Successful co-production of QI, in their own words
By Fiona McRobbie, Hope Stubbings, Chloe Devaux from the Richmond Wellbeing Service QI project team
With Catherine Heaney, Improvement Advisor
This case study shares learning from members of a QI project team in Richmond Wellbeing Service, following a reflective session with their Improvement Advisor. Together they share the key ingredients they believe are needed to ensure that staff and service users work well together, in authentic partnerships, when leading quality improvement.
Long read: Approx. 9 minutes
Introduction
Richmond Wellbeing Service (RWS) offers a range of free and confidential talking therapies and specialist support, in the London borough of Richmond. In May 2021 the service began their QI project to increase the number of service users who complete their Low Intensity (LI) Cognitive Behavioural Therapy (CBT). Their aim is stated below in Figure 1 and you can read more about the project in their Life QI record, and the story log the team have created.
Figure 1. Improvement aim statement
This project was led through an authentic partnership between a service user, Fiona, and Psychological Wellbeing Practitioner, Hope. In this story Fiona, Hope and their colleague Chloe share their experiences of coming together to use quality improvement approaches to tackle a complex problem.
Meet the QI project team
Fiona, the service user
Fiona attended the service for stress management and found it easy to access and supportive. After her last session Fiona was asked if she’d like to help the service, which following recent retirement she was keen to do. Fiona was motivated by the experiences of friend who unlike her had received a negative experience of the service.
Fiona described this invitation as:
Fiona, Service User
Hope, the project leader
In her year as a trainee Psychological Wellbeing Practitioner (PWP), Hope discovered this QI project through her line manager, who was the project lead. With previous experience in audit and research, Hope identified that project work was something missing from her job and joined the QI team feeling that this was a great opportunity. Hope describes how this project:
Hope, PWP
Chloe, a team administrator
When Chloe first joined RWS the team were finishing a QI project about staff wellbeing (as part of cohort 3 of the Enjoying Work programme)
Having attended Pocket QI training, she was keen to get involved in a project at RWS from the beginning and make a difference to the daily challenges she sees.
Chloe describes her motivation for addressing the quality issue in this project (those not completing their LI CBT treatment):
Chloe, Administrator
Forming as a QI project team
Fiona joined the QI project team and shortly afterwards Hope became the project team leader. Fiona describes her reflections on this time:
“I have to say that for me it [the QI project] really took off when Hope stepped in, because she was already doing the data analysis side of things and came in with a very strong voice on what the current situation was. I think Hope’s leadership style suits my way of working and she’s very efficient… she documents everything quickly and I know exactly what I’m supposed to do and when I’m supposed to do it, and that’s just the way I like to work. I don’t know if it would have been the same if it hadn’t been Hope leading it. So, I think a lot has to do with who’s leading it, what their skill set is, what the skill set of the service user is.”
Hope’s first role focused on data, an area which, on reflection, she felt she had a lot to learn about. Over time she grew in confidence, describing how:
“I really gelled with the other people in the group and then felt more confident to try things out. And I knew that I’d have been supported if I’d got things wrong… I wouldn’t have grown so much if I hadn’t had a very experienced service user on the project to learn from.”
Chloe recalls the project beginning with a much larger team of 7 people, compared to the trio they are now. Chloe shared that initially she felt that it wasn’t clear how she could contribute and so naturally “took a bit more of a back seat”. When Hope started to lead and the team reduced in size, things changed for her:
“When [the project team] got a bit smaller and we got into a routine, we all knew each other’s way of working and had more of a structure. I felt like I could be more involved… and it was nice because [we have a] service user, a therapist and admin. So, it’s like all different perspectives on the issue, so we can all contribute something unique, which is nice.”
How the QI project team used support from the wider organisation
At East London Foundation NHS Trust (ELFT) there are a variety of QI training offers, which follow a natural progression (see Figure 2).
Figure 2. QI training offers at ELFT
Taking on the leadership of this QI project part-way through, Hope hadn’t had the opportunity to take up the ILP beforehand, so she attended Pocket QI. Fiona and Hope then discovered and attended a one-off series of QI tools Learn and Apply sessions together. They found them helpful, and Fiona reflected that:
“… it would be good if it was the other way around so we would have come at the project with some kind of a QI understanding … I think we were driven by our own passion to find out the answers and then came across a tool [thinking] ooh, this might be helpful.”
The project team were also supported by Zara Keane, a QI coach at ELFT. Zara joined the project meetings and then spent regular time on a 1:1 basis with Hope, to reflect on progress and advise how to navigate and capture the use of the QI method, to achieve their improvement aim. Hope summarised this as “it’s so helpful to have QI coach actually making sure you’re following the QI method”.
She also shared an additional perspective on having the necessary support when running a QI project:
“Really, I think the support came from within the team, I didn’t feel as though I was under any pressure to get things right. I think everybody was very accepting that I was learning at the same time, and they were patient with me. We were just learning together, and it was just such a collaboration from the beginning. I wasn’t bringing people along with me. We were just all moving together.”
Key ingredients that make a successful QI team
The QI project team discussed and identified several areas that they believe are key ingredients to their success.
Learning and top tips for authentic partnership with service users in QI projects
Table 1 summarises the learning and top tips for a QI project which is led through authentic co-production. They pose questions readers might consider when working towards co-production of QI. You can learn more about this here
Personal advice from this team to help you co-produce quality improvement work
From Chloe:
“Note the challenges of sharing information, setting up virtual meetings and so on, when service users don’t have NHS email addresses. Establishing methods to overcome this early on is advised.”
From Fiona:
QI training for service users and staff before beginning a QI project “So the team are all well prepared before they initiated” would have been helpful.
Ensure that the project team bring skills from their whole life, beyond their role or lived experience of a service, to enhance the way the team work together.
From Hope:
“I think you need a team of people who are gonna be there week in, week out, gonna do their actions, gonna keep passionate, gonna keep you on track, keep the fire going.”
Where next for this talented team
Being part of this QI project has inspired everyone in the team to develop further. Hope leaves ELFT in September 2022 to begin her doctorate in clinical psychology. Chloe has joined the next cohort of Improvement Leaders Training, to continue her personal development in QI. Fiona plans to start training as a counsellor.
To conclude our interview with the project team, we asked our service user Fiona to summarise what this means to her and why being a part of co-produced QI project matters.
