The Quiet Wins of QI Projects – Lessons from the Improvement Leaders Programme through the eyes of Project Leads

 6th March 2025

What does successful a QI project look like? Most would say simply achieving the project aim and embedding improvements into business as usual. They’d be right of course, but that’s not the full picture.

Many projects do not achieve the aim they set out with, but that isn’t failure. Not all improvements are captured tidily on a neat chart; this doesn’t mean nothing has changed and certainly doesn’t mean it was not worthwhile.

In ELFT, we use QI methodology to tackle complex issues. By definition it’s a challenge. There are number of pitfalls that can restrict even the most energised project teams. In this article we will be looking at two projects, one London, one Bedfordshire, to learn from the experiences of the leads.

Success without numbers?

Hackney Carers Hub – 2024

Sam McGavin has shared his insights on the challenges and often unseen benefits of QI projects. Sam has been involved in several QI projects and is currently leading on improving the experience of carers in Hackney. This project started with Sam’s journey through the improvement leaders programme in 2023 as part of wave 13.

“We’ve learnt a lot with this project. We’ve made big changes to how we work with and support with carers. However, we don’t have a chart of an outcome measure showing this. When looking at the project through the lens of charts, it’s at times felt like failure or that we’re not moving. This isn’t the case when we reflect back on what’s been achieved though. We’ve had great feedback on the changes we have made.”

The carers project has achieved a lot:

• A carers hub was started in May 2024 to better support, inform, and involve carers through the inpatient care of their cared-for.
• Follow up phone calls take place to carers upon treatment of service users in hospital.
• Improvements to these calls have been made, making them more helpful and memorable.
• Staff have better knowledge of the important role of a carer.
• It’s brought the issue of lack of carer engagement and satisfaction to the heart of senior leadership, which has unlocked the changes in infrastructure and culture.
• An added bonus of this project is that we are more CQC prepared. We’re meeting higher standards, and better equipped to evidence them.
• There is still work to be done. This project has enabled us to better understand the system we are trying to change. We’ve identified shortcomings we previously would have missed, and can work towards improving. You can’t improve what you don’t know.
• There has been a lot of learning. Not just in the space of carer experience, but in understanding of quality improvement, which we are taking into the next improvement work we embark on.

Sam reflects on the learning of the project and shares advice for others leading on QI projects, particularly those undertaking the Improvement Leaders Programme.

“The foundations of a project are vital. Primarily the aim. If this is the first project you’re leading on and it feels too big… it might be too big. We set off with a broad aim and in hindsight, some of our change ideas could have been entire projects themselves. We probably had about 4 aims rolled into 1, and we were trying to do it all. If we tackled our project with smaller aims, maybe it would have been more manageable, and provided a platform of more achievable outcomes to build on. Ultimately still achieving everything we wanted, but with more structure and realistic timelines.

Energy is a big factor too. Improvement takes time and energy. It’s important to understand how much energy each change idea will likely take, and prepare accordingly. You don’t want to lose momentum. I look back on my QI training and think about the importance of understanding the concepts of the vital few vs the important many. Next time we will be applying that knowledge alongside our new experience, for hopefully an even more productive project.

We were fortunate to have some fantastic lived experience within our project, that made a massive difference in generating meaningful change ideas, as well as driving the energy and momentum. We wouldn’t have made it this far without that. If you want to make change meaningful and long-lasting this is a non-negotiable, a must-have.”

Identifying and Celebrating Improvement – Luton Home Treatment Team

At the same time Sam and the team set off on carer improvement, a team in Luton, Bedfordshire, set off on theirs.

Peter Gatti and Attia Mushtaq aimed to improve acceptance rates to the Home Treatment Team. The team had been dealing with high levels of referrals (above the national average) and low acceptance rates.

Project Team on the Improvement Leaders Programme – ILP13

On the surface, one could look at a chart of the percentage of accepted referrals and dismiss the project work done. The percentage remained largely unchanged. However, this is missing the wider context.

Since 2022 referral figures rose by about 33%. A huge increase in demand. Despite this increase they managed to hold on to their acceptance rates. It meant higher pressure on the team, and reduced capacity for the project. On top of increased demand, much of this was done during an area wide critical incident regarding inpatient bed availability. They persevered. The team identified a big referrer being the inpatient wards and focused there. A Process measure looked specifically at the acceptance rates from wards.

This was the outcome!

The percentage of referrals accepted from inpatient wards has doubled since 2021.

Pete and Attia shared improvements to the system that are hard to capture – the soft improvements: emotion, communication, relationships.

“The relationships and communication between the inpatient wards and Crisis improved significantly over the course of the project. We have a better understanding and a collaborative plan for our service users. We now attend all ward management rounds and have been providing support, advice, guidance of community-based treatments and try to support in taking people out of the ward settings earlier at around 75% recovery, therefore our acceptance rate should increase.

This is an ongoing project and will always be looking for improvements, as we are now blessed with the Quality Improvement mind!”

The 3 lessons of our Improvement Adventurers

Aim – Is it achievable given the resources and capacity available? Is the timeline manageable? Pace yourself, a project that takes years to achieve an aim has psychological impacts on the team. Moral is an often-overlooked resource.

Process measures – a vital part of understanding the complex system you are changing. An outcome measure won’t paint the full picture or include your system’s nuances; just ask Peter and Attia. Process measures will often show you improvements in a system earlier than an outcome measure too – a good emotion driver for a team. It makes a difference.

Team – Diversity rules the waves. A diverse set of stakeholders bring the widest array of ideas. Having the right stakeholders, from the start, is make or break for a project. Our services, processes, and systems all overlap across places ‘outside our remit’ or ability to influence. It’s vital to have a project team with representatives of all the systems you are trying to change or understand… of course the most important being that of lived experience expertise. In the case of the Hackney carers project, despite the challenge with data, they were able to get the right people in the room to test impactful changes.