My IS4 Project: Decreased mortality rate after intracerebral haemorrhage


With applications for the next round of IS4 about to open, Haelo’s Project Manager Jess sat down with Emily Birleson to talk about how she got involved in IS4.

The project

Emily joined IS4 as part of Adrian Parry-Jones’ team, ABC-ICH, who had successfully decreased the mortality rate after intracerebral haemorrhage (brain bleed type stroke) at Salford Royal Foundation Trust (SRFT) the previous year. They implemented an acute bundle of care for patients that reduced mortality rates by 10 percentage points; in real terms, this saved the lives of approximately 2 patients per month.

The project won the Warlow Prize, and further funding from the Health Foundation, so they came back to Haelo for a second year on the programme. Their aim was to scale the project across two further sites, Stepping Hill and Fairfield, while holding the gains at SRFT (where Emily is based).

“I think they said they wouldn’t have been able to run as successful a QI project without IS4.”

Prior to the recent project in Salford there had been a lot of clinical research into treatment of intracerebral haemorrhage, but Emily noted the standard gap there seems to be between research and implementation. The IS4 project gave them the autonomy to close that gap, to be more aware of what is going on, and to see what wasn’t going to plan.

Being completely new to QI before starting the project, Emily told us about the “new language” of QI that she had to adjust to. In spite of her anxiety about learning this “language”, Emily was reassured soon after starting on the course.

“I was a bit apprehensive really…I just felt like they knew so much and I knew absolutely nothing, so then obviously actually sitting down and going through the sessions which were fun and very useful, I wasn’t scared anymore.”

Despite never having been involved with QI before IS4, Emily now collects all the data for the 3 sites, and puts together all of the run charts.

IS4 workshops

Emily describes how the practical aspect of the workshops made them incredibly useful. Having mock-up data to play with allowed everyone to make sure they really know what they are doing. Site visits then allowed them to go into a bit more detail about their projects, taking what they’ve learnt in the workshops, and applying it to what they’re doing.

Teams are brought together three times over the course of the programme for 3 day interactive workshops.

In the workshops, teams came together and shared the challenges they faced when implementing change in their organisations, which reassured Emily and her team. Every single team were tackling a unique problem, but they all faced universal challenges like engagement and buy-in that everyone could relate to.

But it wasn’t all plain sailing. Having 3 different sites only increased engagement complications: on one site people struggled to see the benefits pf the project and were more resistant to to change, whereas on another site everyone was excited to get involved. It was important that the team could work out what wasn’t going well at each site, and learn from this.

“Even simple things, like getting everyone together regularly to look at the data were a struggle.”

Ensuring as much forward planning as possible, and regular contact between the sites soon enabled the team to work in a much clearer way.

Emily Birleson presents her team’s project at the second IS4 workshop.

When it came to identifying who would join Emily on the IS4 team, people from a variety of levels and roles in the hospital were chosen, from the specialist nurses who would actually be implementing the changes, to the 3 project leads from each site that came with the influence at their sites.

Moving forward

After making incredible progress, this is most certainly not the end for Emily’s team; they are working with Manchester University to create an app to help guide clinicians through the bundle.

And what would Emily’s top tips be for a team thinking of signing up to IS4?

Be open! It is such a safe environment for everyone to learn in, everyone is in the same boat. Keep persevering with engagement, and be consistent with what you’re doing.

Teams bring together their learning by running a mini improvement project over the course of the final afternoon of workshop one.

If you have a patient safety issue in your organisation that you need to tackle, the IS4 programme provides the skills and methodology to start to make real improvement.

Applications are now open: visit for more details.

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