QI continued at BEH


Welcome to the event blog for learning session two at Barnet, Enfield and Haringey Mental Health NHS Trust (BEH).

Haelo have been busy supporting quality improvement (QI) teams in a collaborative series as part of their Live, Love, Do initiative. Now into it’s second year, a new wave of QI teams are embarking on the improvement programme which aims to equip front line teams with the tools required to improve the delivery of health care services. Year two teams attended a launch on the back of the first year graduation, have attended learning session one and we now eagerly await learning session two.

The collaborative has developed in the second year, with improvers from cohort one becoming faculty members and taking a key role in coaching year two teams. QI alumni have joined the Haelo team in shaping the collaborative and teaching at learning sessions.


Andy Graham, BEH Interim Chief Executive, officially opened the event welcoming teams and faculty, outlining the quality commitment that’s now embedded at BEH and his ambition to be outstanding. Chairing the event, BEH Director of Improvement, Richard Milner, outlined the agenda for the day and projection of the QI programme. Richard expressed his desire that this programme marks the end of top-down change, saying “the people who are best placed to identify and solve the problem are in the room today”. Our QI approach recognises that teams have the inside knowledge and experience to identify and implement change.

Richard welcomed our guest speaker today, Adam Sewell Jones, Executive Director of Improvement at NHS Improvement who presents the case for QI and the key features of successful QI.

Referencing work by Dr Richard Bohmer, Adam uses the hard work of healthcare transformation to recommend where your should focus should be if you set an ambition to be a leading improvement organisation “and you should be”:

  1. Local teams – The importance of local teams working together and engaged. Don’t work from the center but from the bit of the world where you are
  2. Local leadership – If you’ve not got the right people it’s very difficult to get sustainable improvement. If you haven’t, you should challenge the board, local leaders can really drive it forward
  3. Cycle of change – Almost every improvement methodology has a Plan, Do, Study, Act (PDSA) cycle at the heart, the idea that we continuously test small cycles of change to measure our impact. Teams working without theory will struggle and wont understand the implications.
  4. Analytics – It’s come to light that most organisations are under powered in their ability. Adam recommends investment in people’s analytic capability is vital and crucially important to deliver this work
  5. Support team – Without a consistent support team, like Haelo in this example, organsiations and teams will lose the opportunity to draw on a centre of excellence and experience
  6. Senior leadership team – A great example is how you have a CEO in the room today who understand your organisations priorities. Senior leaders offer opportunities and commentary around your QI project in board meetings, for example
  7. Mechanisms of behavior alignment – Importance of having the right values and culture in place. Frankly we work in an environment that claims to be a learning organisation with a no blame culture but there are too many examples where improvement doesn’t work out how you had predicted and it’s therefore seen as a failure with negative connotations. Teams should be encouraged and feel safe in their workplace to try, to learn from failure, celebrate and exchange successes. Without the right culture it’s difficult to embed improvement in a sustainable and innovative way.


Adam follows this up with 10 lessons for NHS leaders, from the Kings fund and Health Foundation.


Adam closes his session by referencing work by Mary Dixon Woods, a leading light in improvement, who warns not to rush the roll out or scaling up of your improvement work, because you think it’s great without really understanding the benefit, sometimes referred to as the ‘ugly baby syndrome’!

Although quality improvement (QI) is frequently advocated as a way of addressing the problems with healthcare, evidence of its effectiveness has remained very mixed. The reasons for this are varied but the growing literature highlights particular challenges. Fidelity in the application of QI methods is often variable. QI work is often pursued through time-limited, small-scale projects, led by professionals who may lack the expertise, power or resources to instigate the changes required. There is insufficient attention to rigorous evaluation of improvement and to sharing the lessons of successes and failures. Too many QI interventions are seen as ‘magic bullets’ that will produce improvement in any situation, regardless of context. Too much improvement work is undertaken in isolation at a local level, failing to pool resources and develop collective solutions, and introducing new hazards in the process.”

Next up to the front is Vicky Grimes, Communications Manager at Haelo to launch the Quality Improvement Alumni Directory. Following the graduation event which celebrated the work of year one teams we saw the potential to create an alumni network and subsequent directory. The alumni resource captures the knowledge and work from year one and offers support to teams in year two who can benefit from the experience, expertise and advice of peers. The directory also hopes to celebrate and raise awareness of QI work both internally and externally, whilst encouraging team engagement in the innovative QI programme. Vicky explains our expectations for year two teams to use the profiles to find teams who could support their work and prepare to submit their own profile to the directory ahead of their graduation. The directory will progress year on year, building a valuable bank on knowledge for current and future improvers.

The Alumni Directory features all teams from year one. Following an introduction to the QI commitment made by BEH, the directory includes five case studies which are double page features on teams and eight single page profiles for the remaining teams. The document ends with a directory that lists the BEH faculty, year one teams and introduces year two teams.

This then takes us to team presentations, a show and tell session where teams can share their progress to date and exchange learning with teams. The Learning and Development team are first up showcasing their project focused on reducing DNA to mandatory training as part of the improving staff experience work-stream. They talked us through their aim and driver diagram and showcased the data they had been collecting since the launch event, this started an interesting discussion around potential future tests of change.

Presenting ‘minding the gap’ are East Barnet CAHMS, Child and Adolescent Mental Health Services. After abandoning the first project, they moved forward with a project focused on improving the experience for patients awaiting treatment, by decreasing wait time and supporting them during their time in the system. Still in it’s infancy, the project hopes to improve the service they are offering patients using QI.

The team have started to collect baseline patient data to understand the scale of the problem. They have also started collecting staff satisfaction data, as it was their frustration that initially highlighted the project. The team plan to focus their next steps on data collection in the second action period, ensuring they have enough to underpin PDSAs. The presentation ignites a rich debate into data, sharing challenges, the importance of defining an aim to support data collection and how QI gives us a different perspective and approach to tackling these problems and challenges within our teams that we didn’t have previously.

The third team, Juniper Ward, present their aim to reduce levels of violence and aggression by 30% by August 2018.  We looked at their data collected for physical and verbal assault on the ward. The team discussed their challenges collecting data, specifically with patients who significantly contribute to violence and aggression on the ward. They also plan to engage staff through education, surveys and via data collection.

There’s nothing like the prospect of data to get people rushing back their seats after a short break! We now open the measurement part of the day with Alex Manya, BEH Project Manager exploring why we measure, use of run charts and how we know we’re improving. Building on the back of the introduction in learning session one, Alex inspires teams to tell their story through data, what are run charts and rules including a shift, trend and astronomical point, as teams become more curious and investigate their data.

In a data double act, Laura Jackman Haelo Data Analyst follows with a session on the appreciation of Statistical Process Charts – otherwise known as SPC or Shewhart Charts. Laura explains the reason we use them over run charts and how they have another level of statistical rigor behind them. SPC can offer teams more confidence in helping to differentiate between special cause and common cause.

Laura explains how SPC are similar to run charts, with a time series along the bottom as we look at data over time, a Y axis to show what it is we’re actually measuring and a collection of data points, but with a mean as the centre line (as opposed to a median). However the main difference between the charts is the use of control limits based on current variation within the system. So, in common cause we would expect data to fall between those two lines/limits are so you can make a judgement what is common and what is special.

Laura tasks teams to become data detectives and identify special cause in examples of real data. In her latest data blog, Laura talks about the components of SPC and her top tips.

The afternoon began with a sharing and learning session with teams splitting into workstreams: staff satisfaction, patient experience and violence and aggression. This protected time within your workstream was supported by the improvement faculty and year one QI alumni. Faculty and alumni have all been through the first year and are here as QI champions and ready to exchange expertise. The session revealed common themes within and across workstreams.

Finally, our second afternoon session focused on dedicated team time. Teams are tasked to truly understand their system, to identify gaps in your knowledge and head space away from the working day.





The Haelo Faculty include Katharine Goldthorpe, Director of Improvement, Stuart Clough, Programme Manager and Data Analysts Laura Jackman and Nick John. To find out more about the programme, contact the team.

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