Central and North West London NHS Foundation Trust (CNWL) is a large provider of services across a person’s life span, in community, mental and specialist services in London, Milton Keynes, Surrey, and Bucks.
Home to almost 7000 staff, caring for people with a wide range of physical and mental health needs. The majority of services are provided in the community, treating people in their homes, local clinics and hospital environments.
Sharing quality improvement results across CNWL as with any organisation spread across a large geography can be complex. The Trust took the decision to launch a QI programme as a way to implement a standardised approach to improvement across the organisation and build on sharing and spreading improvement.
The commitment to change
In 2017 came the shift, it was clear to the organisation that for staff to embrace improvement they had to re-look at their approach and start to imprint a new strategy across the entire organisation.
The aim was to:
“Enable a Trustwide change in culture and shift it to continuous improvement with everyone using the same methodology” Simon Edwards, Trust-wide QI Clinical Lead, CNWL
The dialogue with staff was crucial for the success of the programme. This was NOT a top down, performance management exercise, quite the opposite. It was a supportive Trust-wide QI programme. The objective of the programme was a fresh approach, to support staff on their QI journey, empowering them to think of great change ideas within their Division. Giving staff free reign to focus on the QI projects they are passionate about and offer them the opportunity to flourish and really make a difference to people’s lives.
Later in 2017 CNWL entered into a strategic partnership with the Institute for Healthcare Improvement (IHI) to help solidify their improvement strategy using the Model for Improvement and support the roll out of the QI programme across the organisation.
Together with the IHI, CNWL decided to build a small centralised team to coordinate the QI programme efficiently and successfully, and allow the actual improvement work to be driven by staff within their own teams. To date this consists of a Trust-wide QI Programme Lead, Trust-wide QI Clinical Lead, one QI Programme Manager and three Divisional QI Clinical Leads.
Whilst this was modest compared to the organisation size, the focus was NOT for these staff to be the data wranglers but focused on supporting staff through their new QI journey, with this direction came a requirement for a systematic approach to tracking project and improvement data from the offset, allowing staff to run projects, track change ideas and collect data individually removing the need for the central team to do it.
“We knew we needed a digital platform to support QI and when we looked at options, Imperial College Health Partners had access to the Life QI platform and recommended it to us.” Bridget Browne, QI Programme Manager
The roll out process
With a centralised team in place, a partnership with the IHI confirmed, Life QI positioned as the trusted platform, a new CNWL QI microsite and a new series of monthly newsletters ready to go, CNWL took a Trust-wide comms approach to rolling out the new QI programme. Divisional leads were in place to do face-to-face engagement and central events were held to encourage staff commitment.
“What helped implementation of QI across the organisation was that staff had access to Life QI from day one. It wasn’t something that we were trying to retrospectively implement” Alison Butler, Trust-wide QI Programme Lead, CNWL
Life QI is incorporated into all of CNWL’s QI training, including the Bite Size in-house half day training, their big-ticket training events they facilitate with the IHI, the virtual workshop training and any individual face-to-face training.
Staff are encouraged to learn from the Life QI community and not to re-invent the wheel! The learning process can be accelerated if they look at similar projects on the Life QI system, tweak it and repeat the successes.
CNWL’s priorities are outlined on the Life QI system as a reminder to all staff of the organisation’s focus. However, it was outlined to staff that this did not have to be exclusive, if someone had an idea that was outside of this scope they would be encouraged to continue.
The organisation has also taken a distinct approach to ensure, where possible, staff seek service user and carer involvement in improvement projects.
The results so far
CNWL’s approach to QI has seen a rapid uptake in internal QI training and staff running projects on Life QI. Life QI has had a great impact on the organisation. Accelerated growth has seen user numbers flourish from 2 to 926 users on the platform in 14 months.
“Any staff member who has QI training with CNWL also has training on the Life QI platform. It helps add structure and process to developing QI projects” Bridget Browne
One of the achievements to date for CNWL is seeing 25% (Dec 18) of all projects with service user and carer involvement, which has been one of the Trust’s main priorities.
Staff engagement in QI has exceeded their expectations with staff independently running QI projects and actively recording them in Life QI remotely, everyone is working in a unified way. The reporting element of the system has significantly reduced time and has even been presented as evidence in Care Quality Commission (CQC) inspections by staff members as it is so accessible and easy to use.
The dashboards on Life QI are used in Executive Team meetings, and are enabling teams to recognise individuals great work; no QI work is going uncelebrated!
“One of the benefits of Life QI is that we can present the live dashboards from the platform in our meetings, we don’t have to rely on excel spreadsheets.” Bridget Browne
"Life QI has helped us think about data differently, allowing us to use live data and have the conversation around how we use data.” Alison Butler
Life QI will continue to play an important part in supporting CNWL's ongoing journey to bring services and teams together with an aspiration of providing the highest quality of care.