Welcome to the ELFT QI

open morning

@ELFT_QI
qi.elft.nhs.uk
qi@elft.nhs.uk

Our focus on Quality Improvement

with Dr Kevin Cleary
(Medical Director)

Professor Jonathan Warren

(Director of Nursing)

Mental health services

Newham, Tower Hamlets, City & Hackney, Luton & Bedford

Forensic services
All above & Waltham Forest, Redbridge, Barking & Dagenham,
Havering

Community health services

Newham

Urgent care centre

Newham

IAPT

Child & Adolescent services, including tier 4 inpatient

service

Newham, Richmond and Luton

Speech & Language

Regional Mother & Baby unit

Barnet

Cultural
diversity

@ELFT_QI

Financial
stability and
strong
assurance
systems

Commissioning
arrangements

Challenges
and
opportunities
in East
London

Social
deprivation

Geographical
diversity

@ELFT_QI

Make quality our

absolute priority
Improving
quality of care
is our core
purpose
Of greatest
importance to
all our
stakeholders
Build on the
excellent work
already
happening to
improve quality

The strategic case for change

National drivers
The need to
focus on a
more
compassionate,
caring service
with patients
first and
foremost

More
structured and
bottom-up
approach to
improvement

Enable our staff

to lead change
The desire to
engage, free
and support
our staff to
innovate and
drive change
Engaged and
motivated staff
leads to
improved
patient
outcomes

The economic
climate
The need to do
more with less
improving
quality whilst
reducing cost

The culture we want to nurture

A listening and learning
organisation

Empowering staff to
drive improvement

Patients, carers
and families at
the heart of all
we do

Increasing transparency
and openness

Re-balancing quality
control, assurance and
improvement

Assurance,
control &
performance
managament

Research &
innovation

Quality
improvement

A perspective from a non-executive

member of our Board
with Jennifer Kay

Our quality
improvement programme
with Dr Amar Shah
(Associate Medical Director for QI)

James Innes
(Head of Quality Improvement)

Build the
will

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

Build
improvement
capability

Alignment

1.
2.
3.
4.
5.
6.

Launch event & roadshows

Microsite
Using the power of narrative
Celebrate successes
Network of champions / ambassadors
Learning events

1.
2.
3.
4.
5.
6.

Initial assessment of alignment & capability

Recruiting central QI team
Online training
Face-to-face training
Follow-up coaching on projects
Develop in-house training for 2016 onwards

1.
2.
3.
4.

Align all projects with improvement aims

Align team / service goals with improvement aims
Align all corporate and support systems
Patient and carer involvement in all improvement
work
5. Embed improvement within management structures
Reducing Harm by 30% every year
1. Reduce harm from inpatient violence
2. Reduce harm from falls
3. Reduce harm from pressure ulcers
4. Reduce harm from medication errors
5. Reduce harm from restraints

QI Projects

Right care, right place, right time

1. Improving patient and carer experience
2. Reliable delivery of evidence-based care
3. Reducing delays and inefficiencies in the system
4. Improving access to care at the right location

@ELFT_QI

Sentinel event

Focus groups

Building the will for change

Early small scale tests

of QI methodology

Visiting other organisations

that successfully
implemented QI

Trust board bespoke

learning sessions

Build the
will
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

QI microsite the
online hub for the
programme has
50,000 page views
to date
qi.elft.nhs.uk

Staff and
service user
newsletter
reaches 5000
people every
month

Build the
will
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

Bespoke QI learning
events for staff, service
users, commissioners,
governors

QI microsite the
online hub for the
programme has
60,000 page views
to date
qi.elft.nhs.uk

QI launch event and roadshows

attended by over 1000 staff,
service users and carers

Staff and
service user
newsletter
reaches 5000
people every
month

QI microsite the
online hub for the
programme has
50,000 page views
to date
qi.elft.nhs.uk

Build the
will
AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

Bespoke QI learning
events for staff, service
users, commissioners,
governors

QI launch event and roadshows

attended by over 1000 staff,
service users and carers

ELFT experience day attended by

over 70 international delegates

Staff and
service user
newsletter
reaches 5000
people every
month

Annual QI conference
attended by over 270 staff,
patients and external
partners

QI visibility wall to describe

programme & update on progress

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

Build
improvement
capability

Where are we?

On track to train over 500
people through 5 six-month
waves of learning between
2014-16. First 3 waves
delivered with the IHI

Estimated number = 3300

Requirement = introduction to quality
improvement, identifying problems,
change ideas, testing and measuring
change
Time-frame = train 10-20% in 2 years

On track. All clinical and

service leads to have
completed the ISIA training
within 2 years

Estimated number = 250

Requirement = deeper understanding
of improvement methodology,
measurement and using data, leading
teams in QI
Time-frame = train 30-50% in 2 years

Leading & Facilitating change

programme will train 30 QI
coaches in 2015

Estimated number = 25
Requirement = deeper understanding
of improvement methodology,
understanding variation, coaching
teams and individuals
Time-frame = train 100% in 2 years

On track. Most Executives

will have undertaken the
ISIA, and all will have
received Board training with
the non-Executives

Estimated number = 10
Requirement = setting direction and
big goals, executive leadership,
oversight of improvement, being a
champion, understanding variation to
lead
Time-frame = train 100% in 2 years

Currently have 3
improvement advisors, with
1.5wte deployed to QI.
To develop 5 more in 2015.

Estimated number = 5
Requirement = deep statistical process
control, deep improvement methods,
effective plans for implementation &
spread
Time-frame = train 100% in 2 years

Experts
Front line staff
Clinical leaders
Directorate
improvement
leads

Executives

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

Build
improvement
capability

Support for improvement

work from the Trusts QI
team

Partnership with IHI on

delivery of QI training to
staff and Trust Board, and
strategic guidance from IHI
executive team

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

Face to face improvement training hundreds of staff, services users,

Governors to be trained over the
next few years

IHI Open School online

training resource available
to all. Providing essential
skills to support people
leading quality
improvement.

Build
improvement
capability

Support for improvement

work from the Trusts QI
team

Partnership with IHI on

delivery of QI training to
staff and Trust Board, and
strategic guidance from IHI
executive team

Improvement Science in Action

- 6 month learning path

Prework

Workshop
Workshop
9/29-10/1
(3 days)

Webex #1
Webex
1
10/14

AP-1

Project
Planning

AP-2

Learning
Webex
2
11/21
set

AP-3

Reliability

Webex
Webex#23
11/30

Sustaining
Gains

Learning Set
2&
graduation
Supports:
Faculty consults
Listserve
The two learning
sets will be focused
sharing the
onWebex
callsparticipants work on their
projects and learning
from each other.
These sessions
Assignments
Coaching
callsalso will reinforce the
AP-4

Webex #3

AP-5

content from the Webex calls and the ISIA workshop.

Working upstream with external

partners to build capability around
continuous improvement

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

QI coaches- 30 staff to become

coaches, spending 1 day/week
supporting local QI projects

Face to face improvement training hundreds of staff, services users,

Governors to be trained over the
next few years

IHI Open School online

training resource available
to all. Providing essential
skills to support people
leading quality
improvement.

Build
improvement
capability

Support for improvement

work from the Trusts QI
team

Partnership with IHI on

delivery of QI training to
staff and Trust Board, and
strategic guidance from IHI
executive team

Time for a video

Alignment

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

Starting an
Improvement Project
At ELFT

qi.elft.nhs.uk

To assist in this
process we
have a Project
Charter form
that defines
what we want
to accomplish.

28

Driver Diagrams

Support and resources

available on microsite:
http://qi.elft.nhs.uk/driver-diagrams/

Complete Your Charter and Driver Diagram!

Email to QI team
qi@elft.nhs.uk
QI team or QI coach will get in contact
in a few days

Project Sponsor

QI Coach

QI Forums

QI Resources

Coaching teams from the very start

Agree the
quality issue
to be tackled

Ensure
patient (and
carer)
involvement

Find time to
meet

Form a team

Success

Learning and coaching over 6 months

Prework

Workshop
Workshop
9/29-10/1
(3 days)

Webex #1
Webex
1
10/14

AP-1

Project
Planning

AP-2

Learning
Webex
2
11/21
set

AP-3

Reliability

Webex
Webex#23
11/30

Sustaining
Gains

Learning Set
2&
graduation
Supports:
Faculty consults
Listserve
The two learning
sets will be focused
sharing the
onWebex
callsparticipants work on their
projects and learning
from each other.
These sessions
Assignments
Coaching
callsalso will reinforce the
AP-4

Webex #3

AP-5

content from the Webex calls and the ISIA workshop.

Quality improvement programme-project support structures

Alignment

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

A process is in place for

teams
to
submit
project ideas to the QI
team, who will help
with
planning,
structure
and
measurement,
and
ensure projects are
aligned with our highlevel aims.

Alignment

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020

QI projects

Our QI Projects

Trust project status over time

7
3
10
17

1
3
2
9
9
19

31

1
3
6
7
9
19

29

2
2
7
10

2
2
7
10

13

13

20

20

25

23

5
4
9
12
17

15
7
3
9

25

17

16

21
15

24
26
25

22

60
16

17

17

18

15

14

12

11

11

15

11

16-Mar-15

30-Mar-15

13-Apr-15

27-Apr-15

19-May-15

28-May-15

15

15-Jun-15

May

June

July
5.0

4.5

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5
1
1

3
2
2
2

7
2

3
1

1
1
1

Addictions

2
6

1
1
3

1
3

Community
Health Newham

3
2
4

2
1
1
4
2
2

3
0

MHCOP

City and Hackney

Mental Health

Children's
Services

0
2

3
1

Corporate

Forensics

3
3
6
1

3
0
3

Newham Mental Psychological

Health
Services &
Learning
Disability

Tower Hamlets
Mental Health

REDUCE HARM
BY 30% EVERY
YEAR

VIOLENCE
REDUCTION
TH Collaborative
Roman, Globe, Bricklane, Lea,
Millharbour, Rosebank

MHCOP
Larch Lodge, Cedar Lodge, Sally
Sherman Ward

Forensics

RIGHT CARE,
RIGHT PLACE,
Right
Care,TIME
Right
RIGHT

Place, Right Time

PRESSURE
ULCERS
CHN
EPCS Teams (North East, North
West, Central, South)
Multiple I/P Wards (Cazebon, Sally
Sherman and Fothergaile)

PHYSICAL
HEALTH
Childrens
All Community CAMHS,
Adolescent MHT

City & Hackney

Adult Psychiatry CMHT, All CMHTs,
Assertive Outreach, Rehab, Joshua,
Conolly

CHN / MHCOP

Childrens
Newham CFCS, CDC West Ham
Lane, Community CAMHS TH, OT,
Health Visiting

C&H
South CMHT, AOS & CRRT, North
Team 1 Recovery/Primary Care

Urgent Care Centre

Clerkenwell, West Ferry

Ward

Forensics

CAMHS

Woodberry, Victoria, Limehouse,

Morrison

Coborn Unit

ACCESS TO
SERVICES

Newham
CMHTs, Newham Centre for Mental
Health

Psychological / LD
Community Learning Disability
Service

Smoking
Forensics, Millharbour

CHN / MHCOP
Newham Memory Service

Psychological
Older People Richmond /
Newham, City and Hackney,
Newham

Tower Hamlets

Time to meet some of our

projects
Rooms:

4 (lower ground floor)

5 (lower ground floor)
Training room
9

(4th floor)

(ground floor)

Is it making a difference?

Number of Incidents resulting in Physical Violence (Trust-wide) - C Chart

230

210

UCL

190

No. of Incidents

170.9
170

150

LCL

130

103.1

110

171 per month

90

103 per month

Datix incident reporting

May-15

Apr-15

Mar-15

Feb-15

Jan-15

Dec-14

Nov-14

Oct-14

Sep-14

Aug-14

Jul-14

Jun-14

May-14

Apr-14

Mar-14

Feb-14

Jan-14

Dec-13

Nov-13

Oct-13

Sep-13

Aug-13

Jul-13

Jun-13

May-13

Apr-13

Mar-13

Feb-13

Jan-13

70

40% reduction across the Trust

Jun-15

May-15

Apr-15

Mar-15

30

Feb-15

Jan-15

Dec-14

Nov-14

Oct-14

Sep-14

Aug-14

Jul-14

Jun-14

May-14

Apr-14

Mar-14

Feb-14

Jan-14

Dec-13

Nov-13

Oct-13

Sep-13

Aug-13

Jul-13

Jun-13

May-13

Apr-13

Mar-13

Feb-13

Jan-13

No. of Incidents per 1000 OBD

Incidents of physical violence per 1000 occupied bed days (OBD)

35
Participating wards

Non-Participating wards

25

20

15

10

May-15

Apr-15

Mar-15

80

Feb-15

90

Jan-15

150
May-15

Apr-15

Mar-15

Feb-15

Jan-15

Dec-14

60

Dec-14

70

Nov-14

Oct-14

Sep-14

Aug-14

Jul-14

Jun-14

May-14

Apr-14

Mar-14

Feb-14

Jan-14

Dec-13

59 per month

Nov-14

Oct-14

Sep-14

Aug-14

Jul-14

Jun-14

May-14

Apr-14

Mar-14

134 per month

Feb-14

Jan-14

Dec-13

Nov-13

Oct-13

Sep-13

Aug-13

Jul-13

Jun-13

May-13

Apr-13

Mar-13

UCL

Nov-13

Oct-13

Sep-13

Aug-13

UCL

Jul-13

Jun-13

May-13

Apr-13

100

Mar-13

170
Feb-13

Jan-13

No. of Incidents
80

Feb-13

Jan-13

No. of Incidents

90

Incidents resulting in restraint in prone position at ELFT - C Chart

44% reduction
33 per month

50

40
LCL

30

20

10

Incidents resulting in Restraint at ELFT - C Chart

160

114 per month

140

130

120

110

LCL

15% reduction

70

6.4 per month

3.2 per month

Jun-15

Jun-15

Jun-15

May-15

May-15

Apr-15

Apr-15

Mar-15

Mar-15

Feb-15

Feb-15

Jan-15

Jan-15

Dec-14

Dec-14

Dec-14

Nov-14

Nov-14

Oct-14

Oct-14

Sep-14

Sep-14

Aug-14

Aug-14

Jul-14

Jul-14

Jun-14

Jun-14

Jun-14

May-14

0
May-14

Apr-14

Apr-14

Grade 3-4 Pressure Ulcers - C Chart

10
9

7
UCL

LCL

50% reduction

90%

20%

10%

28-Apr-14
05-May-14
12-May-14
19-May-14
26-May-14
02-Jun-14
09-Jun-14
16-Jun-14
23-Jun-14
30-Jun-14
07-Jul-14
14-Jul-14
21-Jul-14
28-Jul-14
04-Aug-14
11-Aug-14
18-Aug-14
25-Aug-14
01-Sep-14
08-Sep-14
15-Sep-14
22-Sep-14
29-Sep-14
06-Oct-14
13-Oct-14
20-Oct-14
27-Oct-14
03-Nov-14
10-Nov-14
17-Nov-14
24-Nov-14
01-Dec-14
08-Dec-14
15-Dec-14
22-Dec-14
29-Dec-14
05-Jan-15
12-Jan-15
19-Jan-15
26-Jan-15
02-Feb-15
09-Feb-15
16-Feb-15
23-Feb-15
02-Mar-15
16-Mar-00
23-Mar-15
30-Mar-15
06-Apr-15
13-Apr-15
20-Apr-15
27-Apr-15
04-May-15
11-May-15
18-May-15
25-May-15
01-Jun-15
08-Jun-15
15-Jun-15
22-Jun-15
29-Jun-15
06-Jul-15
13-Jul-15

Overall Waterlow Completion Rate in EPCT - P Chart

100%

Series3

80%

70%

97%

60%

50%

40%

30%
Series4

57%

40% increase
in reliability

0%

Leading cultural
transformation through QI

Building will

Build a broad
coalition for
change

Take time to
bring people
with you

Shift decisionmaking to the

edge

Develop a
compelling
narrative

Find some
clear signals
of change

Use the power

of stories

Take every
opportunity to
celebrate

Building capability &

capacity

Be prepared
to invest

Train all levels

and across
disciplines

Realign
existing
resources

Stop lower
value work

Alignment & integration

Start at the top

Create a
support
structure

Build a learning
system

Ensure patients
and carers are
integral

Ensure the
context is ripe

Line of sight
from team to
system goals

qi.elft.nhs.uk
qi@elft.nhs.uk
@ELFT_QI