26 March 2024

“Quality Improvement has become our go-to problem-solving methodology”: a Q&A with deputy director Petra Nittel

Written by Petra Nittel and Clarissa Sørlie

Petra Nittel is the deputy director for Community Health Services in Tower Hamlets. In addition to her role as Quality Improvement (QI) sponsor, Petra is also a QI coach. She has worked for ELFT since 2017.


Could you tell us a bit about your journey with quality improvement?

When the Tower Hamlets Community Services (TH CHS) transferred to ELFT in 2017, it was a very busy and challenging time. The teams had to get used to working in a new Trust with new colleagues and procedures and we undertook a Transformation Programme that involved almost all services in the first 18 months. This meant service redesign, staff consultation implementation and getting used to working in a new Trust while continuing to provide safe and effective care.

During this initial period, Quality Improvement (QI) just felt too much to fit into everything that was going on. Both staff and the senior leadership team focused on the immediate priorities. The QI methodology at the time also entailed having fully established projects, which were difficult to manage with staff many of whom are not office-based. Nonetheless, staff trained as Improvement Leaders and Coaches. A few projects were initiated, some of which needed closing later, but others produced great ideas that were spread across the Directorate. As a team, we learnt a lot from the projects that were closed, particularly about what QI at our level in terms of population health could deliver and what not. We learned to keep our QI focused, and with data that we can realistically produce.

Now that the services are settled and there is a greater feeling of stability, QI has become our go-to problem-solving methodology. Now that improvement methodology encompasses ‘Everyday Improvement’ as well as formal projects, QI for TH CHS has become a very flexible way of supporting improvement work.

When you think about QI in Community Health Services London, what are you proud of?  

  • My wonderful colleagues, who are always keen to improve, innovate and not accept the status quo as a default position and improve QI with such energy and imagination.
  • The GP Communication QI has achieved fantastic results in addressing the long-standing and knotty issue of communicating with GPs.
  • The Joy at Work Project resulted in amending the supervision template to include questions on staff wellbeing as a matter of routine.
  • In the last 12 months or so, the QI Forum has gone from strength to strength and attendance is growing and I know that my colleagues find attending it useful.


In addition to being a QI sponsor, you are also a QI coach. How do you incorporate your coaching skills into your leadership role?

Literally every day, all the time. Opportunities frequently arise both in formal and informal settings. After a while, it becomes second nature.

What QI advice would you have for other leaders in the organisation?

Start small. The principle of testing an idea with one person or one member of staff has not failed the team here at TH CHS yet.



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