Quality improvement aims to improve the quality of care delivered to patients by bridging the gap between known best practice and the routine delivery of care.
We have set up a Quality Improvement Committee, chaired by Dr Amah Shah, to advise on promoting quality improvement methods.
Dr Shah leads one of the largest mental health improvement programmes in the world, with the aim of providing the highest quality mental health and community care in England by 2020.
Quality improvement has three core components: it's a systematic way to tackle complex problems, it's continuous – always evolving and learning, and it's about engaging people at all levels.
The Model for Improvement and Innovation is an internationally recognised improvement tool that is designed to provide a framework for developing, testing and implementing changes that lead to improvement.
The framework, which was developed by the Institute for Healthcare Improvement (IHI) in the USA, includes three key questions to ask before implementing a change, and is supported by a process for testing change ideas using Plan, Do, Study, Act (PDSA) cycles.
The Model for Improvement supports the process of taking the time to plan change and testing it out in small-scale cycles of change. Using this approach, we can see what is working well and what is not, before we implement wholescale changes to systems.
Case Study: The Partnership for Patient Protection (P4P2) - Mersey Care NHS Foundation Trust
The Partnership for Patient Protection (P4P2) is a unique collaboration between the Centre for Perfect Care and The Risk Authority Stanford which aims to identify and mitigate key clinical risks.
The programme pairs leading edge software (Innovence Pulse) and Design Thinking methodology to develop projects that will improve quality of care.
The starting point for their Quality Improvement project was to analyse five years of incident reports, claims, complaints and investigation reports.
After inputting this information into Innovence Pulse, the Trust received an initial risk identification report which highlighted the primary clinical risks facing the organisation.
From that report, the specific area of ‘Violence Reduction’ was selected for further analysis.
Violence Reduction: Within the Trust's Specialist Learning Disabilities Division, assaults on members of staff was selected as the priority area.
In 2015, Calderstones NHS Foundation Trust, now Mersey Care Specialist Learning Disabilities Division, had the highest rate of assaults on staff in the country. Of 6700 incidents, some 2800 (42%) were assaults on staff.
The project team sought to reduce levels of assault by 30% over a two-year period. Interventions included restorative practice and strengthening preventative strategies in Positive Behaviour Support (PBS) plans.
Cohort 1 – Enhanced de-escalation workshops and summary PBS plans
- Every service user now has a summary PBS plan, and they are exploring ways to ensure they are shared widely within MDTs.
Cohort 2 – Restorative Practice
- Entails a 'restorative meeting' following incidents of assault, where service user and staff member are brought together to reflect on how the incident came about and the impact it had on those affected.
The purpose is to repair therapeutic relationships and agree a plan as to how similar incidents can be avoided in the future. Over the past few months, they have been ensuring service users have given their consent, been risk assessed and approved by their MDTs.
So far there has been a 53% reduction in the frequency of assaults on members of staff across all secure wards since the first of the interventions were implemented. There has also been an 85% reduction in the number of injuries sustained.
As seen in RCPsych Insight, Issue 2, Autumn 2017, Page 7 (A commitment to QI - Dr Amar Shah)
Where can I learn more about quality improvement?
- Aqua – Advancing Quality Alliance
- Quality Improvement: An Introductory Guide for Trainees and Trainers
- East London Foundation Trust Quality Improvement
- What is Quality Improvement? - West of England Academic Health Science Network
- HQIP HealthCare Quality Improvement Partnership
- NHS England Quality Improvement
- King’s Fund report Improving quality in the English NHS: A Strategy in Action
- King’s Fund Quality Improvement in mental health care
- Institute for Healthcare Improvement
- Quality improvement made simple - The Health Foundation
- The Healthcare Improvement Studies (THIS) Institute
- Working well together
- Patients as partners
- The improvement journey
- What is co-production?
- Don Berwick: Quality improvement in the NHS