First triple aim QI projects across the Trust

 22nd February 2019

In the early stages of the Triple Aim work at ELFT, we welcomed guidance from our strategic partners, the Institute for Healthcare Improvement, in a visit in February 2019. Read more about how teams are progressing with this work in this blog by our Improvement Advisor Jen Taylor-Watt. 

Teams from across ELFT welcomed Trissa Torres from the Institute for Healthcare Improvement on 19-20 February. Trissa has a huge amount of experience supporting care systems to improve the Triple Aim of Outcomes, Experience and Value for their populations. She visited Tower Hamlets Adult Mental Health, Learning Disabilities, Newham Child and Adolescent Mental Health Services (CAMHS), Tower Hamlets Community Health Services, Forensics and City & Hackney Adult Mental Health, to support them to develop their work on the Triple Aim.

We’re at the early stages of our work at ELFT, but Trissa met with teams to help them move forwards with their first steps, which include reaching out to partners and undertaking ‘three-part data reviews’ to develop a deeper understanding of their populations. Find out more about how to conduct a 3-part data review for a population here.

Examples of these first steps from across ELFT are as follows:

Forming partnerships

The CAMHS Triple Aim project is focused on improving the health and well being of 14-16 year olds who are at risk of self-harming. The five ELFT CAMHS Community services will each partner with a local school to take this forwards, along with other local organisations, who are involved in supporting young people. Newham CAMHS is working with Kingsford Community School and Headstart, a local lottery funded initiative.

What do we know about our populations?

A very important first step is to pull together what we know about the population we’re going to work with. In CAMHS, teams will be looking at data the schools have about young people, as well as data we have at ELFT. Figure 1 shows an example of the richness of data from Kingsford School which will help inform the project strategy in Newham.

 

Learning more about our populations

Quantitative data can only tell us so much though, so it’s really important to get out as quickly as possible and start speaking to people from the population and others who care for them, to understand their perspectives on what matters, what’s working and not working and what are the needs and assets for the population.

In the space of just two weeks, Bedfordshire Learning Disabilities (LD) Service achieved just this by splitting the task across their team and interviewing or getting survey feedback from ten service users and 14 professionals and carers who work with people with learning disabilities. The team now have a wealth of feedback and insight to help shape their theory of change and project strategy, which is aiming to better meet the needs of people with LD, and thereby reduce behavioural symptoms and the use of antipsychotics to manage those symptoms. Feedback from just one question from the professionals/carers interview is shared in Figure 2 below:

 

Dr Shakeel Islam, Consultant and co-project lead said: “It’s shown us a different side to our patients and captured important stuff we don’t usually talk about”.  Samantha Morrison, Specialist Health Care Team Manager and co-project lead from Bedfordshire Learning Disabilities Service, said: “It’s been a really interesting process and a great opportunity for us to go out and ask these different questions. We’ve been pretty amazed by the responses and the really different trains of thought it has taken us on”. Next steps for LD are to bring this together into a driver diagram to capture their theory of change.

Turning data into strategy

Tower Hamlets Adult Mental Health brought together partners from housing, voluntary sector organisations, community health services and clinicians from Health E1 practice to work on their project to improve quality of life for homeless people in Tower Hamlets. The group reviewed quantitative and qualitative data which indicates that important drivers, or factors affecting the health, wellbeing and experience of homeless people, are stability of housing, stability of mental and/or physical health conditions, social connection and effectiveness of integration in services.

Next steps for the team are to meet again to map out 5 different patient journeys and to then use this to help develop the driver diagram further.

It’s early days for our Triple Aim journey at ELFT, but it was clear that our teams are deeply committed to improving the lives of the people we serve. The triple aim approach helps us really think about the needs and assets of individuals, communities and organisations, and consider how to tackle the determinants of health and quality of life, in partnership with others.

It’s a big ambition, but a really exciting one – so watch this space!