27 October 2021

Increasing People Participation in Bedfordshire Community Health Services

By Nicola Ballingall, Improvement Advisor and Carole Green, People Participation Lead

In this 6-minute read learn how, in 11 months, a QI project team successfully increased the number of service users involved in Bedfordshire Community Health Services from 8 to a total of 37.


Do you want to increase service user involvement in your team but not sure how?

In September 2020, Bedfordshire Community Health Services (BCHS) only had 8 people signed up to People Participation. Understanding that involving more service users and carers in service development would increase the likelihood of improving outcomes and experience of care for those receiving services, BCHS set to work on increasing the number of people signed up to participation.

A team of staff and service users, in collaboration with the local People Participation Lead, used Quality Improvement methods to increase the opportunities for people to get involved in People Participation. In this six minute read, learn how they used ELFT’s Sequence of Improvement to understand the problem they were facing, develop and test some change ideas and use data over time to know if the changes they made resulted in an improvement.



BCHS had a low number of service users and carers involved in People Participation and the team knew that authentic involvement of service users and carers improves services, experience of care and value for money. Service users and staff from podiatry, palliative care, primary care home, speech and language and heart failure committed to an 11 month project to tackle this quality issue.


The project team had hypotheses about the general causes for the lack of co-production, such as service users (SUs) not having the confidence and staff feeling that they did not have the time to involve service users. They used a QI tool called the ‘5 whys’ to drill down to the root cause of each of these symptoms, as shown in Figure 1.

Figure 1: The 5 Whys


The team knew there were more contributors to the problem so they used a cause and effect diagram to visualise how these were inhibiting sign ups to People Participation (Figure 2).

Figure 2: The team’s Cause and Effect, or ‘Fishbone’ diagram



By this stage the team had a great deal of ideas for improvement. They used the nominal group technique to collect everyone’s ideas and generate divergent thinking. Once they had prioritised the ideas they predicted would have the most impact on People Participation they themed them and arranged their ideas in a driver diagram (Figure 3).

Figure 3: The team’s Driver Diagram




For each change they tested, the team went through a cycle of ‘plan, do, study, act’. For example, they planned a test for one podiatrist to speak to nine service users about people participation in one week during a clinic. The podiatrist followed this plan successfully and recorded four people who wanted to get involved in services.

Number of New Service Users/Carers Signing up to PP (monthly) Run Chart

Figure 4: the Run Chart


Figure 5: Cumulative Number of People Signed up to People Participation in BCHS


In 11 months, the QI project team successfully increased the number of service users involved in BCHS from 8 to a total of 37. They monitored their progress monthly using a run chart (Figure 4), a great way to display measurement for improvement when there are fewer than 20 data points. This was the first time collecting these data so the baseline data was only for 2 months before testing started and they started to see improvement.


No QI project is ever plain sailing and this project was no exception. The team shifted their mind set from failing to learning and overcame several issues;

  • Finding protected time to meet for long periods each month hindered progress. The team decided shorter fortnightly huddles were more manageable and, as a result, both attendance and progress improved.
  • Completing the MUSIQ tool at the start of the project alerted the team to their limited QI experience, with only some having worked on QI projects in the past. Knowing this at the start enabled the project lead to better prepare for the difficulties this could throw up. Meeting spaces became places to learn about QI, practice using tools and foster enthusiasm for QI. Members of the team have since gone on to further their understanding of QI through training programmes such as the Improvement Leader’s course and Pocket QI.
  • Running the project during a global pandemic, the team quickly realised that the timeframe would need to be extended. Originally hoping the project would take no longer than 8 months, the team took the decision to give themselves more time. It was during this extension period where the most effective change ideas ended up being tested.

The team were keen to have Big I Involvement in the project and encouraged two service users to join the team. Their input helped shape the direction of the project from the outset. Having a unique perspective as people with lived experience, the service users supported the team to plan tests with a higher degree of belief. The team could then make more robust predictions about what might happen. Had the project not included service users, the team do not believe the changes would have been nearly as successful.

The team were invited to present at ELFT’s Quality Open Morning. Below you can watch a 5-minute summary of their presentation.



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