20 January 2022

A Nurse’s ‘Daily Improvement’ Idea to Improve the Experience and Outcomes for Service Users in Tower Hamlets

By Susan Alfred, Improvement Advisor

 Anyone can use quality improvement tools in their everyday work. Daily improvement can be applied to simple quality issues and process problems to help make small improvements in more straightforward scenarios. Big, complex issues will still benefit from the structure of a project and a team, and we should continue to look for opportunities to use improvement tools in our day-to-day work. One community health nurse did just that. In this story,  find out how she used ‘Plan Do Study Act’ cycles to rapidly test an idea.

Nurse, Afia Begum, joined the Trust as a permanent member of staff following successful recruitment to the Community Health Service (CHS) Older Person’s Clinic in October 2020. Although, she was not new to ELFT, having previously worked for the Trust as a bank staff member, she soon discovered ‘daily improvement’ was a key factor in her new role.

Supervised by Patrycja Lockwood (Highly Specialist Older Person`s Clinic Physiotherapist), Afia was given ample opportunity, in her nursing role, to consider what improvements could be made that would impact the experience and outcomes for elderly service users in Tower Hamlets. “How can we make our service better?” was a regular question she asked herself.

It was not long before Afia observed a gap in the information given to service users about postural hypertension; a condition in which an individual’s blood pressure can drop with a change in body position. This can lead to dizziness and falls which can be dangerous in an elderly population. Although staff provided information verbally in clinics to service users, Afia felt there was an opportunity to improve awareness of the condition. NICE guidelines suggest the provision of written information, and Afia decided to test the use of solution focused reading material for service users to take home with them. Although it was clear written information should be distributed to service users by staff in the CHS Older Person’s clinic, what this looked like had to be explored.

Afia decided to use a Plan Do Study Act Cycle (PDSA) to help her test the leaflet that was being developed. PDSA’s are a key component of the model for improvement and help to rapidly test a change idea on a small scale and iterate the idea based on that learning.

Having developed an initial prototype leaflet (see figure 1), Afia tested it with a small number of service users to quickly gather feedback. Three key questions that needed answering during this PDSA cycle included:

  • Was the leaflet helpful?
  • Was the messaging and advice easy to read and follow?
  • Did people understand all the information shared?

Figure one: Afia’s draft of a written resource for service users on postural hypertension)

With support from John Kauzeni (People Participation Lead for Tower Hamlets), the draft information resource was shared at the Tower Hamlets Working Together Group (WTG), where several service users were able to feedback on draft 1 of the resource.

The feedback was largely positive with service users indicating that it was helpful service users gave feedback that the leaflet was very helpful and relevant but also added that there was room for improvement around the look of the leaflet and how easy it was to understand in parts. Service users then helped redesign the leaflet with Afia, creating 2 more prototypes with the final product shown in figure 2 below.


Figure 2 – The chosen design


The leaflet has since been signed off by the ELFT Comms Team and sent for translation to Sylethi language. Using a PDSA approach allowed Afia to quickly develop and gain feedback on a prototype in collaboration with service users. It also helped her answer some key questions she had about the leaflet before going ahead and implementing. This outcome is a great example of successful collaboration for successful daily improvement.

Afia shared “The whole experience has made me feel empowered to improve and has definitely increased my job satisfaction.  I am looking forward to more opportunities to improve our service.”


Well done to Aifa and Patrycja and the rest of the Older Persons Clinic Team!

Aifa                       Patrycja

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  • YesNo
  • 12345
    1 = poor | 5 = great
  • 12345
    1 = not useful at all | 5 = very useful


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