Co-production lies at the heart of our improvement work

 7th February 2024

At East London NHS Foundation Trust (ELFT), we believe in the power of co-production. We understand that the key to successful improvement work lies in the hands of those who use our services, in addition it is 2.8 times more likely that an aim will succeed if there is Big I* service user involvement (Kostel and Shah, 2021). This is why we strive to ensure authentic and meaningful involvement of service users and carers in all our Quality Improvement (QI) projects. Below are some ideas being tested across the Trust to encourage and support coproduction across the Trust. 

 

Training Together for Better Services 

Our staff and service users receive training together on QI learning programmes at ELFT. This joint training equips them with the necessary skills to collaborate effectively and make their services better. We also offer specific training for service users and carers as an introduction to QI to encourage involvement so they can improve where they receive care. You can find out more and sign up by clicking here  

 

*Big I Involvement: Service Users as Active Members of Project Team 

Across the Trust, the QI and People Participation teams have been testing change ideas to increase the number of projects with ‘Big I’ service user involvement. This means that service users are full active members of the QI project team. While most projects have ‘little I’ involvement where service users have been consulted, ensuring ‘Big I’ requires a proactive approach. Ideas are tested using Plan-Do-Study-Act (PDSA) cycles, just as we do in any improvement work. 

 

Collaborative Action Plans and Information Packs 

Community Health Services in London and all the mental health services across Beds and Luton have been testing out more regular meetings between People Participation and the Improvement Advisors to work together to create an action plan to recruit service users to join improvement work. 

In addition, London Community health services have been sending information packs about ‘Big I’ Involvement to all new project team members before they pitch to the QI Forum. This ensures that everyone is on the same page about the importance of service user involvement. You can see the impact in the charts below.  

 

Dedicated QI Forums and Specific Agenda Items

All directorates have service user involvement as a consistent agenda item in the QI Forum. Here, the data is reviewed and discussed to think through what change ideas to test. Bedfordshire and Luton Mental Health Services have hosted dedicated QI Forums focused on improving service user involvement which include hearing a service user’s story to anchor the purpose of improvement work. There is also a specific section on the QI Forum template for project leads to share their plans for ‘Big I’ involvement.

Moreover, the QI team and People Participation have established a regular QI slot at the Trust wide Working Together Group. This is to share stories of service user/carer involvement.

There has been an overall Trust wide improvement in service user involvement with 40% of all projects having ‘Big I’ involvement. More locally, in Bedfordshire and Luton there has been an increase in Crisis and Inpatients services and there is a steady increase in London Community Health Services.

Myles Trigham and Sheila Menzies (people participation leads in Bedfordshire and Luton) have been working closely with the Improvement Advisors to take a proactive approach and supporting clinical staff to encourage service users to get involved. Here’s what they suggest around meetings that encourage service users to attend….

“…The trick is crafting meetings that embody inclusivity, respect, and warmth. When you cultivate an environment where individuals feel seen and acknowledged, they’ll naturally want to dive into the improvement work. Begin by fostering the right “Vibes,” and rest assured, the true “Drives” of productivity will follow suit. Prioritise this at the beginning because trying to flip the script the other way around is a tough uphill battle. If people aren’t invested, it snuffs out the creativity and passion that fuels our successful improvement work. Patiently focus on people over outcomes. With committed, consistent, lived experience expertise, outcomes will follow naturally.

 

In Bedfordshire and Luton Mental Health we are blessed to have fantastic improvement advisors. They are not just passionate about lived experience involvement; they are actively fun to be around as people. It’s brought us to a place where people want to work with them, resulting in them getting involved in projects they otherwise wouldn’t have. These relationships mean instead of meeting resistance and dropping off, people feel more comfortable raising concerns, so they stick with projects longer, and problems get addressed”. 

Kostel, G. and Shah, A. (2021). Putting improvement in everyone hands: opening up healthcare improvement by simplifying, supporting and refocus on core purpose. British journal of healthcare management, Vol 27, No 2.