QI in Primary Care and Psychological Services
Reducing Wait Times
Learn more about this QI project presented at the ELFT Quality Conference in April 2018
Please find the team’s poster available here>>
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Reducing Wait Time for First Contact with Psychology in Luton
Learn more about this QI project presented at the ELFT Quality Conference in April 2018
Please find the team’s poster available here>>
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Psychology Group Attendance Project
Learn more about this QI project presented at the ELFT Quality Conference in April 2018
Please find the team’s poster available here>>
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Acute Psychology Group Attendance Project
Please learn more about this completed ELFT QI project from the adjacent poster.
ELFT staff, service users and carers can access full details of this project on QI Life.The project code is 101080 please log onto your QI Life account before clicking the logo below.
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Trust Board QI Story: reducing waiting times at Luton CMHT Psychology service
Dr Timothy Sporle, Consultant Clinical Psychologist, presented some results from the QI project aimed at reducing wait times for 1st appointments in Luton in the latest ELFT Trust Board meeting. The presentation is available below.
The Luton Community Mental Health Team (CMHT) Psychology service has seen a 50% drop in first contact wait times over the past few months, as a result of change ideas put into practice as part of a QI project. Dr Timothy Sporle, Consultant Clinical Psychologist, presented results from the Reducing Wait Time for 1st appointment QI project in the ELFT Trust Board meeting, which took place on 14 December 2017.
Service user waiting times to first face to face contact was between 11-13 weeks before July 2014. There was also evidence of lack of service user knowledge about the psychology assessment, whilst staff also felt that receiving more information before an assessment could be more effective.
In an attempt to tackle those problems, the team then implemented a Psychology Awareness Programme (PAP) as a change idea. The programme is comprised of three group sessions and allows service users to gain more understanding about the service. Also as a result of the programme, service users are receiving wellbeing advice more quickly and are encouraged to think about their goals early on.
“By the time they reached their first assessment, service users were better informed about the process”, said Dr Timothy Sporle. The team is now focusing on processing staff and service user feedback in order to refine the PAP programme. The project will also concentrate on assessing whether the introduction of the PAP could also have led to a drop in DNA rates for first assessments.
The slides prepared by Dr Timothy Sporle and Assistant Psychologist Ros Humphreys are available below:
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How to keep going with QI when pressures mount
Francisco Frasquilho – Improvement Advisor and QI Project Coach
Francisco Frasquilho, Improvement Advisor and QI Project Coach at Tower Hamlets, reflects on persistence and Quality Improvement, in collaboration with Project Leads Tamsin Black and Helen Healy
The psychotherapy service (PTS) in Tower Hamlets began their Quality Improvement (QI) project on reducing therapy wait times in early 2016. With a new team operational lead and a keen desire to improve the experience of their service the PTS team set up regular weekly meetings to look at how their systems and processes related to service user wait times. Such work is challenging in its own right, given the complexity of factors that impact on demand and capacity, but this team also faced significant external and internal challenges. As a QI coach and Improvement Advisor with this team since October 2016 I’ve experienced some of the ups and downs of this journey. This is their story, so far. It is a testimony and reflection on their hard work, especially their persistence in managing the challenges that face many teams working in the NHS while keeping a focus on QI.
An essential part of any QI framework is the space to learn, to test out ideas, and to study change. Success is not always guaranteed, but in QI the outcome is only as good as the journey taken. The risk of uncertainty is an ever present companion in this work; in fact this is often one of the main reasons for engaging in QI work in the first place. Uncertainty and unplanned change became a very real challenge for the Tower Hamlets PTS. Midway through the project there was an urgent need to achieve assessment wait time targets of fewer than 11 weeks. Achieving these targets became the over-arching focus for a period of months and drew much of the thinking in the project, whereas previously the focus had been on the wider PTS system. Under such circumstances any project team risks moving from “Plan – Do – Study – Act”, the classic PDSA engine that powers QI work, to “Must Do”, and often multiple simultaneous “Must Do’s”, in order to reach targets. Maintaining a rigorous QI approach under such circumstances can be very difficult unless there is protected space to meet, review data, and plan. Tamsin Black and Helen Healy, the project leads, supported by the wider PTS QI team, insured that consistent time and space to meet was secured. Those meetings formed the basis for balancing real life urgency with the reflection and learning a QI framework encourages.
Tamsin Black – Project lead, Consultant Clinical Psychologist
As if such an environment was already not challenging enough, the natural ebb and flow of talented and motivated staff members leaving or joining the team can also impact the rhythm of improvement. The PTS team’s openness in making use and learning from a wide range of views, experience, and skills was essential in helping them manage the impact of staff changes. These ultimately included skilled administrators, people participation, clinical psychology trainees, and staff with diverse therapy backgrounds. Looking at ways to keep a focus on testing changes in such a rich flow of ideas and experiences depended again on the team’s capacity to continue to meet regularly, to test changes, and ultimately to collect and use data. Techniques such as the “7 step meeting process” also brought the wide range of skills and interests in the group into a coherent ongoing structure, especially when key members of the team left or others joined. The team were also very willing to talk more and learn about QI, and this curiosity was often backed up with further contact with the core QI and Improvement Advisor team. The Head of Department, Tamsin Black, also made use of her own reading around QI, looking at developing ways to support staff to become “leader-leaders” supporting them to take ownership of changes based on the work of David Marquet (2013).
The capacity to keep going, persist, and stay focused, especially given multiple demands and staffing changes, was demonstrated in the outcomes. One of PTS’ key change ideas involved introducing a telephone booking process for assessments, immediately shaving off two weeks from prior waits, while subsequently seeing an increase in assessment slots booked. These changes bore fuller fruit in December 2016, with the team achieving their goal of reducing service users’ wait for assessment to less than 11 weeks. Further improvements culminated in a total reduction in wait times of 65% from date of referral received to assessment through 2017. This substantial improvement was maintained over a period of 6 months. A subsequent increase in wait times was seen from June 2017 and has been attributed to further staffing changes impacting from May 2017. Since then the call and book system has been implemented as “business as usual” and the team are continuing to keep an eye on assessing wait times.
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The team are now part of the new Access Collaborative, focusing on managing flow and wait times across the whole PTS system, from referral received to end of therapy. They hope that the same desire to improve the experience of their service users and lessons learned from this project will ensure that success will be seen in their new venture.
Authors:
Francisco Frasquilho (Tower Hamlets Improvement Advisor and QI Project Coach)
Helen Healy (Project lead: Clinical Psychologist and CBT Lead)
Members of PT QI Project Team:
Tamsin Black, Helen Healy, Maria Papastegiou, David Beecraft, Rowena Russell, Nicola Godwin, Anna W., Sue Goulding, and Francisco Frasquilho.
References:
Marquet, D. L. (2013). Turn the ship around!:A true story of building leaders and breaking the rules. Penguin Portfolio: London
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Clinical Psychology QI SRRP Annual Conference
On Wednesday 2nd August Clinical Psychologists from across the Trust came together for their QI SRRP Annual Conference.
Service Related Research Projects (SRRP) are undertaken by all trainee Psychologists at ELFT and are focused on quality improvements to their service.
Our trainees presented their QI work from the last 12 months, sharing improvement work happening in Tower Hamlets, Bedfordshire, Hackney and Newham. All presenters, teams and projects are listed below, You can access all project presentations by clicking on the hyperlinks above
The work of the trainees and their teams is very impressive. Its making a real difference to our service and the learning from these projects can be shared far and wide. Many of the teams also harnessed the expertise of our service users and carers to great effect, you can learn more about how they did this in the short video below.
Congratulations and thank you to all involved. You can learn more from the trainees about their experiences of leading a QI project in another video below.
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Evaluating a Trust-Wide Strategy to Coordinate Trainee Clinical Psychologist Service Related Research Projects (SRRPs) within QI Methodology
This projected presented at the 2017 Annual QI Conference is focussed on supporting Clinical Psychology Trainees on placement to complete SRRPs in their first year as part of their training.
A co-ordinated QI approach to devising, planning, running and disseminating trainee SRRPs was developed across three ELFT Boroughs
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Psychological Medicine in Bart’s: improving access and awareness (BMJ Quality)
Providing good quality psychiatric services to patients who attend general hospital has been an area that has attracted a lot of interest.(1)(2) We know that more than one quarter of general hospital patients have a mental disorder, mental ill health impedes recovery from physical illness, and mental disorders are often unrecognised in patients with physical illness. By improving the quality of our service we hope that we can achieve better integration with the medical teams and thus tackle the aforementioned problems. In our trust, relevant work has been completed by the clinical health psychology team in Cardiac Rehabilitation wards.
Education improves understanding and awareness of mental illness and a care pathway focuses attention on this area, improving patient safety and quality of care.
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Active QI Projects – August 2019
This is the monthly report generated from Life QI, showing all active projects within all the directorates.
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QI SRRP Trainee Conference
On the 3rd August 2016 Psychology trainees on placement with ELFT gathered for their QI Clinical Psychology Service Related Research Projects (SRRP) conference.
Psychology Trainees at the QI SRRP Conference, August 2016
The conference was a chance for all trainees to share with each other and guests, the quality improvement work they had been involved in as part of their placement with ELFT.
Projects included aims such as: Improving engagement in personality disorder treatment, Improving CMHT Working with Personality Disorder Patients, providing high quality, efficient therapeutic input throughout the patient journey.
Dr Erasmo Tacconelli (Consultant Clinical Psychologist) commented to trainees after the event “It was really impressive to hear the work that you have done and are completing. Your presentations were extremely well prepared, impressive, professional and really demonstrated how you are developing leadership roles in your work”.
Click on the presentations below to view the slides of each QI project and psychology trainees involvement in them…
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