26 February 2020

Making QI a way of being

In October 2019, Craig Donohoe, a QI Coach and Service User, aptly summarised the sentiment that was being echoed from different parts of the organisation – “QI should be a way of being”

The way we do quality improvement work at ELFT has been expanding to include everyday improvement activities that happen outside of formal quality improvement projects. We are calling this #DailyImprovement, signalling the use of quality improvement tools, methods and approaches to improve things in daily work, interaction with services and personal life.

In February 2020, Satwinder, a QI coach and service user and Michelle Rigozzi, an QI Improvement Advisor, attended Stockwood Community Mental Health Team’s away day and put this new teaching session to test. The team learnt two new tools…

  1. Fishbone exercise
  2. 6 thinking hats

Fishbone diagram: One group practiced the tool on a room bookings issue.  The fishbone tool expanded their theories about why it is difficult to book rooms.  Initially the theories focused on not having enough meeting rooms, but the fishbone prompted them to think about more factors, e.g. the process of booking and behaviours that could also be addressed.  For example, it surfaced the need for improving the process of cancelling room bookings when not in use.  The tool ‘Five Whys’ was then used to dig deeper into the causes behind the causes.

  • First why: Why are the rooms not cancelled?  Because people don’t know the process.
  • Second why: Why do people not know the process?  Because it hasn’t been communicated.
  • Third why: Why has it not been communicated? And so on…


Six thinking hats: The team applied this to planning their summer party.  They spent two minutes seeing the planning through the lens of six different hats, which represent six different mindsets:

  • Red hat: Emotions, hunches, intuition, gut feelings
  • White hat: Facts, neutral, objective, information
  • Grey hat: Critic, analyst, logical negative
  • Yellow hat: Sunshine, optimism, logical positive
  • Green hat: Creative growth, possibilities, ideas
  • Blue hat: Cool, agenda, process, organiser, overview, decision

This helped the team to think of creative (green), positive (yellow) things like live music in a park and fancy dress, as well as logistics – when, where, who etc (blue hat) – and what could happen if it rains (grey hat)!  Each hat was made in play-doh and held up one at a time as a reminder of which hat they were on.

Edward De Bono who created the tool says: The main difficulty of thinking is confusion. We try to do too much at once.  Emotions, information, logic, hope and creativity all crowd in on us.  It’s like juggling too many balls. 

The exercise helps to not just see things one or two ways, but creatively and from many sides.  It is not about labelling people as a particular hat e.g. “she’s so yellow hat”.  The purpose is to ensure that all types of thinking are brought into the conversation when generating and selecting ideas.

Satwinder and Michelle planned to teach the team a third tool, The Driver Diagram, but to their delight the team were already using this tool. The team had used a driver diagram to align their objectives with the Trust’s overall strategy.

"One of the things I was just delighted to hear about from this Team Away Day was that work happening within this team was a product of learning from the Improvement Leaders Programme, Wave 8. This is a fantastic example of #DailyImprovement. " - Auzewell Chitewe, Associate Director of Quality Improvement

Slides from the away day can be found here.

If you haven’t already, have a read of Dr. Amar’s blog and catch up on all things Daily Improvement.


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