The presenters have nothing to disclose@ELFT_QIqi.elft.nhs.uk

Mental health servicesNewham, Tower Hamlets, City & Hackney

Forensic servicesAll above & Waltham Forest, Redbridge, Barking & Dagenham, Havering

Child & Adolescent services, including tier 4 inpatient service

Regional Mother & Baby unit

Community health services Newham

Urgent care centre Newham

IAPTNewham, Richmond and Luton

Speech & LanguageBarnet

Challenges and

opportunities

Cultural diversity

Social deprivation

Geographical diversity

Commissioningarrangements

Financial stability and

strong assurance systems

QualityBetter

Reject defectives

Requirement,Specification or Threshold

No action taken here

Worse

The old or only way we knew (Quality Assurance)

Performing well?

The culture we want to nurture

A listening and learning organisation

Empowering staff to drive improvement

Increasing transparency and openness

Re-balancing quality control, assurance and

improvement

Patients, carers and families at the heart of all

we do

@ELFT_QI

Trust board bespoke learning sessions

Visits to other organisationsSentinel event

Developing the strategy through engagement

Building the case for change

Early small scale tests

Long-term business case approved

Assess readiness for change

Identify strategic partner

AIM:To provide the highest

quality mental

health and community

care in England by

2020

Build the will

Build improvement

capability

Alignment

QI Projects

1. Newsletters (paper and electronic)2. Stories from QI projects - at Trust Board, newsletters3. Annual conference4. Celebrate successes – support submissions for awards5. Share externally – social media, Open mornings, visits,

microsite, engage key influencers and stakeholders

1. Build and develop central QI team capability2. Online learning options3. Pocket QI for those interested in QI4. Improvement Science in Action waves5. Develop cohort and pipeline of QI coaches6. Bespoke learning, including Board sessions & commissioners

1. Embed local directorate structures & processes to support QI

2. Align projects with directorate and Trust-wide priorities3. Support staff to find time and space for QI work4. Support deeper service user and carer involvement5. Support team managers and leaders to champion QI6. Align research, innovation, improvement and operations

Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from pressure ulcers

3. Other harm reduction projects (not priority areas)

Right care, right place, right time1. Improving access to services2. Improving physical health 3. Other right care projects (not priority areas)

QI Stories at Trust Board

QI Visibility Wall

Electronic & paper newsletters

http://qi.elft.nhs.uk

12 QI projects published or submitted for publication

Shortlisted for 12 national awards, won 5

Pocket QI commenced in October 2015. Aim to reach 200 people by

Dec 2016.All staff receive intro to QI at

induction

600 staff have completed the ISIA

67 QI Coaches by end of 2016

Most Executives will have undertaken the ISIA.

Annual Board session with IHI & regular Board development

discussions on QI

7 Improvement Advisors

Bespoke QI learning sessions for service users and carers. Over 40

attended in 2015. Build into recovery college syllabus, along with

confidence-building, presentation skills etc.

Estimated number needed to train = 5000Needs = introduction to quality

improvement, identifying problems, change ideas, testing and measuring change

Estimated number needed to train = 1000Needs = deeper understanding of

improvement methodology, measurement and using data, leading teams in QI

Estimated number needed to train = 40Needs = deeper understanding of

improvement methodology, understanding variation, coaching teams and individuals

Needs = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead

Estimated number needed to train = 11Needs = deep statistical process control,

deep improvement methods, effective plans for implementation & spread

Needs = introduction to quality improvement, how to get involved in improving a service, practical skills in

confidence-building, presentation, contributing ideas, support structure for

service user involvement

All staff

Staff involved in or leading QI projects

QI coaches

Board

Internal experts (QI

team)

Experts by experience

QI ResourcesService User Input

Support around every team

Project Sponsor QI Coach

QI Forums

QI Team

Governance Improvement

Little i Big I

Surveys

Focus groups

Community meetings

Service user

forum

Portfolio thinking

67,8

51,1

UCL

LCL

25

35

45

55

65

75

85

95

06

-Jan-1

4

20

-Jan-1

4

03

-Feb

-14

17

-Feb

-14

03

-Mar-

14

17

-Mar-

14

31

-Mar-

14

14

-Ap

r-14

28

-Ap

r-14

12

-May-1

4

26

-May-1

4

09

-Jun-1

4

23

-Jun-1

4

07

-Jul-1

4

21

-Jul-1

4

04

-Au

g-1

4

18

-Au

g-1

4

01

-Se

p-1

4

15

-Se

p-1

4

29

-Se

p-1

4

13

-Oct-

14

27

-Oct-

14

10

-No

v-1

4

24

-No

v-1

4

08

-De

c-1

4

22

-De

c-1

4

05

-Jan-1

5

19

-Jan-1

5

02

-Feb

-15

16

-Feb

-15

02

-Mar-

15

16

-Mar-

15

30

-Mar-

15

13

-Ap

r-15

27

-Ap

r-15

11

-May-1

5

25

-May-1

5

08

-Jun-1

5

22

-Jun-1

5

06

-Jul-1

5

20

-Jul-1

5

03

-Au

g-1

5

17

-Au

g-1

5

31

-Au

g-1

5

14

-Se

p-1

5

28

-Se

p-1

5

12

-Oct-

15

26

-Oct-

15

09

-No

v-1

5

23

-No

v-1

5

07

-De

c-1

5

21

-De

c-1

5

04

-Jan-1

6

18

-Jan-1

6

01

-Feb

-16

No.

of In

cid

en

ts

Incidents resulting in physical violence (Trust-wide) - C Chart

VIOLENCE REDUCTION

150

200

250

300

350

400

450

500

550

2013 2014 2015

No

. of

Inci

de

nts

Physical violence to patients (per 100,000 occupied bed days)

300

400

500

600

700

800

900

2013 2014 2015

No

. of

Inci

de

nts

Physical violence to staff (per 100,000 occupied bed days)

25% reduction

16.9

7.9

3.5

UCL

LCL

0

5

10

15

20

25

30

35

40

13-A

pr-

16

16-A

pr-

16

19-A

pr-

16

22-A

pr-

16

25-A

pr-

16

28-A

pr-

16

01-M

ay-1

60

4-M

ay-1

60

7-M

ay-1

61

0-M

ay-1

61

3-M

ay-1

61

6-M

ay-1

61

9-M

ay-1

62

2-M

ay-1

62

5-M

ay-1

62

8-M

ay-1

63

1-M

ay-1

60

3-J

un-1

60

6-J

un-1

60

9-J

un-1

61

2-J

un-1

61

5-J

un-1

61

8-J

un-1

62

1-J

un-1

62

4-J

un-1

62

7-J

un-1

63

0-J

un-1

60

3-J

ul-1

60

6-J

ul-1

60

9-J

ul-1

61

2-J

ul-1

61

5-J

ul-1

61

8-J

ul-1

62

1-J

ul-1

62

4-J

ul-1

62

7-J

ul-1

63

0-J

ul-1

60

2-A

ug

-16

05-A

ug

-16

08-A

ug

-16

11-A

ug

-16

14-A

ug

-16

17-A

ug

-16

20-A

ug

-16

23-A

ug

-16

26-A

ug

-16

29-A

ug

-16

01-S

ep

-16

04-S

ep

-16

07-S

ep

-16

10-S

ep

-16

13-S

ep

-16

16-S

ep

-16

19-S

ep

-16

22-S

ep

-16

25-S

ep

-16

28-S

ep

-16

01-O

ct-

16

04-O

ct-

16

07-O

ct-

16

10-O

ct-

16

13-O

ct-

16

16-O

ct-

16

19-O

ct-

16

22-O

ct-

16

25-O

ct-

16

28-O

ct-

16

Control Chart: Number of recorded red incidents (physical violence) every 3 days on Safety Cross - Conolly, Gardner, Joshua, Ruth Seifert

& Brett

Red IncidentsW

ho

le C

olla

bo

rative

Me

asu

res fro

m S

afe

ty C

ross

01/04: Testing started on all wards except

Conolly

01/04: CHVRC* 2

13/04: Testing started Conolly

24/06: CHVRC* 4

*CHRVC = Meetings of the “City and Hackney Violence Reduction Collaborative”

13/05: CHVRC* 3

01/08: CHVRC* 5

30/09: CHVRC* 6

79%

^ 05/09

X transferred

Please note, some of this reduction is due to changes in patient mix on Brett Ward. Please see the next chart for the reduction, excluding Brett Ward

PRESSURE ULCERS

57,30%

73,10%

92,01%

UCL

LCL

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

28-A

pr-

14

19-M

ay-1

4

09-J

un-1

4

30-J

un-1

4

21-J

ul-1

4

11-A

ug

-14

01-S

ep

-14

22-S

ep

-14

13-O

ct-

14

03-N

ov-1

4

24-N

ov-1

4

15-D

ec-1

4

05-J

an-1

5

26-J

an-1

5

16-F

eb

-15

16-M

ar-

00

06-A

pr-

15

27-A

pr-

15

18-M

ay-1

5

08-J

un-1

5

29-J

un-1

5

20-J

ul-1

5

10-A

ug

-15

31-A

ug

-15

21-S

ep

-15

12-O

ct-

15

02-N

ov-1

5

11-J

an-1

6

Com

ple

tion R

ate

/ %

Waterlow Completion Rate - P Chart

3,5

2,5

UCL

LCL0

1

2

3

4

5

6

7

8

9

10

07

-Ap

r-14

28

-Ap

r-14

19-…

09

-Jun-1

4

30

-Jun-1

4

21

-Jul-1

4

11-…

01-…

22-…

13

-Oct-

14

03-…

24-…

15-…

05

-Jan-1

5

26

-Jan-1

5

16-Feb-…

09-M

ar-…

30-M

ar-…

20

-Ap

r-15

11-…

01

-Jun-1

5

22

-Jun-1

5

13

-Jul-1

5

03-…

24-…

14-…

05

-Oct-

15

26

-Oct-

15

16-…

07-…

No.

of P

ressure

Ulc

ers

Grade 2 Pressure Ulcers - C Chart

Outcome Measure 2: Total Grade 2 PUs, Acquired in EPCS, On a Weekly Basis

14/03EPCT Consultation

Launched

12/04EPCT Consultation

Concluded

06/06Senior staff on late/evening

shift

04/07New structure implemented

UCL

4,537

2,375

1,3…

0

2

4

6

8

10

12

07

-Ap

r-1

4

28

-Ap

r-1

4

19

-May

-14

09

-Ju

n-1

4

30

-Ju

n-1

4

21

-Ju

l-1

4

11

-Au

g-1

4

01

-Sep

-14

22

-Sep

-14

13

-Oct

-14

03

-No

v-1

4

24

-No

v-1

4

15

-Dec

-14

05

-Jan

-15

26

-Jan

-15

16

-Feb

-15

09

-Mar

-15

30

-Mar

-15

20

-Ap

r-1

5

11

-May

-15

01

-Ju

n-1

5

22

-Ju

n-1

5

13

-Ju

l-1

5

03

-Au

g-1

5

24

-Au

g-1

5

14

-Sep

-15

05

-Oct

-15

26

-Oct

-15

16

-No

v-1

5

07

-Dec

-15

28

-Dec

-15

18

-Jan

-16

08

-Feb

-16

29

-Feb

-16

21

-Mar

-16

11

-Ap

r-1

6

02

-May

-16

23

-May

-16

13

-Ju

n-1

6

04

-Ju

l-1

6

25

-Ju

l-1

6

15

-Au

g-1

6

05

-Sep

-16

26

-Sep

-16

17

-Oct

-16

No

. of

Pre

ssu

re U

lce

rs

Grade 2 Pressure Ulcers - C Chart

70%

2 new teams join

collaborative

AV

ERA

GE

WA

ITIN

G T

IME

October 2016 1- Baseline data

Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets)

Average Waiting Time from Referral to 1st face to face appointment – I Chart

51.52

45.56

57.46

36.45

31.44

16/02Learning

Set 1

10/05Learning

Set 9Test

ing

be

gin

s

28/03Learning

Set 2

27/07Learning

Set 3

03/09Learning

Set 4

01/10Learning

Set 5

25/11Learning

Set 6

05/01Learning

Set 7

16/02Learning

Set 8

3 teams leave collaborative

39.85

60,66

53,17

44,51

51,23

UCL

LCL

35

40

45

50

55

60

65

70

Ja

n-1

4

Feb

-14

Mar-

14

Apr-

14

May-1

4

Ju

n-1

4

Ju

l-14

Aug

-14

Sep

-14

Oct-

14

No

v-1

4

De

c-1

4

Ja

n-1

5

Feb

-15

Mar-

15

Apr-

15

May-1

5

Ju

n-1

5

Ju

l-15

Aug

-15

Sep

-15

Oct-

15

No

v-1

5

De

c-1

5

Ja

n-1

6

Feb

-16

Mar-

16

Apr-

16

May-1

6

Ju

n-1

6

Ju

l-16

Aug

-16

Sep

-16

Avera

ge W

aitin

g T

ime / D

ays

Average waiting time from referral to 1st face to face appt (Collaborative, 10/12 teams) - X-bar Chart

ACCESS TO SERVICES

Staff experience and engagement

3,5

3,6

3,7

3,8

3,9

4

2010 2011 2012 2013 2014 2015

Sco

re

Overall Engagement Score

ELFT Score

National Median

3,5

3,6

3,7

3,8

3,9

4

4,1

4,2

2010 2011 2012 2013 2014 2015

Sco

re

Staff Motivation to Work

3,3

3,4

3,5

3,6

3,7

3,8

3,9

4

4,1

2010 2011 2012 2013 2014 2015

Sco

re

Staff job satisfaction

55

60

65

70

75

80

85

90

2010 2011 2012 2013 2014 2015

Sco

re (

%)

Staff able to contribute towards improvements at work

Make it feel meaningful

Make it feel possible

Make it feel valued and permanent

Provide skills and support

@ELFT_QIqi.elft.nhs.uk qi@elft.nhs.uk