Event Blog: BEH Learning Session 4


Welcome to the event blog for learning session four for Barnet, Enfield and Haringey Mental Health NHS Trust (BEH) Quality Improvement Collaborative on Wednesday 19th September 2018.

Haelo have been busy supporting quality improvement (QI) teams in a collaborative series as part of the BEH Live, Love, Do initiative. Now into it’s second year, a new wave of QI teams are embedded into 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 as part of the first year graduation event, have attended learning session onelearning session two ,learning session three and now on to learning session four.

Director of Improvement, Richard Milner starts the day by setting up the agenda. 

The day has been divided into 3 main themes:

  • Reporting on team dynamic and progress
  • Providing space to support teams
  • Looking forward into year 3

Richard sets up the first ice-breaker for all the attendees. He asks them to consider the following questions on their tables.

Why are we here?

  1. What has been your most interesting change and why?
  2. What has been your most difficult challenge and why?
  3. What part of the QI methodology have you struggled with the most?

Some of the feedback from attendees included:

What has been your most interesting change?

  • A whiteboard for post-its of suggestions and comments
  • High level of engagement from front line staff- an amazing amount of change ideas
  • Looking at body language and non-verbal cues of staff to improve patient experience

What has been your most difficult change?

  • Automated appointment text reminders- often needed manual send out as system would oversend
  • Bringing together a QI team across different sites
  • Staff turnover

What part of the QI methodology have you struggled with the most?

  • The introduction of QI methodology
  • Finding an aim
  • Act part of PDSA

We began the next section of day hearing about several of the QI projects that have been going on.

Richmond and Noxi from Sussex Ward were the first to present their project: reducing violence and aggression on the ward.

The team started by talking us through their driver diagram, focusing on the aim of their project: To reduce violence and aggression by 30% by 31st December 2018.

Their main change ideas were around smoking cessation, 24hr access to hot and cold drinks, and positive behaviour support. Sussex Ward then went on to explain what is next for their project, with the highlight being introducing more indoor activities on the ward.

Following their presentation, we had a short Q&A session. One of the key questions asked was around how Sussex Ward get staff buy-in to their project?

Richmond and Noxi shared some great tips: including information in supervisions with staff, encouragement in ward rounds, getting consultants involved in the project, and giving staff individual tasks to encourage ownership.

The next team to present their project was Enfield CAMHS who are looking at reducing DNA rates.

The team noted that they had met a few initial challenges in the project, particularly around staffing. They started a steering group, made up of experienced clinicians and new admin staff to work on the project.

It was great to hear that the team had successfully met their initial target of reducing DNA rates by 10% by July 2018. However, they did note that work is still on-going to improve even further.

Adding some structure to what we’re doing, really does add value, and helps us measure the success of what we’re doing.

Again, we went to a Q&A following the team’s presentation, where they were asked, what would you do differently if you were running it again from scratch?

The team noted that one of the main challenges was around having time to meet, especially for clinicians. Therefore, allocating more time to support would be useful. They also explained how having a better quality of data, with increased regularity would also have been very useful.

The final team to present was Jide talking to us about staff engagement on a reflective model for improving practice in employee disciplinary matters.


The project used a checklist to help managers understand what would count as ‘disciplinary’. Jide noted the 3 main challenges with this project were the lack of data rich ways to measure outcomes, working with volunteers, and the length of time these changes can take to make.

Our final session of the morning was an expert panel, led by Gareth and Sam.

This session was run as an open Q&A session, where Gareth and Sam could answer any burning questions our attendees may have had.

Before the questions got going, Gareth and Sam just began by talking about their experiences of QI projects.

How do you stop losing momentum towards the end of your project?

Gareth explains that we should move away from calling it QI, and having that separation, quality improvement should just be seen as BAU. Sam adds that it is important to get staff to see the benefit PDSA can have to their role, so that it is not seen as making their lives more difficult.

They shared some of the best tools to build staff engagement, including: newsletters, 121s, staff suggestions and protected time to work on projects. Gareth notes that this is where the power of data comes in, they are vital to back up decisions, especially regarding staff time.

It’s ok for it not to be successful, as long as you are still learning…

The discussion then moved on to look at how can you include QI methodology as a behaviour shift?

Gareth started by explaining how his excitement and enthusiasm for QI came about after the last collaborative. He realised that focusing on one small thing, can often have a big impact.

Sam adds to this by mentioning how important it is to empower people to make a change, anyone can make a change, you just have to give them the tools to do so.

A question arises from this, how can we authorise protected time to focus on improvement projects?

Richard advises that the best way to make changes at board level is to show results. He also highlights the importance of using patients to tell your stories. There is no better evidence than seeing how your changes have had a direct impact on a patient.

As discussions continue, it was great to hear from other teams about challenges they have faced throughout their projects.

We kick off the afternoon with Richard leading a session reminding us of the journey we’ve come on so far.

He highlighted the great work that’s been done in each of the learning sessions. Across the previous 3 learning sessions, we looked at:

  • measuring improvement
  • sharing challenges
  • refreshing methodology
  • presenting team progress
  • understanding data
  • sharing issues by theme

Richard then goes on to discuss plans for the next year. The plan will be to introduce a ‘bitesize’ model. Offering all of the same training that has been available previously but in bitesize chunks.

We want to spread learning in a much quicker way…

Richard went on to explain how they want to build QI into statutory and mandatory training, maximising the channel used to train staff, and mainstreaming QI.

The day ended with a visit from BEH Chief Executive Jinjer Kandola who came to view some of the fantastic poster presentations from our teams.

What do you think?

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