QI and Pandemics in Bedfordshire, six months later: What did we learn?

 21st January 2021

By Liz Dawson, Medical Director of Primary Care since April 2020 and former Clinical director for adult community services across Bedfordshire and Carlos Santos, Improvement Advsior for Corporate Services, Adult Community Services across Bedfordshire and for Primary Care across the Trust

On the brink of Covid-19, multiple difficult decisions had to be made about which activities should stop or continue across Bedfordshire Community Health Services (BCHS). It would have been justifiable to pause most of our Quality Improvement (QI) efforts and focus on what felt like the most urgent work to respond to the pandemic.

But then we thought: ‘what if we throw some QI into the Covid-19 mix?’

And so we did it.

With QI in mind, we decided to start by collectively agreeing an Aim Statement. By developing the Aim Statement together, we managed to have the whole Directorate focusing their attention and energy to a common purpose, giving opportunity for teams and individuals to join forces and “respond to, and learn from the Covid-19 outbreak, improving outcomes for our team, our patients and the Trust” (this was our Aim, which you will see right below).

Another example of collective endeavour was the development of our Driver Diagram (figure 1) and the series of ‘Shaping Our Future’ workshops (figure 2). The Driver Diagram helped the Directorate to better conceptualise what we were trying to accomplish, building a collective awareness of the drivers that could lead us to achieve the overarching aim.

Figure 1: Initial Driver Diagram, built during the first week of the Covid-19 Lockdown (March 2020)

 

Equally important, the ‘BCHS Shaping Our Future’ workshops brought staff, service users and partners together to help shape the future of the ‘Integrated Discharge Hubs’ in both Luton & Dunstable and Bedford hospitals. The hubs were set up in all ELFT Community Health Service directorates, initially established to facilitate the Covid-19 discharges at the start of the crisis and are now set to continue, after proving to be a successful change.

 

Figure 2: Evaluation of Covid Strategy during ‘Shaping our future’ Workshop 

 

The structure and simplicity of a QI approach seemed to be a great way to go. After all, QI is known for its collaborative nature, whereas many advocated that emergencies such as the Covid-19 outbreak would call for a more autocratic style of leadership to ensure speed in the response.

How did we manage to get QI work done in the midst of Covid-19?

The key was engaging people – and the lessons we learned are transferable to virtually any collective endeavor.

Some of these lessons are:

• People are short on time – keep things short and simple. Short surveys, simple questions, easy-to-read emails etc are the order of the day
• Make it easy for people to be involved. Can you run a quick activity in a meeting that people are already attending rather than create extra meetings? They will thank you for it
• Co-design everything! If people can see their contribution in your QI work, they will be much more likely to be involved
• Share the project, with everyone. You are so much more likely to succeed if you build energy and momentum with others: your end-product will also be much richer and authentic

 

What’s Next?

This work is far from finished. Nothing we did was perfect – but we know that something perfect can’t be improved, and QI is all about continuous improvement.

Thanks to the amazing teams we work with (figure 3) and the patients & carers who have given their time and energy, we have a really good road-map for the work we are going to do to continue our response to Covid-19.

 

 

A similar approach to using QI tools in progressing complex work is being applied to build the Primary Care strategy across ELFT – more will be shared in a future article.