Using QI to support access and outcomes for Black and Minority Ethnic populations in Newham, Tower Hamlets and City & Hackney
By Carlos Santos, Improvement Advisor and Sam Ogunkoya, Black and Minority Ethnic (BAME) People Participation Worker & QI Project Lead
Carlos
Sam
In this interview you will hear from Sam Ogunkoya and the project he is leading to improve the accessibility of Mental Health Services for the BAME population of Newham, Tower Hamlets and City & Hackney. This project is part of the Pursuing Equity Programme. The programme is supporting teams to use Quality Improvement methodology to tackle an aspect of equity in their area of work.
Hear about why this project matters, how they are working with their communities, what they have learnt so far and what’s next.
Sam, tell us a little bit about yourself, and how this idea came about?
I have been working in NHS services for the last five years, and I am currently the Black and Minority Ethnic (BAME) People Participation Worker (PPW) for the Community Mental Health Team at ELFT. Prior to this role, I worked in two forensic mental health services, where there was an apparent over-representation of people who look like me receiving treatment. This is in line with what the data about the proportion of people from minority ethnic backgrounds who are detained under the Mental Health Act rather than being supported at an earlier stage and research linking social inequalities to poorer mental health. I have always been an advocate for justice and equity, which is what drives my passion for this work. When I started as the BAME PPW, my aim was to give a voice to BAME people within mental health services.
And you brought this passion to your current role with People Participation and the community mental health transformation programme?
Yes! when I came into People Participation, I had all these grandiose ideas around how we could transform services. I saw a really enlightening short movie on YouTube, which is called Homoworld. In that world, heterosexual people were the ‘minority’. When I saw that video, and how reversed norms played out in various scenarios, it really got me thinking about the White and Western norms that exist in mental health services and why we need to focus on making services more equitable and representative. And then I wanted to change the world.
Eventually, I sat with my supervisor, and we were able to kind of, you know, take that massive idea and turn it into something tangible. From there, things started moving forward.
Where did you start?
I knew it was important to understand the challenges of those in the population experiencing inequity, so I reached out to Primary and Secondary Care networks within Tower Hamlets, Newham and Hackney to find people to talk to. From this we were able to engage people in safe spaces to talk about the experiences that are unique for us and really understand what matters to them when thinking about accessible services.
By asking this, we were better able to understand the barriers around cultural awareness about our approach to care, and particularly what we can do to improve the accessibility of mental health services for BAME communities. We synthesised the feedback into a report and disseminated it across the Trust, getting a lot of recognition. People are really interested in in knowing more about this topic, which has been brilliant.
Can you tell us any example of the impact from this report that you have already seen?
You know, it has been brilliant already. We had several different partners from the voluntary and community sectors linking in with us and are using it to inform their work. Many of things that people told us aren’t new, but it’s helped create momentum and a focal point that people are rallying around as a catalyst for change.
Now, our senior management have supported us to try and test some ideas, which is why I’m part of the wonderful Qi program.
What we learned through report has been helpful in helping us identify what is important to people and we’ve summarised in the following driver diagram:
Figure 1: Driver Diagram from the BAME Accessibility project
Where are you now with your QI work?
We are at the stage of continuing understanding the problem, and at the same time trying to identify what ideas we can truly test to see and understand it real impact. We need to register our work on Life QI, the trusts online platform for supporting QI work, as this will help us keep track of the ideas we will be testing.
Some of these ideas will focus on improving access to psychological therapies and testing ways to provide online information to help people to identify the right service for them. We identified a gap on how information about the services is conveyed and we believe that, by tackling this, a fairer chance of access to services will be in place. To improve this, we are working to ensure that correct and easy to understand information about services is provided online, so everyone can access and decide for themselves if a service is right for them.
Figure 2: The ELFT Sequence of Improvement
Apart from the Mental Health Transformation team, are there other teams championing the work?
The Pharmacy Team have been great at reaching out to our community groups and have been running sessions on medication side effects. It is interesting having this discussion in these groups, because these spaces are considered safe for our service users and our residents, which makes it different from a medication review in the consulting room. Such outreach initiatives in culturally meaningful spaces can be an important piece of work. We hope to begin testing these further to learn what works and doesn’t, with a view to spreading them across the trust
And how you are using QI to support your work?
QI has been very important in helping us establishing relationships. Forming a team around an aim, choosing an idea to test and following it up to see how it goes has been very important, as this is something that I didn’t do so systematically before, and I have seen the difference.
Also, being in the Pursuing Equity Programme and hearing from other teams has also been great to share ideas and learning. Setting Smart Aims and having them even smarter as the time goes by really helps us focus. QI has helped us really focus around what we are trying to accomplish, and how we are going to test it in detail. This has been really helpful.
And what is next?
As our next step, we will develop our driver diagram further (figure 1) and ensure people’s ideas are reflected in all we do moving forward. We also hope to continue testing different change ideas, so watch this space.
