Bedfordshire and Luton Launch Event on Tuesday 22 March 2016

1. Luton and Bedfordshire
Quality Improvement
Launch
Join the online discussion and tweet your thoughts or ideas using the hashtag
#QIConf
Follow us on @ELFT_QI

2. • Fire Exits
• Tea-break
• Lunch
• Slido
House-keeping

3. Welcome
John Wilkins
Deputy CEO & Managing Director
for Bedfordshire and Luton
Dr. Richard Evans
Deputy Medical Director

4. What’s coming up this morning?
All about

5. Let’s join the conference
in East London

6. Back to Bedfordshire

7. What is QI?
Dr Zelpha Kittler
Clinical Director, Bedfordshire

8. Institute of Medicine, Crossing
the Quality Chasm: A New Health
System for the 21st Century,
2001
What is Quality?

9. Why does Quality matter?
Our core purpose for existing
Of greatest importance to our patients,
carers, staff, GPs and all our stakeholders
Poor quality costs
Provides a clear long-term focus – guiding
decision-making, investment, organisation

10. Where do we want to get to?
Working in partnership
with patients and carers
to continuously improve
Empowering front-line
staff to innovate and
improve the care we
provide
Systematic ways of
implementing change
and monitoring
progress
Improve quality
improvement capability
in our organisation
Continuous
quality
improvement
Where do we want to get to?

11. How do we do QI?

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

14. How are we planning
to develop QI across
Luton & Bedfordshire?
Dr Farid Jabbar
Clinical Director, Luton

15. 67.8
51.1
UCL
LCL
25
35
45
55
65
75
85
95
06-Jan-14
20-Jan-14
03-Feb-14
17-Feb-14
03-Mar-14
17-Mar-14
31-Mar-14
14-Apr-14
28-Apr-14
12-May-14
26-May-14
09-Jun-14
23-Jun-14
07-Jul-14
21-Jul-14
04-Aug-14
18-Aug-14
01-Sep-14
15-Sep-14
29-Sep-14
13-Oct-14
27-Oct-14
10-Nov-14
24-Nov-14
08-Dec-14
22-Dec-14
05-Jan-15
19-Jan-15
02-Feb-15
16-Feb-15
02-Mar-15
16-Mar-15
30-Mar-15
13-Apr-15
27-Apr-15
11-May-15
25-May-15
08-Jun-15
22-Jun-15
06-Jul-15
20-Jul-15
03-Aug-15
17-Aug-15
31-Aug-15
14-Sep-15
28-Sep-15
12-Oct-15
26-Oct-15
09-Nov-15
23-Nov-15
07-Dec-15
21-Dec-15
04-Jan-16
18-Jan-16
01-Feb-16
No.ofIncidents
Incidents resulting in physical violence (Trust-wide, excluding Luton and Bedfordshire) - C Chart
TRUST WIDE VIOLENCE REDUCTION
25% reduction

16. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build the
will
Build
improvement
capability
Alignment
QI Projects
1. Launch event & roadshows
2. Microsite
3. Using the power of narrative
4. Celebrate successes
5. Network of champions / ambassadors
6. Learning events
1. Initial assessment of alignment & capability
2. Recruiting central QI team
3. Online training
4. Face-to-face training
5. Follow-up coaching on projects
6. Develop in-house training for 2016 onwards
1. Align all projects with improvement aims
2. Align team / service goals with improvement aims
3. Align all corporate and support systems
4. Patient and carer involvement in all improvement
work
5. Embed improvement within management structures
Reducing Harm by 30% every year
1. Reduce harm from inpatient violence
2. Reduce harm from falls
3. Reduce harm from pressure ulcers
4. Reduce harm from medication errors
5. Reduce harm from restraints
Right care, right place, right time
1. Improving patient and carer experience
2. Reliable delivery of evidence-based care
3. Reducing delays and inefficiencies in the system
4. Improving access to care at the right location

17. How do we drive improvement?
Culture change – from managing
performance to supporting quality
improvement
Leadership
Invest in our people - provide our staff
with the skills and space to make
improvements
Innovate - Small-scale change led by
front-line staff with short cycles of change
to keep momentum
Spread what works

18. How do we align QI projects to the overall Aims?

19. The Tennis Ball Game

20. Break out Exercise
At your table: How many people are at your table?
6, 7, 8, 9 or 10
Assign a time keeper
Assign a number to each of the other people at your
table, starting with the number 1 and continuing until
you run out of people

21. Break out Exercise
Your current process involves tossing a tennis ball
from person to person, following the sequence
provided on the next slide
Practise your process one time
Time keeper - please time how long the team
takes to complete the process (in seconds)

22. 6 people
7 people
8 people
9 people
1
2
3
4
5
6
1
1
2
3
4
6
7
5
1
1
5
3
4
7
8
2
6
1
1
2
3
5
7
9
6
4
8
1
5 people
1
1
2
3
4
5

23. Break out Exercise
Team Aim: To reduce the time taken for every person to
touch the ball
Come up with change ideas and try them out
Rules:
• The initial sequence as provided must be adhered to
• You may only test one change idea at a time
• You have 4 minutes to test out different change ideas
to achieve your aim

24. 6 people
7 people
8 people
9 people
1
2
3
4
5
6
1
1
2
3
4
6
7
5
1
1
5
3
4
7
8
2
6
1
1
2
3
5
7
9
6
4
8
1
5 people
1
1
2
3
4
5

25. Knew your aim and worked together to…
• Think of a few different ways of doing it
• Tested out the approaches
• And you learned…
What worked well and perhaps what didn’t too!
You’ve just done some PDSAs!

26. Reducing Harm and Developing
the Right Care in
Right Place at the Right Time
QI In Luton & Bedfordshire
Ishrat Love-Chowdhury
QI Lead

27. “…Using data, we can determine what
care is working well and what needs to
be improved, allowing patients,
clinicians and commissioners to <see>
the quality and efficiency of care…”
Chief Data Officer
NHS England

29. 669
283
182
168
133 128
89 86 80 80 69
49 46 45 42 35 26 25 21 17 15 14 13 12 12 9 9 9 4 3 2 1 1 1
80%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
100
200
300
400
500
600
700
800
Frequency
%
Pareto Analysis
Luton & Bedfordshire
incidents

30. 551
125
90
78
58 57
46 44
31 26 24 23 20 20 20 17 11 11 9 8 7 5 4 2 2 2 1 1 1 1
80%
0%
20%
40%
60%
80%
100%
120%
0
100
200
300
400
500
600
Frequency
%
Pareto Analysis
Luton incidents

31. 325
127
96
63
55
43 40 38
31
26 23 23 22 20 19 18 17 17 15 14 12 12 11
5 4 4 1 1 1
80%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
50
100
150
200
250
300
350
Frequency %
Pareto Analysis
Bedfordshire incidents

32. REDUCE HARM
BY 30%
EVERY YEAR
RIGHT CARE,
RIGHT PLACE,
RIGHT TIME
QI Work in East London on
Violence and aggression

33. Globe ward

34. Designed and developed the
Safety Culture Bundle of
interventions throughout 2015
Used on 4 acute wards with
some success on PICUs
Shared bundle includes:
• Safety huddles
• Broset Violence Checklist
• Safety Crosses
• Safety discussion in ward
community meetings
Tower Hamlets Violence Collaborative

35. 0
10
20
30
40
50
60
05-…
07-…
14-…
02-…
07-…
14-…
24-…
10-…
11-…
20-…
22-…
15-…
18-…
06-…
24-…
13-…
18-…
23-…
01-…
05-…
11-…
23-…
26-…
14-…
11-…
06-…
27-…
16-…
22-…
04-…
17-…
28-…
12-…
05-…
18-…
16-…
14-…
30-…
03-…
02-…
23-…
05-…
21-…
14-…
Timebetweenevents/days
3 days
8 days
5.8 2.4
UCL
LCL0
2
4
6
8
10
12
14
16
06-Jan-14
20-Jan-14
03-Feb-14
17-Feb-14
03-Mar-14
17-Mar-14
31-Mar-14
14-Apr-14
28-Apr-14
12-May-14
26-May-14
09-Jun-14
23-Jun-14
07-Jul-14
21-Jul-14
04-Aug-14
18-Aug-14
01-Sep-14
15-Sep-14
29-Sep-14
13-Oct-14
27-Oct-14
10-Nov-14
24-Nov-14
08-Dec-14
22-Dec-14
05-Jan-15
19-Jan-15
02-Feb-15
16-Feb-15
02-Mar-15
16-Mar-15
30-Mar-15
13-Apr-15
27-Apr-15
11-May-15
25-May-15
08-Jun-15
22-Jun-15
06-Jul-15
20-Jul-15
03-Aug-15
17-Aug-15
31-Aug-15
No.ofIncidentsper1000OBD
MHCOP service
Tower Hamlets collaborative

36. REDUCE HARM
BY 30%
EVERY YEAR
RIGHT CARE,
RIGHT PLACE,
RIGHT TIME
QI Work in East London on
Improving Access

37. Newham Child and Family
Consultant Service
Front Door QI Project

38. Driver diagram
To reduce waiting
times for CFCS from
11weeks to 9 weeks
by April 2015 and
improve the patient
experience of
referral to CFCS as
demonstrated by
increased
attendance at first
appointment
Referral Processes
Define Admin process for
handling referrals
Define standards from
CAMHS clinicians in liaison
activity with referrers
Streamlining referral
processes
Identify and use onward
pathways for cases diverted
from CFCS
Demand Management
Information provided to
referrers about CFCS
Checklists/ Screening tools
for referrers
Awareness events
Signposting to alternative
services
Limited Capacity
Increase proportion of
telephone consultation time
Workload balancing
Broaden interventions Develop self help materials
Standardise liaison activity with
referrers
Develop telephone screening
protocol for families
Develop welcome call to
families accepted to CAMHS
prior to appt
Develop library of easily
accessible self-help materials
Screening checklists for
GPs/referrers
Review and rationalise info sent
to families
Develop knowledge about
alternative services in
community / ‘secret shopper’
users.
Review and develop
administrative systems for
referrals
AIM PRIMARY DRIVERS SECONDARY DRIVERS CHANGE IDEAS

39. A P
S D
A P
S D
Cycle 1: Collect baseline data on current referral process
Cycle 2: Standardize triage assessment script
Cycle 4: Pilot triage (‘Front door’) service
Cycle 3: Develop self-help library and local service database
Sequence of PDSA’s – for one change
idea or secondary driver
Cycle 5: Using interpreters

40. A P
S D
A P
S D
Cycle 6: : Drop-in appointments
Cycle 7: Pilot combined DLC & ‘front door’ role
Cycle 9:Implement the full ‘front door’ service
Cycle 8: Align referral admin with ‘front door’ service
Sequence of PDSA’s – for one change
idea or secondary driver (cont.)

41. OUTCOMEMEASURES Improving Access Collaborative – CAMHS Newham CFCS Front Door Service
March 2016
BALANCINGMEASURES - Baseline data
58.5
48.8
UCL
LCL
25
35
45
55
65
75
85
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
AverageWaitingTime/Days
Average waiting time from referral to 1st face to face appt (NH CAMHS) - X-bar Chart
144.1
UCL
LCL
60
80
100
120
140
160
180
200
220
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.ofReferrals
No. of referrals received (NH CAMHS) - I Chart
28.54%
20.58%
UCL
LCL
5%
10%
15%
20%
25%
30%
35%
40%
45%
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
DNA/%
% of 1st face to face appt DNAs (NH CAMHS) - P Chart

42. REDUCE HARM
BY 30%
EVERY YEAR
RIGHT CARE,
RIGHT PLACE,
RIGHT TIME
QI Work in East London on
Improving Physical Health

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

44. AOS

45. Sapphire ward

46. Luton & Bedfordshire
Looking at data over time…

47. How has QI impacted on staff?
55
60
65
70
75
80
85
90
2010 2011 2012 2013 2014 2015
Score(%)
Staff able to contribute towards
improvements at work
3.5
3.6
3.7
3.8
3.9
4
4.1
4.2
2010 2011 2012 2013 2014 2015
Score
Staff Motivation to Work
3.3
3.4
3.5
3.6
3.7
3.8
3.9
4
4.1
2010 2011 2012 2013 2014 2015
Score
Staff job satisfaction
3.5
3.6
3.7
3.8
3.9
4
2010 2011 2012 2013 2014 2015
Score
Overall Engagement Score
ELFT Score

48. Let’s hear from some of
the staff and patients in
East London about what
kind of impact QI has
made…

49. Tea break
15mins
…Take a look at the
posters on display

50. Running QI Projects
within a supported
environment

51. Running a QI Project
Neil Lad
Staff Nurse, Onyx ward

52. Being a QI Coach
and supporting projects
Jamie Stafford
Clinical Nurse Manager
Jade ward PICU

53. Next up for
QI Luton & Beds
Ishrat Love-Chowdhury
QI Lead

54. Area Project
Luton To ensure Physical Health Needs & Risk
Assessment are completed for all admissions
Luton To improve Patient Safety and Follow-up
discharge
Bedfordshire Reducing waiting times in Bedfordshire’s East
and West CMHTs
Bedfordshire Improving Outcomes
Bedfordshire Embedding a system of practice audit
Bedfordshire Provision of synchronised and high quality
reporting
Other initial QI Projects

55. Learn more about QI
April – August 2016
• General QI Roadshows
• Service / Team sessions
• Preparatory Workshops
All the details will be on
the Microsite as more
dates are confirmed
www.qi.elft.nhs.uk

56. Date: Service:
23rd March 2016 Ash Ward Away-day
30th March 2016 Keats Ward Away-day
25th April 2016 General QI Roadshow 1
27th April 2016 Coral Ward Away-day
27th April 2016 Fountains Court Away-day
26th May 2016 General QI Roadshow 2
4th July 2016 General QI Roadshow 3
July 2016 Psychiatric Liaison Services
July 2016 Jade Ward PICU
July 2016 Older People’s Services
July 2016 Bedfordshire All Community Services Away-day
6th Sept 2016 Bedfordshire Well-being Service Away-Day
Early July 2016 CAMHS
August 2016 Learning Disabilities
And we’ll be coming to meet your teams..
Please check on www.qi.elft.nhs.uk for all confirmed
dates and venues…

57. Prework
Workshop
9/29-10/1
Webex 1
10/14
Webex 2
11/2
Supports:
• Listserve
• Assignments
AP-1 AP-2
Webex 3
11/30
AP-3
Project
Planning
Reliability
Sustaining
Gains
Workshop
(3 days)
Webex #2Webex #1
• Faculty consults
• Webex calls
• Coaching calls
Webex #3 Learning Set
2 &
graduation
AP-5AP-4
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.
Learning
set 1
Improvement Science in Action
6 Month Learning Path

58. Service User Input
Support around every team
Project Sponsor QI Coach
QI Forums
QI Team
www.qi.elft.nhs.uk
qi@eastlondon.nhs.uk
@ELFT_QI

59. Let’s re-join the
conference in
East London

60. Back to Bedfordshire

61. We’re Quality
Improving…”

62. • Lunch available
• Posters
• Drop-in session
Wrap up

63. The
ELFT
Has now
launched in