“A journey of a thousand miles begins with a single step.”

By William Diaz, Improvement Advisor

Bedford Community Health Services recently held an online session with 40 staff members and service users to share learning amongst teams. The session was joined by Pedro Delgado, Vice President at the Institute for Healthcare Improvement.

Firstly, we celebrated the success of a team who have seen a 24% reduction in the percentage of Speech and Language Therapy (SALT) patients waiting over 18 weeks for their appointments. Change ideas include follow-up phone call for re-assessment, establishing a dedicated triage clinic, and the use of additional staff support in their outpatient clinics. During the group discussion, they consider other things to help services in BCHS with waiting list issues, such as managing expectations and experience of service users through empowering them with their own experience and crafting a personalised approach to their care, training for care providers around the referral process, and exploring data further to ensure that capacity and resources are directed when the demand is high. Pedro invited the team to consider an opportunity to view this with an equity perspective – do we have people from certain backgrounds that may be disproportionately affected?

Figure 1. P Chart showing the percentage of breaches (patients waiting over 18 weeks)

The team also considered how, they can do more to help further reduce waiting list in other services with their own resources, without approvals, further budget, or support – their single step – using the 15% Solutions. 15% Solutions is one of the 33 approaches to group discussions suggested in The Surprising Power of Liberating Structures by Henri Lipmanowicz and Keith McCandles, where participants discover and plan on what each person has the freedom and the resources to do at present to address a challenge or an issue. The group identified their 15% and reaffirmed commitment to become empowered to make decisions, reduce professional risk-aversion, increase pro-activity in reminding service users prior to their outpatient appointments, and confidence in exploring other means to discourage waste in appointments.

Photo 1. BCHS staff members, guests, and services users during the online IHI Visit

Service users, Peter and Moniek, also shared their experience around collaboration and active participation in QI projects. They both shared QI gave them a voice within ELFT and beyond, learned transferable skills such as storytelling, workshops facilitation, and other useful QI trainings. Pedro encouraged both Peter and Moniek to explore ways to teach improvement in the recovery college for other service users , which they’ll move forward with the help of People Participation Lead, Kamila Naseova.

Lastly, Debbie Martin, Associate Director, and chair of the session, shared her journey around multidisciplinary team working with local councils Leighton Buzzard and Dunstable around population health using QI tools to roll out a model of care that involves all MDT members in the community. Teams feel revitalised to look forward for another 10 years of improvement!