Spotlight on Quality Improvement
Quality Improvement: a case study
Last month we told you that Amar Shah had become the college’s
first Quality Improvement lead. Amar
would love to hear your stories of quality improvement in your
Each month from now, we’ll include a QI case study.
The first one focuses on Durham and Darlington Child and
Adolescent Mental Health Services Senior Management Team, which is
part of Tees Esk and Wear Valleys NHS Trust.
Long waiting times, high caseloads
In February 2016, the service was facing particular issues with
children waiting to access services.
There were 923 children waiting and 212 had waited over 9
To compound the issue there was poor staff retention &
recruitment with 35 vacancies, staff sickness was at 10.1%.
Staff caseloads were high; there was limited transparency on the
performance of the service.
How QI methods helped
The introduction of daily lean management has provided a system
for baselining demand and daily monitoring.
Daily huddles and visual control boards were introduced to
provide transparency and visibility within the service.
This process enabled the leadership team to identify issues,
agree actions and ensure accountability. For example, a particular
issue with the ASD pathway was identified and a formal improvement
event was commissioned.
A number of interventions, including
daily clinical huddles
caseload management and
were introduced into each community team.
This has supported the improved flow of patients, the ability to
flex capacity in line with demand to ensure patients are seen
promptly and an improved levelling of work across all team
Boosting recruitment and other innovations
A recruitment fair was held to recruit new members of staff to a
number of vacancies.
A single point of access service was introduced through the use
of a formal quality improvement event. There is now one single
point of access to the service.
All of the improvements and interventions have been developed
into standard work and leaders undertake Gemba walks to ensure that
standard work is being followed.
In November 2016, there was a significant reduction in waiting
times with a total of 122 waiters (only 10 over 4 weeks and none
over 9 weeks). Staff sickness was 4.6%, there were no vacancies and
there was an improvement in the staff Friends and Family Test.
A combination of Gemba walks and the DLM process has enabled the
service to understand their value stream and identify opportunities
to remove waste from the system. A number of improvement
events with Durham & Darlington CAMHS were held during 2016
using the trusts QIS methodology.
Upon identification of the events, the leaders observed the
process to understand the issues and potential areas for
improvement. Improvement teams consisting of a Sponsor
(Director of Operations) and Process Owner (HOS and Service
Manager) and Workshop Lead (Certified Leader in the Trusts QIS)
were identified to lead the pre-event, the event and post event
A key role of the Sponsor is to identify the targets for
improvement. 12 weeks prior to the events, the Workshop lead
and their team lead completes a series of deep dive observations to
provide a baseline for metrics.
The metrics were developed into a Target Progress Report which
provided the system for measurement post event.
Amar would like to hear your QI success stories to help
spread best practice. Please email him at email@example.com and
we will publish a success story in the eNewsletter each
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