The ELFT QI method
What does each stage involve?
We want to make sure that we use quality improvement at ELFT to tackle the things that people care most about. We also want to work as whole multidisciplinary teams, with our service users and carers, to tackle these complex issues together. So it’s important to involve everyone in identifying what matters most, what is our greatest issue or opportunity, and achieving consensus on this.
There are a variety of tools that we can use to help, but it will involve asking people who deliver the service and who receive the service what they think, and what matters most to them, and also involve analysing the various data and information available about the service.
We also want to make sure that we use QI to tackle our most complex issues, where we need to be creative in our problem solving, test and learn quickly (from both successes and failures).
Most teams use away days or some other reflective space to think about this question, and achieve consensus on what complex quality issue they want to spend the next 9-12 months tackling using QI.
Once a team has clarity about the quality issue it wishes to tackle, the team should propose this at the directorate QI forum, and explain why this is the biggest and most important issue to spend valuable time solving. Once the directorate sponsors agree, and allocate a coach to provide deeper support, the team should move onto the second stage.
In this second stage, the team (including both those delivering the service and receiving the service), need to dive deeper into the issue to understand the system better.
There are a variety of tools available to help with this – including flow-charting (process-mapping) to understand the steps in a process, cause and effect diagrams (Ishikawa or Fishbone diagrams) to understand the causes of the problem, pareto analysis to identify which parts of the system contribute greatest to the problem (to enable us to prioritise our interventions), walking the pathway to experience the service from the viewpoint of a service user, and capturing more detailed qualitative information from both staff and service users.
This detailed understanding of the system and the problem that the team has chosen to solve will help the team understand where it needs to focus its effort, start to articulate what the future might look like (and define an aim for the work) and start identifying possible changes.
This third stage involves developing the charter for the project, using the Model for Improvement. The team should utilise its deeper understanding of the system to articulate a SMART aim for the project, identify how it will measure progress (using outcome, process and balancing measures) and identify potential changes that might help achieve the aim. This forms the basis of the project charter.
Within this stage, the project team should start understanding their theory of change for the work using a driver diagram, to illustrate how changes will impact on drivers to help achieve the ultimate aim of the project.
During this fourth stage, the team are using PDSA cycles to undertake rapid-cycle iterative learning – testing ideas from small scale, learning and building degree of belief in ideas as they scale up the size of testing.
Through the testing phase, the team will be using run charts or control charts to understand whether they are moving towards their aim.
Each individual PDSA though may utilise more qualitative data to understand whether the test run met the predictions that were set.
In this final stage of the quality improvement project, the team will work to embed the ideas that have been tested and shown to work in multiple contexts into day-to-day operational practice. This still requires PDSA cycles, but of a slightly different type (and which may last longer). Teams at this stage will be considering how to utilise training, inductions, control systems to embed changes into routine business and to keep an eye on reliability.
Teams may also be purchasing new equipment or resources in order to ensure availability and operation of the new change/process continuously. There should be no further testing or adaptation at this stage.
