Creativity and QI
This is only a sample of some of the creative QI work that’s happened at ELFT over the past 5 years. If you have anything you would like to share here please get in touch.
An Illustrated Guide to Quality Improvement
To open an interactive version of the Illustrated Guide please click on the image below. Also find out below how you can order your own copy!
Order your own Illustrated Guide to QI
We have made the guide available on Blurb, who you can order the guide from in a premium magazine format. This is a not-for-profit arrangement that will allow Quality Improvers around the world to get hold of their own copies. The price is £4.80 per magazine and the unit price reduces if you order multiple copies. Click on the icon below to find out more and place an order:
Are you a staff member, service user or carer within ELFT? If so please get in touch and we can send you a copy of the book for free!
Background to the Illustrated Guide
At the 2019 ELFT Quality Conference we were excited to launch our illustrated guide to QI, produced by ELFT in collaboration with Sonia Sparkles. It’s an interactive picture book that takes you on a journey from ‘What is QI?’ through to improving the health of populations using Triple Aim. Explore the illustrated guide here >>
Thank you to all involved in the creation of this book, especially Sonia Sparkles for her wonderful illustrations.
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It’s a QI rap!
‘We’re Quality Improving’ is a celebration of QI at ELFT and all of our achievements so far. The music and video was created by staff, service users and carers across the Trust using QI methodology in the process. We used affinity diagrams and nominal group technique to decide on the content and musical style.
The track was written, performed, filmed and produced entirely by ELFT staff and service users across all our sites in East London, Bedfordshire and beyond. ‘We’re Quality Improving’ was previewed at the Trust’s Annual QI Conference in 2016 and all delegates performed the final scene of the video.
Thank you to all of the staff and service users from East London NHS Foundation Trust who helped make this video. We welcome any thoughts and feedback you have on how we can further use the arts, creative and fun ways to share our QI work. We hope you enjoy the movie as much as we did making it together.
Music and Lyrics: Camilo Tirado, Von-de-viel Nettey, Stuart Wood
Filming and production: Salem Hanna, Emma Binley, Stephen Sandford
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Enjoying Work Cohort 2 Illustrations
Our second cohort of Enjoying Work at ELFT ran from February 2018 to November 2019. We delighted to have artist Jonny Glover to join us over the course of this collaborative to illustrate the activity and learning along the way. Enjoy exploring the illustrations below.
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- Learning Set 1
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- Learning Set 4
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- Learning Set 3
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- Learning Set 4
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- Learning Set 5
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- Learning Set 6
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- OVerall Cohort Illustration
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ELFT in One Voice – Quality Conference 2019
Watch the #ELFTin1Voice performance at the Quality Conference here
A group of staff and service users from across the trust came together in one voice to give a rousing performance ending the morning of the 2019 Quality Conference. Over the past few months, singers met in Bedford and London to learn a specially composed piece of music by choir leader Leanne Sedin which highlighted the importance of co-production in health care. #ELFTin1Voice were excited to be joined by psychiatry trainee and rapper, Mandeep Singh, who created a spoken word vignette to open the piece and an improvised rap, reflecting on themes from the talks in the morning. Inspired by the theme of co-production, the performance also included improvised ‘music in the moment’, with singers working together to create a musical soundscape underpinning the improvised rap.
Reflecting on the performance, Jennifer French (Head of Arts Therapies, Tower Hamlets Directorate and Professional lead for Arts Therapies Trustwide) said:
“A huge thank you to everyone who took part in this amazing, inspiring and joyous performance rounding off the quality conference. It’s wonderful to see the creative capacities of our staff and service users being shared and celebrated in so many different ways as part of ELFT culture and values. Can’t wait for the next exciting adventure!”
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The Coborn QI Wall!
In April 2019 we were proud to complete the artwork for the Quality Improvement visibility wall at the Coborn Centre for Adolescent Mental Health in Newham.
Building on the experiences from previous QI wall projects at Robert Dolan House and Newham Centre for Mental Health, this work was a collaboration between young people at the Coborn, ELFT staff and Jonny Glover, a local artist who has worked on the previous QI artwork including the walls and Enjoying Work illustrations.
At the beginning of the project the QI team ran an introductory session on quality improvement for young people at the Coborn, who came up with some themes for the design of the wall, along with preferences for location.
Jonny took these ideas away and produced a design before beginning painting work during March. Young people got involved throughout the process, helping with painting and suggesting adaptations to the final design. You can find some more photos of the work in this gallery >>
Thank you to everyone involved in this fantastic work, we look forward to celebrating it’s completion and know it will inspire quality improvement work across the Trust and beyond!
QI mission statement written by young people at the Coborn
Find out more about the project on Jonny’s website >>
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The Grand Unveiling of Newham’s QI Wall
On the 26th April 2017 our Trust Chair, Marie Gabriel joined service users, carers , staff and international visitors for the unveiling of Newham’s Quality Improvement wall.
Over the last few months ELFT service users, carers and staff have been working together with Jonny Glover, a local artist, to create a QI visibility wall at Newham Centre for Mental Health. The purpose of the wall at Newham is to share the quality improvement work going on locally and encourage everyone to get involved. The finished design includes our version of the Newham Greenway, a popular footpath and cycle route that runs across the area. As we journey from one end of the Greenway to the other people are working together to improve their environment and celebrate achievements along the way.
At the opening event some of our service users involved in the project spoke about the design and their involvement. One service user talked about how well-known this area is in Newham, and that it was a memorable place in her recovery; she spoke about taking walks along the Greenway during her time on one of the wards. The themes of growth and nurture were encouraged throughout the design process and this is represented by people planting seeds and nourishing them. This growth from seeds also symbolises how small ideas for quality improvement can develop and really make a difference.
Another service user who contributed to the design of the wall spoke about the meaning behind the large tree; she described it as the tree of life and how the wall is not just about Newham, it’s about Quality Improvement, which she went on to describe is something that gives us hope.
Marie Gabriel said “It was wonderful to participate in the international opening of the Newham QI wall, what was most inspiring about the event was the theme of a journey of hope, both in the co-creation of the wall and in the diverse journeys it depicts.”
Jonny Glover gave us his reflections on the project too “It was a fantastic experience working with the QI team and all the volunteers. Having lots of people involved in the design was initially daunting, but it turned out to be great fun, and I think ultimately it’s lead to an image that is both singular and meaningful to Newham. I hope the wall is able to galvanise people to get started on their own projects and I look forward to hearing how they each develop.”
The wall demonstrates how people can work together to improve something and includes posters and details about some of the achievements and the current improvement projects taking place. See some of the pictures taken during the launch event below and find out more about how the ideas and designs of our service users & carers have led to this wonderful piece of work>>
Special thanks to everyone involved in the project, and especially to the artist Jonny Glover, whose work has been shortlisted for the 2017 World Illustration Awards. All the best Jonny!
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Introducing our Service User and Carer QI Project Meeting Role Plays
In the lead up to the 2017 annual quality conference some of our service users and carers came together to plan an hour long conference breakout session. They developed a session that included information on getting involved with People Participation at ELFT. Also looking at opportunities, benefits and barriers for service users and carers involved in QI. At the centre of their presentation were two role plays in which positive and negative experiences of involvement in QI project team meetings were acted out.
The learning materials developed and performance given by all involved was very well received at the conference. The group went on to repeat the session for an audience of international visitors during the International Forum on Quality & Safety in Healthcare and they also picked up the Trust Chair’s Award for Project of the Year at the annual People Participation Awards.
The service user & carer team got back together recently to record these role plays for use as learning resources. Please find them below and see which one you think is a positive experience of involvement and which is not so positive…
You can find the whole service user & carer involvement conference session here>>
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Working Together on the Triple Aim at ELFT
Please find our illustrated version of the IHI Triple Aim for ELFT. The ideas for this illustration were inspired by staff, service users and carers at a half day workshop in February 2018. Illustrator Sonia Sparkles then took these ideas and created our patchwork version of the Triple Aim.
Find out more about the creation of this work in this short video>>
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Newham QI Wall artist Jonny Glover interviewed BBC Radio London
Jonny Glover, the artist behind our Newham Centre for Mental Health Quality Improvement Wall was interviewed about his work on BBC Radio London recently.
Jonny talked to Robert Elms about this fantastic project which won a prize at the 2017 World Illustration Awards
You can listen to the interview below and visit Jonny’s exhibition at Somerset House in London from 31 July to 28 August. Further details here>>
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Celebrating 65% reduction in violence and the impact on staff and service users through the City & Hackney Violence Reduction Collaborative
Jane Kelly, Associate Director for Inpatient Services & Lead for the City & Hackney Violence Reduction Collaborative, supported by Jen Taylor-Watt, Improvement Advisor for City & Hackney
In early 2016, a person was injured every 3.7 days on our inpatient unit from incidents of physical violence. Some staff reassured themselves about the threat of violence when they came to work with the idea that “A&E is only next door”.
As the Associate Clinical Director for Inpatient Services & Borough Lead Nurse, on hearing this, I felt devastated. Things were getting worse and worse, and I felt I was failing my ward teams and communities, by not being able to stop them experiencing such very high levels of violence and aggression.
I knew that something needed to change, and with the support of Jen Taylor-Watt, Andy Cruickshank and the QI team, in February 2016 launched the City & Hackney Violence Reduction Collaborative, using a package of change ideas that had been proven to help reduce violence on the Tower Hamlets inpatient unit.
Fast forward 22 months, and we have just spent 2 wonderful afternoons with inpatient staff, reflecting together – and with friends from the broader system – on the achievements of this work within Hackney. Our inpatient wards have succeeded in reducing violence across the unit by 65%, using data over time and this has had a huge impact on us as a unit.
Changing course
Gardner Ward and Joshua Ward were our 2 acute admissions wards with the most violence 2 years ago. Staff talk about running from the door to the office on the Gardner Ward because they were so scared to be on the floor. Some of our new starters on Joshua Ward were so frightened when they were on the ward they needed to be escorted by other staff members. Gardner and Joshua have now both reduced violence by over 70%.
Rebecca Finnegan, Ward Manager on Bevan, our intensive care unit, which cares for our male service users who are most unwell, describes sitting in her office and hearing the pinpoint alarms going off 2-3 times an hour; levels of violence which meant the dominant mentality was “how am I going to get through the next 12 hours before I go home, rather than having a sense of fulfilment in the job”. Bevan has now reduced violence by 39% as a straight count of incidents, or 61% if you take into account changes in occupancy on the wards (as a rate per 1000 occupied bed days). In August-September 2016 there were 61 incidents of violence on Bevan. In the same period in 2017 that’s down to 14 (see image).
So what impact have these reductions had on our wards? What is the meaning behind the numbers?
Staff and service users spent time reflecting on this and bringing their feelings to life on artwork that we shared at the afternoon events. See the journey of each ward here:
As you can see, each ward has represented their experiences differently, but there are movements from darkness to light, from division to togetherness, from fear to calm, etc. We have also created a film, on which staff and patient representatives shared their perspectives on the impact of violence and aggression and the difference this project has made. View it here.
Journey
Brett Ward’s second canvas makes clear that they are still in transition. They’ve come a long way and the present state is much better than where they were 2 years ago, but staff and service users can see a future where things can be even better.
This is true for all of us on the unit in Hackney. This package of change ideas has had an incredible effect on the culture and functioning of the unit; such simple ideas like having proactive conversations about safety and violence in community meetings and bringing the team together to manage risks in safety huddles have really changed the dynamic of the care environment… but we can go further.
It’s a bit like we are a sail boat, which 2 years ago made some adjustments to slightly change the angle of our course. At the time, these felt like small changes; almost imperceptible initially, but after a bit of time we began to notice that we were going in quite a different direction and the sea around us began to look different. Less choppy, more calm.
That change in angle means that, nearly 2 years on, we now really are in a completely different part of the ocean from where we would have been. Rebecca Finnegan talks about how the changes on Bevan Ward mean staff and service users can now spend time on creative projects together, like making jewellery and bookmarks to sell at events and raise money for a bilingual ward library. This really was unimaginable 2 years ago; in terms of where the staff team were at, how service users felt on the ward and the dynamics and culture of everyone together. She comments,
“when you take away the violence, the fire-fighting, that stress of constantly feeling like you’re battling against your patients, you open your service up to doing so much more”
Experiences and expectations have changed.
Staying the Course
The key, of course, is that we ensure we carry on with this new trajectory. It’s so easy, when you do work like this, to get buffeted back to where you were before. The demanding nature of what we do unfortunately contributes to this, as well as the fact that continuing these new ways of working requires continued leadership and energy – the whole crew of the boat committing to continue working in the same direction, if you like. Hear about the leadership this work has already involved here.
Our recent events were partly celebration, but also a time to reflect together on where this work has taken us and to renew our commitments to each other to continue to chart our different course. As well as reflecting on what we found most inspiring about the sessions, we made commitments to each other – as ward teams, clinicians and other partners in the broader system and our Trust and Directorate Management Team – about how we could support each other to hold the gains. See these in the slideshow below.
We also needed to acknowledge as a unit the incredible support and commitment we received from Jen, without whom we would not have achieved the results we did. Her input enabled the ward teams to be creative and fun, as well as achieving and maintaining great results. Jen has certainly been the first mate on our boat and we will miss her leadership and guidance!
So finally, I’d like to renew this call – to everyone in Hackney – to support this work. To encourage your team to do your safety huddles, to make sure you are recording your incidents on your safety cross and to continue to talk openly as a ward community – staff and service users – about your experiences and learning from violence and aggression. Service users and relatives, please discuss and challenge your ward teams to keep up with this work. People from beyond the wards in the broader system, please show interest and support when you are working with us. All of your leadership and interest will make a difference.
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‘Mission Improvable’: an entirely factual and anonymous blog
Here’s an honest and humorous account of the highs and lows of a QI project journey in the Tower Hamlets CAMHS triage pathway. This is the second story of the Improving access and flow within Child and Adolescent Mental Health Services series. Click below to read:
CAMHS Access and Flow series – access all stories here >>
If you are part of ELFT you can learn more about this project on Life QI here – Project Code 107104
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Newham Child and Family Consultation Service in: The Busy Bees
Here’s the third story of the Improving access and flow within Child and Adolescent Mental Health Services series. The Newham Emotional & Behavioural Team share their journey of reducing cancellation rates and other improvements as part of their QI project.
The team also recently threw open their doors for a week-long CAMHS festival, reaching out into their community, with immediate access to some interventions pathways. They are continuing to look for creative ways to improve the experience of their service.
CAMHS Access and Flow series – access all stories here >>
If you want to learn more about this project, visit LifeQI – Project Code 107105
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Enjoying Work Learning Set 6 – Celebration Event
Thank you to everyone who attended the Enjoying Work Celebration event on on 1st February 2019. Well done for the amazing work teams have done over the last 8 months. Your teams’ stories were so inspiring. Keep up the good work!!
Illustration of Enjoying Work Celebration by Jonny Glover
In this area you can find the presentation from the event, along with a photo gallery, plus video and poster presentations from all teams involved. Please find all of these resources shared throughout the learning system available here >>
Photo Gallery
Click on the images to open the full photo gallery
Celebration Event Presentation
Poster and Video Stories
Executive Team
Medical Management Team
Extended Primary Care Team
Bedford Community Rehabilitation Team
Coborn Centre for Adolescent Mental Health
City and Hackney Rehabilitation Team
Newham CAMHS (Child & Adolescent Mental Health Service)
Extended Primary Care Team – North West
Access all Enjoying work team posters and videos in this collection >>
Related Resources
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Highlights from our Quality Conference
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On Tuesday 14th May we were delighted to welcome over 400 people, including staff, service users, carers, governors and external guests to the 5th ELFT Quality Conference. This year’s event was special because it was co-designed with service users and carers, who helped shape the overall theme of the event as well as the content of main stage and project presentations.
The day started with a welcome from Mary Elford (Vice Chair) and Satwinder Kaur (Lived Experience), followed by a keynote talk on population health from Jason Leitch, QI World Cafe presentations from 19 project teams, a plenary session on Co-Production delivered by service users and carers, closing messages from our Chief Executive Navina Evans, who also launched our ‘Illustrated Guide to Quality Improvement‘. The conference was closed by the ELFTin1Voice choir who sang ‘See me as I am’, a specially commissioned piece of music which highlighted the importance of co-production in healthcare.
You can find full highlights from the event below. Thank you to everyone who was with us on the day and those that couldn’t be with us who are all contributing towards the ELFT mission to improve the quality of life for all we serve.
Quality Conference highlights!
Keynote presentation from Professsor Jason Leitch
We were delighted to welcome Professor Jason Leitch to the event who gave a keynote talk on population health, sharing experiences from Scotland and helping the Trust progress in our mission to improve the quality of life for all we serve. You can access a PDF of his presentation here >>
Jason is National Clinical Director of Healthcare Quality and Strategy for the Scottish Government, he has visited the Trust on a few occasions and also spoke at the 2016 Quality Conference.
Co-Production – What it is and what it isn’t
ELFT service users and carers presented the morning plenary session – Co-Production: What it is and what it isn’t. Introducing delegates to ‘The Ladder of Participation’ and used a game show format along with their own experiences to highlight the various steps on the route towards co-production.
Quality Improvement World Cafe
All delegates at the conference got the chance to be part of the QI Project World Cafe session. Nineteen QI project teams presented their work and learning around tables, with each delegate getting to be part of the discussion with up to three teams. All projects showcased Big I and Little I involvement and were presented by service users, carers and staff. You can find out more about the projects presented in these short videos produced by the teams themselves >>
Closing message from Dr Navina Evans
In her closing remarks, ELFT CEO Dr Navina Evans thanked all service users, carers and staff who shared their stories in the plenary session and in the World Café project presentation sessions. Speaking about the plenary session on Co-production, she said:
“You demonstrated what a struggle it is to properly do co-production. Out of that what I took is the incredible patience, understanding and kindness of our service users, carers and people participation colleagues, because sometimes we take two steps forward and one step back and you help us push to go forward again.”
She also thanked keynote speaker Jason Leitch, National Clinical Director of Healthcare Quality and Strategy in Scotland, who talked about Population Health and ELFT’s new mission.
“We are privileged to have Jason here, for giving us a few minutes to celebrate and then immediately getting us to the heat of the mater of what we want to do”
ELFTin1Voice
See me as I am!
A group of staff and service users from across the trust came together in one voice to give a rousing performance ending the morning of the 2019 Quality Conference. Over the past few months, singers met in Bedford and London to learn a specially composed piece of music which highlighted the importance of co-production in health care. Learn more about how this all came together here >>
An illustrated Guide to Quality Improvement
The Quality Conference was also the launch of a new book that ELFT has developed in collaboration with Sonia Sparkles. You can find an interactive online version by clicking the front cover below.
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Quality Conference 2018 highlights
Over 400 people, including ELFT staff, service users, carers, governors as well as external guests, attended the annual Quality conference on 24th April 2018. Below you can read about the highlights of the day.
The ELFT Quality Conference 2018 was composed of powerful presentations, the revelation of the trust’s new mission statement and inspiring conversations. In her closing speech, ELFT CEO Dr Navina Evans emphasised that the 2018 Conference was special because it coincided with the launch of the trust’s new strategy, which embodies the trust’s priorities around the Triple Aim.
“We took our time, we really wanted to think about how this trust does that is relevant for the communities that we serve. Our new ambition is bold, it is challenging and our mission”, Dr Evans said. “We realised that we cannot continue to do what we do and to improve in isolation”, she added, whilst also making the point that without patient input into quality improvement it is a pointless discussion.
Earlier that week, the trust released its new strategy, which is the culmination of over 100 focus groups and discussion with more than 800 staff, governors and service users. “We want this strategy to be meaningful to every single person who works in this organisation, every single person who comes into contact with us and who uses our organisation and for every single person to hold us to account on what we promised to deliver.”
You can watch Dr Navina Evans’ full speech here.
At the start of the Conference delegates were greeted by the energetic ELFT Beats! drummers, supported by the expertise of the Pandemonium Drummers. A video celebrating highlights of the past year opened the day’s agenda, followed by remarks from the trust’s Chief Quality Officer Dr Amar Shah and Chair Marie Gabriel.
The first keynote address was delivered by Dr Jennifer Dixon, CEO of The Health Foundation. Her presentation focused on the role of improvement approaches to make progress on population health.
You can watch her presentation and view her slides here.
Breakout sessions
Delegates were also able to join two breakout sessions in the morning. In the World Cafe rooms, each attendee had the change to hear directly from three of a total of 18 project teams about their QI journey and what they have learned so far. Themes revolved around improving access, service user involvement, reshaping community services, enjoying work and learning from failure.
Short video presentations from all projects were also on display during the conference. You can access the content here.
The session S+P+C=O, which is short for Structure + Process + Culture = Outcomes, was led by James Innes, Associate Director of Quality Improvement, Duncan Gilbert, Head of Quality Assurance and colleagues from our City & Hackney Adult Mental Health Service. They presented work and achievements made in City & Hackney around reducing harm from violence. You can access the slides here.
In the afternoon, external delegates took part in four workshops. Materials used in those sessions can be accessed here: Leadership for Improvement; Tips and Tricks for getting started with QI; Research and Improvement; and Service User and Carer Involvement.
Arts at ELFT
Also as part of the Conference we unveiled our ‘Working together on the triple aim‘ illustration developed in partnership with Sonia Nosheen, who is also known as Sonia Sparkles. The illustration is a result of a collaborative art project, facilitated by ELFT Arts. The poster reflects how service users, carers and staff see trust’s Triple Aim journey.
You can learn more about the process that led to the creation of the poster below.
What to see more?
Below you can see a photo gallery and a video in which delegates comment on their experience.
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