19 July 2019

Directorate updates – Triple Aim

This month we caught up with project teams across the directorates to check in with all the work they’re doing on Triple Aim projects

City and Hackney

The City and Hackney Triple Aim team have analysed their three part data review (6 service user and staff interviews, one neighbourhood focus group, neighbourhood case studies, and a raft of database data including DIALOG and health outcomes data). We have identified 2 key areas of need in the data: loneliness (contentedness and social isolation), and resilience for our population of focus – people who experience SMI in City and Hackney. We are looking to invite stakeholders now around these key needs.

We are most proud of our ability to restart and review, evolve our learning through reflecting on the three part data review. Acknowledging and identifying such a key area of focus around loneliness has been very important to help focus our energy. It feels like we are having less traditional conversations, from a service/staff side, and uncovering important service user experiences.


Project teams have formed base in four schools across Luton, Bedfordshire, City & Hackney and Newham. We have formed partnerships with the school staff, local authorities, third sector organisations, and young people to better understand self-harm, and think what we can do systemically to promote and support wellbeing.

We are most proud of the trust we have already built in our collaborations. This has really enabled us to think more broadly about the health and wellbeing of the young people in the schools, and to break down the traditionally ‘siloed’ nature of our public services. By really listening to the voices of young people talking about such a sensitive and complex subject, we have been able to think about changes that we can make to the system to better support them, and to help them better support each other.

Now, each of the four teams are highlighting some initial tests of change to try when schools resume in September. We are also developing a measurement strategy so that we can understand the impact of the changes both locally within the schools, and collectively across the four geographies.

Community Health Services, Newham

We have almost completed our three part data review for housebound adults with BMI over 40 living in Newham. This has highlighted the need for better integration and networking of all services and social assets for this overlooked and isolated population. The staff responses to this work has been overwhelming, and this is something that we are really excited and proud of! We look forward to testing two change ideas this month.

Tower Hamlets Community Health Service (THCHS)

Our three part data review has revealed the scale of the problem in many aspects for this population such as poorer health outcomes, unmet mental and cultural needs, and social isolation due to being housebound.

To start, we will be focusing our improvement effort in the South West locality of Tower Hamlets. We have chosen to start a QI project at SW locality (team 2) for an estimate of 200 patients who require insulin injections as part of their diabetes care. We aim to empower patients and carers to take a more active role in their disease management. We feel this project will give patients and carers more independence and satisfaction with their care, will free up nursing time to manage complex cases, and ultimately contribute towards the Triple Aim portfolio of work.

Tower Hamlets Adult Mental Health

We’ve completed the three part data review and have been developing plans for how to focus the project. We’re going to be partnering with 2 hostels initially, Daniel Gilbert House and Edward Gibbon House, and are forming a project team to take forwards the work, led by a psychologist, working within the hostels. We’ve been also thinking about how we can measure progress in the three areas of the Triple Aim.

We are really excited that there is a huge amount of will and commitment within the borough to really make a difference for people who find themselves homeless. It is equally challenging and poses lots of hurdles and highlights the need for a big systems approach, but that in itself is something that we are keen to do!

We are now working to arrange meetings to review the strategy and develop first tests of change and develop further work to refine our measures.


The project is in the testing phase and a Driver Diagram has been added to Life QI. We’ve also worked with the QI team to develop a first version of our data dashboard.

The most exciting and proud part of the project has been networking with local community organisations; finding out about how these services have been established for a long time and that there is already a developed group of services users who have been working behind the scenes with services across national and local NHS and government to raise profile and develop services for this clinical population

Our next step is to see if testing will help services to integrate and work more collaboratively to support recovery and improved quality of life for this population in Newham and to try to find solutions for the gaps in current provision in the local areas.

Learning Disabilities

We’ve been focusing on developing and engaging people from across the system in the project. We held an event at the end of June, which was attended by 40 people. The event focused on getting people’s ideas and input in terms of strategy and priorities for the project. This included identifying assets and ‘untapped potential’ which we could better use to improve the lives of people with LD, reflecting on people’s own personal challenges and how we can support each other with these and identifying first ideas for change.

We are delighted with the enthusiasm and interest from our partners outside of ELFT and that they see this as an opportunity to make real improvements to people’s lives. We are excited to carry on working with our service users as the work develops.

We’re meeting soon to process everything we got from the engagement event. In mid-August we’ll be meeting with our newly revitalised project team, which will have on it partners from outside ELFT who have said they want to be involved. We’ll continue work to develop our measures.

Newham adult mental health

We’ve completed our three part data review and used this to build our driver diagram. We’ve refined and agreed our project statement. We’ve gathered some really rich narrative and themes from our citizen interviews that enabled us to build our driver diagram. Our Project Team has developed and has a diverse membership, which has fostered innovative thinking and driven the project forward. We’ve also got some changes we are planning on testing over the next few weeks and we are starting to think about building our measurement system


Forensics is changing the way they work with service users at Wolfson House, the Trust’s low secure unit. Service users explained that their relationships with staff, friends and family are very important to leading happier, more meaningful and productive lives in the unit and beyond. To improve this, the Triple Aim project team has been working with the wards to test ways of improving relationships, starting with a new induction process for all new service users.  The team is excited about how the voice of service users is showing new ways to make and sustain improvements, in particular for those who get stuck in services.

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