project. The team have prioritised attendance at the local clinical indicator meetings and engagement with the lead therapist, ward Consultant and pharmacy team.
Currently the team are exploring ways in which they are working in partnership with a service user from the Expert by Experience Forum and will be co-producing hand hygiene posters for the project as a first step, leading to engagement of patients on the wards.
The next step for the IPC Team is to fully develop their measures, so they have frequent plots of their outcome, process and balance measures. It is already apparent that collecting straightforward numbers of missed hand hygiene moments per week is not going to tell the whole story; the team need to look at the numbers in relation to the number of observations performed each week and the Team are looking forward to understanding and reporting how the data varies over time.
Follow the Improvement Collaborative on Twitter on @CNWLImprovement and the hashtag #iCollab
Details of the Improvement Academy education programme are available at: https://cnwl.franktesting.co.uk/ia/book-training
References
1 Fishbone or Ishikawa Diagram https://www.instagram.com/p/CGFsw_BB8SF/?igshid=MDJmNzVkMjY=
2CNWL Improvement Academy webpages
https://cnwl.franktesting.co.uk/ia/resources/fishbone-diagrams-aka-cause-and-effect-diagrams
3Driver diagram https://www.ihi.org/resources/Pages/Tools/Driver-Diagram.aspx and https://www.youtube.com/watch?v=PqxGAtnl2t8
Welcome to our new Improvement Coaches
Isaac Obeng
Isaac Obeng joined the QI Team in October 2022 as an Improvement Coach. Isaac has previously worked as a clinician, healthcare manager and an academic. While working as a Junior Doctor, he was involved in some improvement initiatives and the realisation that simple changes could make meaningful impact for large patient groups was his eureka moment as it really honed his interests in QI. He has since been very passionate about QI.
After further studies in Healthcare Management, Isaac worked as a lecturer with a Higher Education Institution. In this role, he was able to indirectly pursue his interests in QI by imparting QI knowledge to the next generation of health leaders.
Isaac said of his role “I am very excited that I am now able to pursue my passion for Improvement Science as an Improvement Coach, by directly contributing to improving the quality of healthcare services here at CNWL”
Sam Diaz-Hernandez
Sam Diaz Hernandez qualified as a Social Worker in Spain before moving to London in 2012. He has worked everywhere from third sector organisations to private and NHS settings, both inpatient and community. Upon qualification back in Spain, he worked in a project with a local Foundation to improve integration in the labour market for people with disabilities and still collaborate occasionally with them and the local university delivering teaching sessions. In London, he completed a Postgraduate in Social Policy and Social research at University College London while working as a Case Manager and Improvement Coach in a community integrated care service in the borough of Kensington and Chelsea. He joined the QI Team as an Improvement Coach in January 2023.
“I am mostly excited about the opportunity of coaching different teams, supporting some of the amazing QI projects, colleagues and people with lived experience we partner with. I’m also passionate about sustainability, both in improvement ideas and the environmental issues. If you have any ideas about the above, or just want to share tips about good local coffee spots, do not hesitate to reach out!”
New Year, New Development Opportunities
If you would like to learn more about QI and improvement please take a look at our Improvement Academy Prospectus where you can learn about all the training on offer.
You can learn more about the Improvement Academy course available here
For information on how to book onto a course visit the Improvement Academy website here
Call for applicants: Level 2: Silver QI Training - Project Team Leader
Applications are now open for Level 2 QI Training, which is aimed at staff who have previous experience of working on a QI project and knowledge of the model for improvement and wish to learn the skills/knowledge to effectively lead a QI project.
Attendees should have a QI project in mind to work on during the course, which lasts over 4 months, commencing in March 2023, with:
- Full day training on the project lead role
- Action periods with support via group coaching sessions and access to a QI Coach, plus QI Clinics
- Half-day session to present a peer reviewed QI Poster
To book your place go to LDZ and search/look for Level 2 QI Project Lead under the Improvement Academy (Quality Improvement) block. If you have any questions please email cnw-tr.improvementsupport@nhs.net
Improvement Coach Development Programme - Celebrating success in 2023
We are pleased to share that we have been shortlisted for an HSJ partnership award for the Improvement Coach Development Programme. The project was funded by The Health Foundation as part of their Q Exchange, which provides funding for innovative improvement efforts in the NHS. This project lead by CLCH aimed to develop a training programme in conjunction with the Health Foundation’s Q Community of which many CNWL improvers are part. CNWL partnered with CLCH as one of the pilot sites for the new improvement coach programme. The course has had overwhelming positive feedback against the learning outcomes.
In QI, our experience is that change can often be difficult and disruptive. This is something we hear from teams too, that change is hard. QI methodology and the use of coaching to support teams through change enables teams to improve using a supportive and inclusive methodology. Any staff member who has led a QI project and is interested in learning more about QI may consider undertaking the Improvement Coach Development Programme. It is a higher-level course that has had input from improvement specialists nationally.
Improvement Coaches have nominally half a day a week allocated to support improvement and work alongside the QI team. They are supported by a network of peers through the QI Coach Forum held monthly. The next cohort of the Improvement Coach Development Programme will launch in Spring 2023. If you would like to register your interest to be notified when applications open please email cnw-tr.improvementsupport@nhs.net or contact your Divisional Improvement Advisor (details at the end of this newsletter).
The QI Clinic is here to support your improvement ideas:
Book time with us today to discuss
Any CNWL teams who would like help with their QI projects can book into a QI clinic.
To book, send a request stating your preferred date and time to cnw-tr.improvementsupport@nhs.net and we shall confirm back to you with a diary invite and link to your QI clinic slot.
We look forward to speaking with you!
Useful Links
Contact information
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Head of QI |
Geetika Singh |
Improvement Advisors:
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Diggory Division |
Peter Toohey |
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Goodall Division and Corporate |
Peter Smith |
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Jameson Division |
Bridget Browne |
CNWL Improvement Academy Microsite: https://cnwl.franktesting.co.uk/ia
Life QI: www.lifeqisystem.com/
If you want to get in touch please contact us here:
cnw-tr.improvementsupport@nhs.net
Follow us on twitter by clicking @CNWLImprovement.