The first ever ‘Using QI to Tackle Inequity’ workshop in Bedfordshire, Luton and Milton Keynes

 12th January 2023

By Lorna Darknell (Inequalities Improvement Advisor at ELFT)

ELFT is supporting the Bedfordshire, Luton and Milton Keynes (BLMK) integrated care system to use Quality Improvement (QI) in their inequalities programme.

Early on, people working in the system said they wanted introductory training in the basics of QI, and how to apply it to inequalities. People also said they’d like it to be as practical as possible, to help them apply it to their work. This led to the development of an exciting new workshop: ‘Using QI to Tackle Inequity’. The workshop has been designed with the aim of understanding:

 

• What inequality and equity is, and how it applies to people’s work
• What Quality Improvement is, and the tools and techniques which are useful for tackling inequity
• How to use QI to tackle inequity in their work

 

A few teams were especially keen to be involved. The BLMK Medicines Optimisations (Med Ops) team work to improve the value of medicines in BLMK by ensuring clinical and cost effectiveness, and they signed up to be the very first team to attend the Using QI to Tackle Inequity workshop.

From there, the Med Ops Workshop Design Group was set up with team members who wanted to codevelop the workshop content. Having the team shape the workshop meant the content was tailored and meaningful for the team in their day-to-day work. In the Design Group sessions, the team discussed that the language of inequality, equity and QI can be daunting. Once people grew in their confidence of the language, we realised that the team already had lots of experience of tackling inequity, they just hadn’t viewed it that way before.

We held the workshop over two mornings in Capability House in Wrest Park, on the 16^th November and 1^st December 2022.

Equality vs Equity

At the start of the first day, we settled on the idea that when we talk about health inequalities, we’re really talking about fairness. The team also said they didn’t feel sure about what the difference between equality and equity was. 

So what does health equity mean? The image below prompted a discussion on the difference between treating everybody the same (equality), and meeting people’s different needs (equity). In the NHS, we often equate fairness with sameness, but really treating people fairly can often mean doing different things for different people to achieve the best outcomes. 

Equitable approaches to QI […] employ different approaches for different groups in order to achieve the same outcomes. (NHS Scotland) 

The Med Ops team agreed that we are aiming for equity, rather than equality. We made a commitment to keep returning to the question: “Is my work helping to achieve equity?” 

Importance of Collaboration to Tackle Inequity

Health inequities are made up of lots of complicated and intersecting factors, known as the Wider Determinants of Health. The World Health Organisation describes these as ‘The conditions in which people are born, grow, live, work and age.” This means that health care services acting alone have very little power – estimates vary between 15-43%* – to influence health and wellbeing.

The Health Foundation, https://www.health.org.uk/publications/how-to-talk-about-the-building-blocks-of-health, 2022

So – how did it go?

By the end of part 1, 100% of evaluation respondents agreed or strongly agreed that they understood what inequality and equity is, and understood what QI is. 86.7% agreed or strongly agreed they had gained an understanding of how to apply QI to tackle inequities in their work.

Following the workshop, evaluation showed that 94.1% agreed they gained an understanding of how to apply QI to tackle inequities in their work, and 94.7% would recommend it to a colleague.

What participants said…

“Very good session. Amazing achievement to cover so much, so clearly in only two sessions.“

“Much more enjoyable that I was expecting! Fantastic presenters and great content.“

“Very well presented and interactive. Well done!“

“Excellent presenters, and good energy in the room, thank you”

What next?

The Med Ops Team each wrote one action they commit to take to identify an equity issue. Some team members have emerged with specific project ideas that they will develop using QI methodology, whilst others committed to use an equity lens and QI tools in their day-to-day work.

The Med Ops Team each wrote one action they commit to take to identify an equity issue

Following the success of the first ‘Using QI to Tackle Inequity’ workshop, other teams across BLMK will now have the opportunity to be participants in future cohorts, to spread learning across the system. This is a big step forward in our commitment to reducing inequalities in our communities.

Applying a Lens of Equity to QI Projects

There are three possible effects of any QI project on the gap between the group with the best and worst outcomes: maintaining it, narrowing it (the aim), or widening it.

There are three possible effects of any QI project on the gap between the group with the best and worst outcomes: maintaining it, narrowing it (the aim), or widening it.

Your project doesn’t need to have equity as the main focus for you to check whether it is narrowing the gap. If you are working on a QI project and want to ensure you are applying an equitable lens, here are some helpful questions to ask at each stage of the Sequence of Improvement:

If you are working on a QI project and want to ensure you are applying an equitable lens, here are some helpful questions to ask at each stage of the Sequence of Improvement.