Demand and capacity in an ADHD team: reducing the wait times for an ADHD assessment to 12 weeks

Authors: Laura Ann Roughan, Jamie Stafford

Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder characterised by the core  symptoms of hyperactivity, impulsivity and inattention. ADHD is thought to affect about 3%–9% of school-age children and young people in the UK. With increased awareness and early identification of ADHD, and the long-term impact of the condition, there is a growing demand for ADHD services for both assessment and treatment of children and young people with the condition. Demand and capacity modelling carried out in October 2017 identified the ADHD pathway team in City and Hackney Child and Adolescent Mental Health Service (CAMHS) were working at 127% utilisation, indicating a mismatch between capacity and demand. A quality improvement (QI) project was implemented to improve efficiency and effectiveness of processes within the team and to support the increasing demand within the limited capacity and resource. The aim of the project was to reduce the average length of time from initial referral to CAMHS to ‘ADHD assessment feedback’ to 12 weeks by September 2018, which is in line with trust-level targets. The team followed the model for improvement and guidance from East London Foundation Trust (ELFT) QI Microsite to structure the project. They used a variety of tools to develop a theory of change, and used Plan-Do-Study-Act cycles to test change ideas. Overall wait times have reduced from 28 weeks to below our target of 12 weeks. Data examining the entry point to the ADHD pathway to completion of the ADHD assessment and feedback reduced from an average of 87 days, to an average of 18 days.The diagnostic rate has increased from 62% to 78% (due to more appropriate screening and referrals). The QI approach was systematic and supported the development of more efficient systems; reducing wait times and increasing capacity to manage the demand. Team engagement in ‘change’, by embedding QI into fortnightly team meetings, has resulted in collective ownership and responsibility across team members. A monitoring system is supporting the sustainability and maintenance of improvement.

Reducing physical violence and developing a safety culture across wards in East London

Violence is the biggest cause of reported safety incidents at East London NHS Foundation Trust. Evidence suggests the utility of structured risk assessment, discussion of violence in ward community meetings and the use of restraint and seclusion in psychiatric wards. The Tower Hamlets Violence Reduction Collaborative brought together six wards with the aim of reducing violence by 40% by the end of 2015. A collaborative learning system was used to test a bundle of four interventions on the four acute admissions wards and two psychiatric intensive care units. A 40% reduction in physical violence was seen across the six wards. Physical violence reduced from 12.1 incidents per 1000 occupied bed days in 2014 to 7.2 in 2015. Across the four general acute admissions wards there was a 57% reduction in physical violence. Key elements of the system that have been addressed through this work have been developing a more predictive approach, and developing a more open and shared experience of violence and aggression on the wards.

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Developing Psychological Services following Facial Trauma (BMJ Quality)

Adults presenting to oral and maxillofacial surgery services are at high risk of psychological morbidity. Research by the Institute of Psychotrauma and the centre for oral and maxillofacial surgery trauma clinic at the Royal London hospital (2015) demonstrated nearly 40% of patients met diagnostic criteria for either depression, post traumatic stress disorder (PTSD), anxiety, alcohol misuse, or substance misuse, or were presenting with facial appearance distress.

The project addressed this need by offering collaborative medical and psychological care for all facial injury patients. The project provided brief screening, assessment, and early psychological intervention. The medical team were trained to better recognise and respond to psychological distress.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality.

Improving access to competitive employment for service users in forensic psychiatric units (BMJ Quality)

Employment has been proven to be an effective recovery tool and therapeutic intervention for those with severe and enduring mental health conditions. Aside from monetary reward, employment is a means of structuring time and provides a sense of worth and achievement, which enhances self-esteem and confidence. A social identity is developed through employment, encouraging social support and increasing social networks. Securing employment can bring about improved quality of life and positive change in one’s social circumstances; therefore it can reduce symptoms associated with mental illness and potentially prevent re-offending, as the individual develops a sense of independence, self-efficacy, and value.

The enterprises are underpinned by the philosophy of the Individual Placement and Support (IPS) model; empirical evidence suggests that the IPS model is the most effective intervention, based on the ‘place then train’ philosophy. The model recommends a focus upon rapid job search to achieve competitive employment for those who want to work; opportunities sourced should be consistent with individual preference and benefits counselling offered. Support should be time unlimited and integrated with mental health treatment. A person-centred and strengths-based approach is also adopted to support people to build on their strengths, establish goals, and encourage motivation.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality

Improving physical health for people taking anti-psychotic medication in the Community Learning Disabilities Service (BMJ Quality)

Adherence with anti-psychotic monitoring guidelines is notoriously low nationally. Without active monitoring and measures to improve metabolic abnormalities, more patients may develop related morbidity and mortality. An audit highlighted anti-psychotic monitoring in this learning disability service in London did not match guideline recommendations. People with intellectual disability also experience health inequalities.

The QI team tested ideas to increase rates of anti-psychotic reviews. The focus was the follow up monitoring of all universal measures recommended by NICE 2014, collected at 2-weekly intervals. We trialled interventions in four broad categories; Intervention 1: to make monitoring more structured and planned; Intervention 2: to increase staff and patient awareness of healthy eating and exercise programs; Intervention 3: to increase the collection of diet and exercise histories from patients; Intervention 4: to improve the uptake of blood tests.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality

Improving the Physical Health Monitoring of City & Hackney Assertive outreach Service Patients (BMJ Quality)

Improving physical healthcare to reduce premature mortality in people with SMI (Serious Mental Illness) is a priority for ELFT (East London NHS Foundation Trust) and NHS England. It is well know that people with schizophrenia have a life expectancy which is approximately 20% shorter than that of the general population and a substantial mortality difference exists between people with schizophrenia and the general community.[1-2] Among other risk factors, such as poor diet, physical inactivity, and high rates of smoking, the iatrogenic effects of anti-psychotic medications have been found to increase the risk of metabolic syndrome. This can easily be detected through regular monitoring.

This project demonstrated that effective leadership, collaborative team work, embedding the project in our daily practice, generating local solutions, and improved communication between primary and secondary care can increase the physical health monitoring of this complex and challenging patient group. The team continues to identify other areas for change that may lead to further improvement in the physical health monitoring of AOS patients while making sure that the improvement is sustained.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality.

Improving the safety and efficiency of nurse medication rounds through the introduction of an automated dispensing cabinet (BMJ Quality)

Information technology (IT) systems are being utilised with increasing frequency at the prescribing and dispensing stage of the medicines-use process in UK hospitals. However, much less development has taken place with regard to the implementation of IT systems at the administration stage of medicines-use.

As a standalone device, the ADC was found to improve the efficiency of the medicines-use process, but had little meaningful effect on medication administration error rate at ELFT. However, it could be anticipated that additional benefit with regard to reducing medication administration errors may be demonstrated if the ADC was used in combination with other IT systems, such as electronic prescribing.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality.

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.

Richmond Wellbeing Service Access Strategy for Older Adults (BMJ Quality)

IAPT (Improving Access to Psychological Therapies) is a national programme aimed at increasing availability of evidence based psychological therapies in the NHS. IAPT is primarily for people who have mild to moderate, common mental health difficulties such as depression, anxiety, phobias and post traumatic stress disorder (PTSD). The programme seeks to use the least intrusive method of care possible to treat people at the time when it will be of most help to them. Individuals are able to self-refer into most IAPT services or alternatively can request to be referred by their GP or other services in the community.

Safer Wards: Reducing Violence on Older Peoples Mental Health Wards (BMJ Quality)

Through the Safer Wards project we aimed to reduce the number of incidents of physical violence on older people’s mental health wards. This was done using quality improvement methods and supported by the Trust’s extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. Violence can be an indicator of unmet needs in this patient population, with a negative effect on patient care and staff morale. Reducing harm to patients and staff is a strategic aim of our Trust.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality.

Using league tables to reduce missed dose medication errors on mental healthcare of older people wards (BMJ Quality)

The unintentional omission of medication is one of the most commonly-reported administration errors on hospital wards throughout the world. The omission of a dose of medication can severely harm the patient affected, but to date there is limited evidence about cost-effective means for reducing the incidence of such errors. The current report describes a quality improvement project, conducted on the mental healthcare of older people (MHCOP) wards in East London NHS Foundation Trust, which led to a greater than 90% reduction in the rate of unintentionally omitted doses of medication. The project involved the publication of a fortnightly league table which ranked each of the wards by how many doses they had missed, with the ward missing the fewest doses receiving a prize.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality

Role of peer support workers in improving patient experience (BMJ Quality)

The aim of the project was to improve patient experience for people in Tower Hamlets Specialist Addictions Unit in order to increase satisfaction by 25% in 12 months starting in August 2014.
The team used the model for improvement as part of ELFT’s quality improvement programme to support iterative cycles of testing and learning. This involved support from the Trust’s quality improvement team.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality.

Low stimulus environments: reducing noise levels in continuing care (BMJ Quality)

In the low stimulus environment project, we aimed to reduce the levels of intrusive background noise on an older adult mental health ward, combining a very straightforward measure on decibel levels with a downstream measure of reduced distress and agitation as expressed in incidents of violence. This project on reducing background noise levels on older adult wards stemmed from work the team had done on reducing levels of violence and aggression.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality.

Improving ward environments and developing skills for discharge with the implementation of self-catering on a low secure forensic unit (BMJ Quality)

The opportunities for service users to develop skills for more independent living and take control of their environments are limited in secure mental health units. This paper will outline a quality improvement project that changed how the catering services were delivered in a low secure unit in East London NHS Foundation Trust (ELFT). A Quality Improvement methodology was adopted incorporating the Plan, Do, Study, Act (PDSA) cycle which included the trial of service users preparing their own meals on a daily basis. The participation rates were measured and functional daily living skills were recorded. Following success of the trial, long-term implementation of self-catering was agreed, with service users being supported to prepare a shared evening meal every day on the ward with an average of 60% participation.

Please click the PDF to the left to read more about this ELFT QI Project published in BMJ Quality.

The Handy Approach – Quick Integrated Person Centred Support Preparation

Integrated Care models have been piloted across the UK to address the call for person-centred care and to minimise the multiple and anonymous hospital admissions and duplicated interactions with both health and social care professionals, which are currently being delivered.

Reducing DNA Rates and Increasing Positive Contacts in an Outpatient Chronic Fatigue Service

The Chronic Fatigue Service at East London NHS Foundation Trust recognised and coalesced around its major issue of engaging its service users. Using the systematic approach of quality improvement, and the infrastructure provided within East London NHS FT’s quality improvement programme, it tested a number of change ideas which saw a significant reduction in non-attendance at appointments, an increase in patient cancellations when they could not attend, and an increase in positive contacts with the service. All these improvements surpassed the initial aims set within the project, and have been sustained over the course of 18 months.

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Improving the patient booking service to reduce the number of missed Community Musculoskeletal Physiotherapy Service appointments (BMJ Quality)

The East London National Health Service Foundation Trust (ELFT) Community Musculoskeletal (MSK) Physiotherapy Service had reported a high rate of non-attendance at scheduled appointments. This was leading to delayed access to treatment for patients and a reduced capacity for service users, as well as a waste of clinical resources. The aim of this quality improvement project was therefore to reduce the percentage of missed appointments within this department.

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Reducing bed occupancy and length of stay on a functional older adults’ psychiatric ward (BMJ Quality)

A quality improvement project was initiated on Ivory ward, a functional older adult psychiatric inpatient ward at Newham Centre for Mental Health, part of the East London NHS Foundation Trust. The project was started by staff on the ward after it had come to their attention that their ward had the highest bed occupancy and length of stay across similar wards in the trust. The mean bed occupancy in the 9 months before the project started was 87.7%. The mean length of stay on the ward in the 9 months before the project started was 70 days. The team used the model for improvement, which is the trust’s methodology of choice for quality improvement projects, to reduce bed occupancy and length of stay.

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Improving access to City and Hackney adult mental health services (BMJ Open Quality)

City and Hackney Adult Mental Health Referral and Assessment Service (CHAMHRAS) is the single point of entry for all mental health referrals to secondary services, with the exception of perinatal referrals, in the City and Hackney region of London, UK. The service was established in 2013 and it was noted that the waiting time for the majority of patients was exceeding the 28-day target set by local commissioners. Indeed, in December 2014, only 30% of patients were being seen within this time frame. The aim of this quality improvement project has been to decrease the average waiting time from referral to first face-to-face assessment, and concomitantly increase the proportion of patients being assessed within the 28-day target period.

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Quality Improvement for Non-Clinical Teams

While there is a growing body of evidence confirming the benefits of quality improvement in clinical settings, there has been little exploration of or published literature on applying a systematic approach to improvement in non-clinical areas. Learn more in this article by Dr Amar Shah, Marco Aurelio and Mason Fitzgerald.

Click on the image to access the resource.

A qualitative study exploring clients’ reasons for missing appointments within a secondary care service

Little qualitative research exists on non-attendance of psychotherapy appointments. Eight psychotherapy clients were interviewed about their reasons for missing sessions and thematic analysis revealed five key themes. The results demonstrate that factors affecting attendance are dynamic and multi-layered. Read this article by the psychology service in Newham to find out more.

Please click on the image to access the full article.

Improving access to services through a collaborative learning system at East London NHS Foundation Trust

The focus on this project was to improve access to community-based services, one of four priority areas of improvement work at ELFT between 2015 and 2017. Quality improvement (QI) at ELFT operates on the ethos that improvement efforts should be identified, initiated and led by teams that have the closest proximity to the quality problem.

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Better care: reducing length of stay and bed occupancy on an older adult psychiatric ward

Length of stay and bed occupancy are important indicators of quality of care. We aimed to reduce length of stay and bed
occupancy on Leadenhall ward, a functional older adult psychiatric ward serving a population of just under 40 000 older adults in two of the most deprived areas of the UK. In 12 months, length of stay was reduced from an average 47 to an average 30 days and bed occupancy from 77% to 54%.

Please click on the image to find out more.

Improving access to genetic testing for adults with intellectual disability:

Recent advances in genetic research have led to an increased focus on genetic causes of intellectual disability (ID) and have raised new questions about how and when clinicians offer genetic testing and the nature of communication around this decision with patients and carers. Determining the right approach to such discussions is complicated by complexities of communication, consent, and capacity and ethical concerns about genetic testing in this population. In this article, we briefly discuss the
recent advances in genetic research relevant to people with intellectual disability, highlighting the challenges that might arise when undertaking genetic testing in this population. We then describe how we have used a Quality Improvement methodology to develop a clinical pathway for routine genetic testing for adults with intellectual disability in a clinical setting in East London.

Read about this project by clicking on the front cover image.

You can also hear the team discuss the project in their video poster here >>

Reducing variation in leg ulcer assessment and management using quality improvement methods

Improving quality is about making healthcare safe, effective, patient-centred, timely, efficient and equitable (Department of Health [DH], 2016). In terms of leg ulcer care, this means ensuring patients receive evidence-based leg ulcer assessments and treatments to ensure their leg ulcer heals in an optimum time frame and that they have a good experience of their care (Wounds UK, 2016). This paper outlines a project that focused on improving venous leg ulcer (VLU) assessment and management for housebound patients, using quality improvement (QI) methods.

Reducing time to complete neuropsychological assessments within a memory assessment service and evaluating the wider impact

In 2016, the Older People’s Mental Health Service (OPMHS) within Bedfordshire and Luton (provided by East London Foundation National Health Service Trust) faced considerable challenges in providing an accessible service for assessment of suspected dementia. Those referred to the Memory Assessment Service (MAS) encountered waiting times exceeding national recommendations. A quality improvement (QI) project was initiated by OPMHS Psychologists within all four multidisciplinary MAS clinics in Bedfordshire and Luton. The project aimed to reduce the time from the date of referral for within-team neuropsychological assessment to finalisation of the report to 6 weeks (42 days) by April 2017. In parallel to the initiative, the wider impact of the QI project was investigated. Through the combination of change ideas tested and implemented, all four MAS clinics were successful in meeting the primary project aim. The combined mean time between referral received by psychology and report finalised reduced by 28.76 days from 65.1 to 36.34 days, and with reduced variation across the clinics. These changes were sustained throughout the duration of the project and beyond, and successful change ideas were incorporated into routine practice with control methods developed. Exploring the wider impact, a focus group with six psychology staff members involved in the project was also completed. Thematic analysis identified three themes from the focus group: staff impact, service impact and service user impact. Further subthemes were identified regarding both desirable and undesirable impact across the system. The approaches used may be useful for other services embarking on reduced wait time initiatives for access to care. Additionally, understanding ongoing areas of impact on staff, the wider service and service users can help reduce or mitigate undesirable or unintended consequences and work towards sustainability of such changes.

How to move beyond quality improvement projects

Read this paper from Dr Amar Shah, Chief Quality Officer at ELFT, published in the BMJ about moving beyond QI Projects. Click the image to open >>

“In recent years we have seen a proliferation in the interest and use of quality improvement in health and healthcare. This represents a promising shift in our mental models about how to solve some of our most complex quality issues. Alongside the increasing use of the word “improvement” in our everyday language within healthcare, there are differences in understanding of what exactly we mean by the term “quality improvement.” This article explores the difference between quality improvement and a quality management system, by defining quality improvement and describing how to best use quality improvement alongside control, assurance, and planning as part of a more holistic management system focused on quality.”

Amar Shah is chief quality officer, East London NHS Foundation Trust; national improvement lead for the Mental Health Safety Improvement Programme, NHS Improvement and RCPsych; quality improvement lead and chair of QI faculty, Royal College of Psychiatrists

Quality improvement in forensic mental health: the East London forensic violence reduction collaborative

Ward-based violence is the most significant cause of reported safety incidents at East London NHS Foundation Trust (ELFT). It impacts on patient and staff safety, well-being, clinical care and the broader hospital community in various direct and indirect ways. The contributing factors are varied and complex. Several factors differentiate the forensic setting, which has been identified as a particularly stressful work environment. Staff must constantly balance addressing therapeutic needs with robust risk management in a complex patient cohort. ELFT identified reducing inpatient physical violence on mental health wards as a major quality improvement (QI) priority. The aim was to use a QI methodology to reduce incidents of inpatient violence and aggression across two secure hospital sites by at least 30% between July 2016 and March 2018. Collaborative learning was central to this project. It sought to foster a culture of openness within the organisation around violence and to support service users and staff to work together to understand and address it.

A QI methodology was applied in medium and low secure inpatient settings. A change bundle was tested for effectiveness, which included: safety huddles, safety crosses and weekly community safety discussions. Operational definitions for non-physical violence, physical violence and sexual harassment were developed and used. Reductions of 8% and 16.6% in rates of physical and non-physical violent incidents, respectively, were achieved and sustained. Compared with baseline, this equated to one less incident of physical and 17 less of non-physical violence per week averaged across seven wards. Three wards achieved at least a 30% reduction in incidents of physical violence per week. Five wards achieved at least a 30% reduction in incidents of non-physical violence per week. This collaborative brought significant improvements and a cultural shift towards openness around inpatient violence.

View the project poster here >>

Improving Access and Flow in CAMHS

Long waiting times for Child and Adolescent Mental Health Services (CAMHS) have been linked to poorer outcomes for those seeking care. CAMHS teams in England have seen recent increases in referrals, resulting in challenging waiting times nationally. Although recent health policy has brought an increase in funding and staffing, it is believed that only 25% of those needing care receive it. Between trusts, there is considerable variation in waiting times, leaving many waiting longer than others waiting for care.

East London Foundation Trust has been seen to have higher waiting times for CAMHS than other organisations across the country between June 2017 and September 2018, seven CAMHS teams were supported to use quality improvement (QI) as part of a collaborative learning system with the aim of improving access and flow. Each team was encouraged to understand their system using
basic demand and capacity modelling alongside process mapping. From this teams created project aims, driver diagrams and used Plan Do Study Act cycles to test changes iteratively. Measurement and data were displayed on control charts to help teams learn from changes. Teams were brought together to help learn from each other and accelerate change through a facilitated collaborative
learning system. Of the seven teams that began the collaborative learning system, six completed a project.

Across the collaborative learning system collectively there were improvements in average waiting times for first, second and third appointments, and an improvement in the number of appointments cancelled. For the individual teams involved, three saw an improvement in their project outcome measures, two just saw improvements in their process measures and one did not see an improvement in any measure. In addition to service improvements,
teams used the process to learn more about their pathway, engage with service users and staff, build QI capability and learn together.

To improve the communication between a community mental health team and its service users, their families and carers

This article describes the application of quality improvement (QI) to solve a long-standing, ongoing problem where service users or their carers felt they were not given enough information regarding diagnosis and medication during clinic assessments in a community mental health setting. Service users and carers had shared feedback that some of the information documented on clinic letters was not accurate and the service users were not given the opportunity to discuss these letters with the clinician. The aim of this QI project was to improve the communication between the community mental health team (CMHT) and service users and their carers. Wardown CMHT volunteered to take on this project. The stakeholders involved were the team manager and deputy manager, the team consultant, the team specialist registrar, team administrative manager, two carers and one service user. The project had access to QI learning and support through East London NHS Foundation Trust’s QI programme. The team organised weekly meetings to brainstorm ideas, plan tests of change to review progress and to agree on the next course of action. The outcome was an increase in service user satisfaction from 59.9% to 78% over a period of 6 months, and a reduction in complaints to zero.

Quality improvement at East London NHS Foundation Trust: the pathway to embedding lasting change

This piece reflects on the Trust’s transformation and its approach. It provides many examples and discusses several of the associated challenges in building and sustaining QI momentum. It is the result of a range of perspectives from staff involved in planning and building large-scale QI capability. It contextualises QI’s current status in UK mental healthcare.

Several key factors were identified: board-led commitment to organisational transformation; investment in training and resources to support staff motivation; clear and realistic project goals in line with the service’s over-arching strategic direction; support for service users and staff at all levels to get involved to address issues that matter to them; and, finally, placement of a high value on service user and staff qualitative feedback

Related Resources

Improving access to Hackney Integrated Learning Disability Service

Aims: Improving access to Hackney Integrated Learning Disability Service (ILDS) using quality improvement (QI) methodology by reducing the time taken to complete eligibility assessment by 50% by April 2021, while improving service user and staff experience. Background: Referrals to ILDS require assessment of eligibility. It was noted that there was significant waiting time between referral and eligibility assessment, exacerbated by the COVID-19 pandemic. Quality Network for Community Learning Disability Services guidelines suggest waiting times for those accessing adult learning disability (LD) community services be locally agreed, although there is limited literature on this topic. Methods: All staff members across the multidisciplinary team were invited to participate in the QI project. We defined outcome measures as days from referral to allocation of eligibility assessment to staff member and to completion of eligibility assessment, comparing referrals received before and after start of the project. The key change ideas tested using Plan-Do-Study-Act cycles were: (1) eligibility screening checklist, (2) eligibility assessments drop-in sessions for staff, (3) formal training for ILDS staff, (4) eligibility screening allocation system, (5) template letters for eligibility decisions, (6) new ILDS referral form, (7) workshops for local general practitioners. Results: Time taken to eligibility assessment allocation decreased from median of 184 (mean=183.5±109.8) to 13 days (mean=19.9±26.4) (93% reduction). Time to completion of eligibility assessment decreased from a median of 271 (mean=296.0±133.8) to 63 days (mean=75.7±34.8) (77% reduction). We received positive feedback from staff and service users regarding the new eligibility process. Conclusions: We report waiting times for accessing our community adult LD services and effective strategies for reducing this. We recommend similar services use a QI methodology to reduce waiting times and improve the experience of staff and service users.

Related Resources

Using Quality Improvement to deliver a systematic organisational approach to enjoying work in healthcare

Abstract

Staff wellbeing is increasingly linked to good outcomes for service users in healthcare.
Therefore, it is important for organisations to find ways to focus on wellbeing and staff
experience at work. This article shares learning from 5 years of using the Institute for
Healthcare Improvement’s joy in work framework, coupled with quality improvement
methods to enhance staff experience and wellbeing. This demonstrates how teams were
brought together in a collaborative learning system to apply quality improvement to
enhance joy in work. Key steps are shared for other organisations wanting to undertake
this work, including the application of improvement methods to empower teams locally to
develop, design and test change ideas, and measure their impact. The design of systems
and structures required to meaningfully bring teams together and the type of leadership
that enhances this work are also considered. Key learning points for other organisations
include the need for improvement principles to iterate the organisational approach, make
measurement simple, encourage a bias to action and make the work fun.

Using quality improvement to pursue equity: lessons from healthcare

Quality improvement has become an increasingly recognised way of tackling complex problems in healthcare. This article presents ELFT’s step-by-step approach for the use of quality improvement to pursue equity, illustrated with case studies from teams.