Putting the Person at the Heart of the Process: Improving the New Starter Experience with QI

By Candace Sinclair, Improvement Advisor, on behalf of the New Starter Working Group

Starting a new job is rated as one of the most stressful life events irrespective of where you are in your career. The feeling of being overwhelmed in the first days of a job is common as new team members learn what is expected of them in their new role.

In 2019, three members of the Quality Improvement (QI) team started in close succession to each other and compared their experiences. They concluded that, with some adjustments, the new starter experience could be improved to ensure better practical and psychological support. This led to a review and adaptation of the QI induction process, formation of a New Starter Working Group (NSWG) and later a collaboration with the Quality Assurance (QA) team.

Initially this work was approached by using ‘#dailyimprovement’ where the team could ‘just try it’. However, as the work evolved, and to enable further improvement and sustainability it was recognised that a project approach would be more appropriate. As the project was dependent on new staff members joining the team, the trio also appreciated that this work would likely be conducted over a long period of time.

The aim was nebulous at the start; however, the trio knew that they wanted to improve the experience for new starts and quickly generated some change ideas which led to the development of a change strategy using a driver diagram (figure 1).

Figure 1: Initial change strategy – Driver Diagram

The theory was that staff members starting in the QI department would feel better prepared for their new position by following a new two-week induction process.

The change ideas listed on the driver diagram above were the first to be tested and have been iteratively developed by each new starter as they have joined and taken over the responsibility of the NSWG and the projects next steps. The ‘rolling membership’ model for the NSWG has been integral to its continuation and growth.

At this point the QA department joined the project so that the change ideas could be tested in two different settings.

Other key change ideas that have contributed to the success of the project are:

1. Assigning each new starter with a “buddy” (see figure 2 for details of their role)
2. A reserved desk assigned to the new starter for first two weeks (paused due to Covid)
3. Having welcome huddles and 1:1 meetings with each member of the team
4. Rolling membership of the NSWG – ensuring that each new starter could feel heard almost immediately based on their experience and contribute to changes for the next new member of staff joining
5. Introduction of survey – to be able to understand if the changes made were leading to an improved experience for the new starter
6. Creation of a new starter handbook
7. Development of a new starter two-week rota

Figure 2. Roles and responsibilities for induction process defined

With the identification of so many change ideas, the team adopted to use the Plan, Do, Study, Act (PDSA) approach to test each of these out and to help inform their learning. Midway through the project, the world suddenly changed, the pandemic hit and new starts had to join virtually. This had an impact on some of the change ideas such as the “buddy system” and “reserved desk” and meant that more significant changes would be required to induct new starts into the team to fit in with the new way of working from home. This approach allowed the team to rapidly adapt the new starter handbook by applying the PDSA cycle to sequentially test and iteratively develop their ideas over time (figure 3).

Figure 3. New starter handbook– iterative learning and development through PDSA cycles

Several of the initial change ideas are now embedded in the process for all new starters to the QI Team and through the rolling membership of the NSWG, are continually reviewed and developed by each new member of staff that joins the team.

After conducting the initial tests, the team took a retrospective look back at the data and then asked the QI data team to assist with developing core measures of success for the project and a data collection tool. A simple survey was designed to collect qualitative feedback (figure 4) from each new starter on their experience of the process at the two week point, triangulated with quantitative data (figure 5) extracted from the new starter survey.

Figure 4. Qualitative feedback from new starters to the QI team

The trainee data analyst, Samina Aklas has also shared her experience of joining ELFT and the QI team virtually.

The survey data was then converted into a ‘run chart’ (see figure 5) so that the data could be viewed over time and analysed to see if the changes being made to the process were leading to (sustained) improvement. The run chart shows a sustained shift, demonstrating that this project has led to an improved experience for new starter into the QI team and has therefore achieved its aim. This data will continue to be collected as and when new staff join the team as a quality control measure, to ensure that the process is continually reviewed and improved based on new starter experiences.

Figure 5. Quantitative responses from new starters to the QI team
(Rating scale: 5. Strongly agree 4. Agree 3. Neither agree nor disagree 2. Disagree 1. Strongly disagree)

The QI team continue to build on this piece of work, with several new change ideas and next iterations of existing change ideas having been identified by the most recent NSWG and plans for testing are already underway. This model provides a sustainable way to ensure that the needs of new staff are continually being met by ensuring a supportive, practical and smooth transition, resulting in improved relationships, increased productivity and reduced anxiety across the team.

Due to the success of the project within the QI Team, it will now be added to ‘LifeQI’ as a corporate project so that the learning can be shared with other directorates across ELFT. It is hoped that other teams may consider some of the key change ideas within this project such as the “rolling membership” of the NSWG, the introduction of a buddy and the development of the new starter handbook, and how these might be adopted and add value to their own new start process.

Key recommendations and learning:

• Initially using #dailyimprovement was very helpful to engage the team but moving forward this ongoing work benefited from a project approach
• The new starts integrated quickly into the team, as they contributed to the team right from the start and felt their suggestions were heard
• Registration on LifeQI ensure all efforts are documented and therefore accessible for other teams
• Create a ‘safe’ space for the new starters to give feedback and actively listen to their suggestions and recommendations for improvement
• Ensure sponsorship from senior leadership – the Associate Director had a special interest in supporting this work
• Rolling the membership of the NSWG to the new starts ensures that the interest is sustained, reducing the burden on any one person/group and provides a continued fresh perspective
• Develop a good data collection plan with both qualitative and quantitative feedback to guide the process