M24: Engaging staff and building a movement for QI

M24: Engaging staff and building a movement for QI @ELFT_QI qi.elft.nhs.uk qi@elft.nhs.uk Monday, December 5, 2016 Introducing the ELFT team Marie Navina Kevin Mason Paul Leigh James Amar 1

Objectives for today s minicourse 1. Developing a framework for creating momentum for improvement at scale 2. Creating ideas and a strategy for engaging people in quality improvement 3. Understanding the key leadership behaviours needed to lead improvement at scale qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI Today s agenda Using complexity and social movement thinking to design your improvement approach Executive leadership for improvement Engaging teams and building an improvement infrastructure Involving patients, service users, carers and families in quality improvement Board leadership of improvement qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI 2

Some key principles to guide how you design your improvement approach with Dr Amar Shah (Associate Medical Director for QI) qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI 3

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Arguably the most important competency for dealing with complexity is systems thinking The three characteristics of systems thinking include: 1.A consistent and strong commitment to learning 2.A willingness to challenge your own mental model 3.Always including multiple perspectives when looking at a phenomenon Senge, 2006 5

A social movement can be defined as a voluntary collective of individuals committed to promoting or resisting change through co-ordinated activity Seven common characteristics of social movements: Energy Mass Passion Commitment Pace and momentum Spread Longevity Bate, Bevan & Robert, 2004) Current prevailing beliefs about change Change starts at the top It takes a crisis to provoke a change Only a strong leader can change a large institution To lead change you need a clear agenda Most people are against change Change management is a disciplined process A movement perspective of change Change builds from bottom-up action Change can be driven by passion to improve Change comes from the collective action of individuals You need to have a clear cause but can be uncertain about how you will achieve it People have an inner desire to make things better Change is opportunistic and spontaneous 6

Five key principles that can help a movement approach 1.Change as a personal mission 2.Frame to connect with hearts and minds 3.Energise and mobilise 4.Organise for impact 5.Keep forward momentum Things to consider Planning versus Prodding, Analysing and Reacting Who should build the movement? Pace & momentum Existing structures versus under the radar qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI 7

Executive leadership of improvement at scale with Dr Kevin Cleary (Chief Medical Officer) Mason Fitzgerald (Executive Director for Corporate affairs) Objectives for this session 1. To provide an understanding of the quality journey that ELFT has been on; 2. To examine the role of all executives in leading quality improvement; and 3. To consider the contribution that executives need to make in order to build an organisation wide QI system and movement 8

Mental health services Newham, Tower Hamlets, City & Hackney Forensic services All above & Waltham Forest, Redbridge, Barking & Dagenham, Havering Child & Adolescent services, including tier 4 inpatient service Regional Mother & Baby unit Community health services Newham IAPT Newham, Richmond and Luton Speech & Language Barnet web email qi.elft.nhs.uk qi@elft.nhs.uk @ELFT_QI 9

The culture we want to nurture A listening and learning organisation Empowering staff to drive improvement Increasing transparency and openness Patients, carers and families at the heart of all we do Re-balancing quality control, assurance and improvement 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. Launch event & roadshows 2. Microsite 3. Using the power of narrative 4. Celebrate successes 5. Network of champions / ambassadors 6. events 1. Initial assessment of alignment & capability 2. Recruiting central QI team 3. Online training 4. Face-to-face training 5. Follow-up coaching on projects 6. Develop in-house training for 2016 onwards 1. Align all projects with improvement aims 2. Align team / service goals with improvement aims 3. Align all corporate and support systems 4. Patient and carer involvement in all improvement work 5. Embed improvement within management structures Reducing Harm by 30% every year 1. Reduce harm from inpatient violence 2. Reduce harm from falls 3. Reduce harm from pressure ulcers 4. Reduce harm from medication errors 5. Reduce harm from restraints Right care, right place, right time 1. Improving patient and carer experience 2. Reliable delivery of evidence-based care 3. Reducing delays and inefficiencies in the system 4. Improving access to care at the right location 10

Support around every team Project Sponsor QI Coach QI Team QI Forums Service User Input QI Resources The role of executives in leading quality improvement 11

Kevin s story Dr Kevin Cleary Chief Medical Officer qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI Mason s story Mason Fitzgerald Executive Director of Corporate Affairs qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI 12

Joys of leading QI Connecting with staff, and seeing them grow and develop Spending time discussing our common purpose Delivering outcomes for patients Helping others, and making a contribution to national policy Challenges Building credibility with staff and managing initiative fatigue Capacity and capability Constancy of purpose and behaviours Managing upwards to commissioners and regulators 13

How to influence and change behaviour at executive level Make quality your business strategy Re-visit your common purpose with the Board, staff, patients and stakeholders Talk about quality before anything else, and with everything else Link quality planning and quality improvement Make quality explicit in all strategies and plans 14

Roles and role modelling All executives to have a formal role (i.e. executive lead, directorate lead, workstream lead, project sponsor) Personal commitment to role Model behaviours with our teams Managing the external world Be an umbrella for your staff shield them from external demands Show others how it can be done Just say no! Influence national policy 15

Executive leadership Table Discussion At your table, have a discussion on what you are currently doing and what you might like to try, in order to engage all executives in quality improvement 1. How can executives support an organisation wide QI system and movement? 2. What are the key drivers and barriers? qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI Engaging staff and building an infrastructure to support QI at scale with Dr Amar Shah (Associate Medical Director for QI) James Innes (Associate Director for QI) 16

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And our QI Rap.. 18

Build the will 1. Newsletters (paper and electronic) 2. Stories from QI projects - at Trust Board, newsletters 3. Annual conference 4. Celebrate successes support submissions for awards 5. Share externally social media, Open mornings, visits, microsite, engage key influencers and stakeholders AIM: To provide the highest quality mental health and community care in England by 2020 Build improvement capability Alignment QI Projects 1. Build and develop central QI team capability 2. Online learning options 3. Pocket QI for those interested in QI 4. Improvement Science in Action waves 5. Develop cohort and pipeline of QI coaches 6. Bespoke learning, including Board sessions & commissioners 1. Embed local directorate structures & processes to support QI 2. Align projects with directorate and Trust-wide priorities 3. Support staff to find time and space for QI work 4. Support deeper service user and carer involvement 5. Support team managers and leaders to champion QI 6. Align research, innovation, improvement and operations Reducing Harm by 30% every year 1. Reduce harm from inpatient violence 2. Reduce harm from pressure ulcers 3. Other harm reduction projects (not priority areas) Right care, right place, right time 1. Improving access to services 2. Improving physical health 3. Other right care projects (not priority areas) Build the will AIM: To provide the highest quality mental health and community care in England by 2020 19

Launch of our QI Programme February 2014 20

1000 staff, service users and partners engaged in 4 months 21

QI Stories at Trust Board Electronic & paper newsletters QI Visibility Wall 22

qi.elft.nhs.uk 23

Visits to see QI at ELFT 24

Influencing national policy and thinking 25

Score (%) Score Score Score 11/29/2016 Staff experience and engagement 90 85 Staff able to contribute towards improvements at work 4.2 4.1 Staff Motivation to Work 80 4 75 3.9 70 3.8 65 3.7 60 3.6 55 2010 2011 2012 2013 2014 2015 3.5 2010 2011 2012 2013 2014 2015 4.1 Staff job satisfaction Overall Engagement Score 4 3.9 3.8 4 3.9 ELFT Score National Median 3.7 3.8 3.6 3.7 3.5 3.4 3.6 3.3 2010 2011 2012 2013 2014 2015 3.5 2010 2011 2012 2013 2014 2015 Building the Will Table Discussion 1. How would you rate the will to undertake a QI programme in your organisation? 2. What are the barriers stopping you from undertaking this work? 3. In light of what you heard today, will you be doing anything differently in order to make a case for change? qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI 26

AIM: To provide the highest quality mental health and community care in England by 2020 Build improvement capability Pocket QI commenced in October 2015. Aim to reach 200 people by Dec 2016. All staff receive intro to QI at induction Estimated number needed to train = 5000 Needs = introduction to quality improvement, identifying problems, change ideas, testing and measuring change 500 people have undertaken the ISIA so far. Wave 5 = Luton/Beds (Sept 2016 Feb 2017) 29 QI coaches graduated in January 2016. Second cohort of 25 to be trained July-November 2016 Currently have 6 improvement advisors, with 4 wte deployed to QI. To increase to 8 IA s in 2016/17 (6 wte). Most Executives will have undertaken the ISIA. Annual Board session with IHI & regular Board development discussions on QI Estimated number needed to train = 1000 Needs = deeper understanding of improvement methodology, measurement and using data, leading teams in QI Estimated number needed to train = 45 Needs = deeper understanding of improvement methodology, understanding variation, coaching teams and individuals Estimated number needed to train = 11 Needs = deep statistical process control, deep improvement methods, effective plans for implementation & spread Needs = setting direction and big goals, executive leadership, oversight of improvement, being a champion, understanding variation to lead Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) Board Bespoke QI learning sessions for service users and carers. Over 50 attended in 2015. Build into recovery college syllabus, along with confidence-building, presentation skills etc. 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 27

QI capability building Flexible, online training resource available to the whole Trust. Essential skills to support in leading QI Certificate which can be added to CPD portfolio. Apps for phone or tablet, or use browser Brand new modular introduction to QI For anyone involved in QI or wanting to learn core QI skills Overview to using QI, PDSAs and testing, Using measurement & data for improvement, QI Tools In-depth training Course length is 6 months. 3days intensive training; 4 WebEx teleconferences; 2 full day learning sets Applying learning to their QI projects in action periods One-stop shop resources Seminal papers, guidelines, whitepapers Videos QI tools Improvement Science in Action - 6 month learning path Prework Workshop 9/29-10/1 (3 days) AP-1 Webex Webex #1 1 10/14 AP-2 Webex 2 set 11/21 AP-3 Webex Webex #2 3 11/30 Project Planning Reliability Sustaining Gains Webex #3 Set AP-4 AP-5 2 & graduation Supports: Faculty consults The two Listserve learning sets will Webex focused calls on sharing the Assignments participants work on their projects Coaching and calls learning from each other. These sessions also will reinforce the content from the Webex calls and the ISIA workshop. 28

Pocket QI- 2 month learning path Workshop 1 Overview to using QI Workshop 2 Using measurement for improvement Workshop 3 PDSAs and testing Workshop 4 QI Tools All 4 workshops are between 2-3 hours in a classroom format and rotate in location throughout the geography of the Trust. 29

QI Coaches 30

Intro to QI - for service users & carers So how are we doing so far? Experts by experience All staff Staff involved in or leading QI projects QI coaches Internal experts (QI team) Board 266 people trained in Pocket QI 692 people have undertaken the ISIA so far 54 QI coaches graduated Currently have 7 improvement advisors Estimated number needed to train = 5000 Estimated number needed to train = 1000 Estimated number needed to train = 45 Estimated number needed to train = 11 5 Executives have undertaken the ISIA course. Estimated number needed to train = 7 Annual Board session with IHI & regular Board development discussions on QI Estimated number needed to train = 15 31

Building Capability Table Discussion 1. What improvement capability exists in your organisation? 2. How could you shuffle existing resources to create some capacity to start improvement work? 3. How would you build a business case and convince your leadership team about the need to invest in building capability and capacity for improvement? qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI AIM: To provide the highest quality mental health and community care in England by 2020 Alignment 32

Support around every team Project Sponsor QI Coach QI Team QI Forums Service User Input QI Resources 33

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All QI information in one place Changing the way we look at data 35

Changing the way we look at data Data at Trust, directorate or team level 36

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SPC Charts showing Special cause variation Notes Linked PDSA s 38

Alignment Table Discussion 1. What would you have to change to produce alignment in your organisation? 2. How do you look at data, and talk about improvement and safety at every level? 3. What can you change, stop or review to create space for improvement? What are the structures in place to support improvement? qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI AIM: To provide the highest quality mental health and community care in England by 2020 QI Projects 39

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Number of active projects 11/29/2016 Make it feel meaningful Make it feel possible Make it feel valued and permanent Provide skills and support Our QI Projects 250 200 150 100 50 0 Month 41

Our QI Projects 225 Active Projects 29 REDUCE HARM BY 30% EVERY YEAR 158 RIGHT CARE, RIGHT PLACE, RIGHT TIME 14 2 18 83 VIOLENCE REDUCTION PRESSURE ULCERS PHYSICAL HEALTH ACCESS TO SERVICES 42

Our QI Projects 47 showing improvement and potential for scale up and spread 43

Our QI Projects Is it making a difference? 44

No. of Incidents Time between events / days 05-Apr-13 07-Apr-13 14-May-13 02-Jun-13 07-Jun-13 14-Jun-13 24-Jun-13 No. of Incidents 10-Jul-13 11-Jul-13 20-Jul-13 22-Jul-13 15-Aug-13 18-Aug-13 06-Sep-13 24-Sep-13 13-Oct-13 18-Oct-13 23-Oct-13 01-Nov-13 05-Nov-13 11-Nov-13 23-Nov-13 26-Dec-13 14-Jan-14 11-Feb-14 06-Mar-14 27-Mar-14 16-Apr-14 22-May-14 04-Jun-14 17-Jun-14 28-Jun-14 12-Jul-14 05-Aug-14 18-Oct-14 16-Dec-14 14-Jan-15 30-Jan-15 03-Feb-15 02-Mar-15 23-Apr-15 05-Jun-15 21-Jul-15 14-Aug-15 11/29/2016 VIOLENCE REDUCTION 21% reduction 550 500 450 400 350 300 250 200 150 Physical violence to patients (per 100,000 occupied bed days) 2013 2014 2015 900 800 700 600 500 400 300 Physical violence to staff (per 100,000 occupied bed days) 2013 2014 2015 Initial prototype unit - violence reduction across the acute adult mental health ward with highest levels of violence Time between incidents of physical violence on an inpatient adult mental health ward (Globe ward) T chart 50% Testing in different conditions - Violence reduction across the three older adult mental health wards with highest levels of violence 60 50 Time between incidents of physical violence on three older adult mental health wards T chart 63% 8 days 40 30 20 3 days 10 0 45

Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs) Orchestrated Testing City and Hackney Conolly Ward Ruth Seifert Ward Brett Ward Provisional agreement by Borough QI Sponsors and DMT to scale-up from February 2016 Mother and Baby Unit Joshua Ward Tower Hamlets Brick Lane Ward Bevan PICU Gardner Ward Newham Roman Ward Mill harbour Clerke nwell (For) Topaz Ward Shore ditch (For) Crystal PICU Opal Ward Globe Ward Rosebank Ruby Triage Emerald Ward Globe Ward Lea Ward Jade Ward Sapphire Ward Violence reduction on acute wards and Psychiatric Intensive Care Units (PICUs) Orchestrated Testing City and Hackney Conolly Ward Ruth Seifert Ward Brett Ward Provisional agreement by Borough QI Sponsors and DMT to scale-up from February 2016 Mother and Baby Unit Joshua Ward Tower Hamlets Brick Lane Ward Bevan PICU Gardner Ward Newham Roman Ward Mill harbour Clerke nwell (For) Topaz Ward Shore ditch (For) Crystal PICU Opal Ward Globe Ward Rosebank Ruby Triage Emerald Ward Globe Ward Lea Ward Jade Ward Sapphire Ward 46

DIRECTORATE LEVEL (TOWER HAMLETS) No. of Incidents per 1000 OBD 06-Jan-14 20-Jan-14 03-Feb-14 17-Feb-14 03-Mar-14 17-Mar-14 31-Mar-14 14-Apr-14 28-Apr-14 12-May-14 26-May-14 09-Jun-14 23-Jun-14 07-Jul-14 21-Jul-14 04-Aug-14 Pre-work / engagement 18-Aug-14 01-Sep-14 15-Sep-14 29-Sep-14 13-Oct-14 27-Oct-14 10-Nov-14 24-Nov-14 08-Dec-14 Testing begins 22-Dec-14 05-Jan-15 19-Jan-15 02-Feb-15 16-Feb-15 02-Mar-15 16-Mar-15 30-Mar-15 13-Apr-15 27-Apr-15 11-May-15 25-May-15 08-Jun-15 22-Jun-15 06-Jul-15 20-Jul-15 03-Aug-15 17-Aug-15 31-Aug-15 14-Sep-15 28-Sep-15 12-Oct-15 26-Oct-15 09-Nov-15 23-Nov-15 07-Dec-15 21-Dec-15 04-Jan-16 18-Jan-16 01-Feb-16 15-Feb-16 29-Feb-16 14-Mar-16 28-Mar-16 11-Apr-16 25-Apr-16 09-May-16 23-May-16 06-Jun-16 20-Jun-16 11/29/2016 Tower Hamlets Violence Reduction Collaborative Tower Hamlets Violence Collaborative - Baseline data - Days between todays date and the last date of incident Monthly Report July 2016 30 Key Trust-wide data Tower Hamlets data Combined wards data Individual ward data No. of Incidents resulting in physical violence per 1000 occupied bed days (OBD) - U Chart 25 UCL 40% 20 15 11.99 10 5 7.17 LCL 0 BASELINE DATA (BEFORE) PDSA DATA (AFTER) Set 1 Set 2 Set 4 Set 3 13/08 Set 5: Safety Huddle outcomes + Safewards 05/10 Set 6: Time of Day & General Adult wards go smoke free 10/11 Set 7: Prediction + Safety Huddle Observation 12/01 24/03 Set 8: Prediction Shift PDSAs + Scale-up pattern prep changes 24/02 17/04 Set 9: Effective Gender Safety Huddle specific PDSAs wards 26/04 Set 10: Reflecting on why and PDSAs 24/06 Set 11 47

Pre-work / engagement Testing begins DIRECTORATE LEVEL (TOWER HAMLETS) 06-Jan-14 20-Jan-14 03-Feb-14 17-Feb-14 03-Mar-14 17-Mar-14 31-Mar-14 14-Apr-14 28-Apr-14 12-May-14 26-May-14 09-Jun-14 23-Jun-14 07-Jul-14 21-Jul-14 04-Aug-14 18-Aug-14 01-Sep-14 15-Sep-14 29-Sep-14 13-Oct-14 27-Oct-14 10-Nov-14 24-Nov-14 08-Dec-14 22-Dec-14 05-Jan-15 19-Jan-15 02-Feb-15 16-Feb-15 02-Mar-15 16-Mar-15 30-Mar-15 13-Apr-15 27-Apr-15 11-May-15 25-May-15 08-Jun-15 22-Jun-15 06-Jul-15 20-Jul-15 03-Aug-15 17-Aug-15 31-Aug-15 14-Sep-15 28-Sep-15 12-Oct-15 26-Oct-15 09-Nov-15 23-Nov-15 07-Dec-15 21-Dec-15 04-Jan-16 18-Jan-16 01-Feb-16 15-Feb-16 29-Feb-16 14-Mar-16 28-Mar-16 11-Apr-16 25-Apr-16 09-May-16 23-May-16 06-Jun-16 20-Jun-16 No. of Incidents per 1000 OBD No. of Incidents per 1000 OBD 11/29/2016 16 14 UCL Incidents resulting in physical violence (Acute wards only) per 1000 occupied bed days (OBD) - U Chart 12 10 57% 8 6 4 2 5.78 2.47 0 90 80 70 60 50 UCL Incidents resulting in physical violence (PICU wards only) per 1000 occupied bed days (OBD) - U Chart 51% 40 30 20 10 0 34.98 17.05 BASELINE DATA (BEFORE) PDSA DATA (AFTER) Set 1 Set 4 05/10 Set 6: Time of Day & General 12/01 Set 8: Prediction PDSAs + Scale-up prep 24/03 Shift pattern changes Set 2 Set 3 13/08 Adult wards go smoke free 10/11 Set 24/02 Set 9: Effective Safety Huddle PDSAs 17/04 Gender specific wards 24/06 Set 11 Set 5: Safety 7: Prediction + Huddle outcomes + Safewards Safety Huddle Observation 26/04 Set 10: Reflecting on why and PDSAs City and Hackney Violence Reduction Collaborative 48

Whole Collaborative Measures from Safety Cross 13-Apr-16 16-Apr-16 19-Apr-16 22-Apr-16 25-Apr-16 28-Apr-16 01-May-16 04-May-16 07-May-16 10-May-16 13-May-16 16-May-16 19-May-16 22-May-16 25-May-16 28-May-16 31-May-16 03-Jun-16 06-Jun-16 09-Jun-16 12-Jun-16 15-Jun-16 18-Jun-16 21-Jun-16 24-Jun-16 27-Jun-16 30-Jun-16 03-Jul-16 06-Jul-16 09-Jul-16 12-Jul-16 15-Jul-16 18-Jul-16 21-Jul-16 24-Jul-16 27-Jul-16 30-Jul-16 02-Aug-16 05-Aug-16 08-Aug-16 11-Aug-16 14-Aug-16 17-Aug-16 20-Aug-16 23-Aug-16 26-Aug-16 29-Aug-16 01-Sep-16 04-Sep-16 07-Sep-16 10-Sep-16 13-Sep-16 16-Sep-16 19-Sep-16 22-Sep-16 25-Sep-16 28-Sep-16 01-Oct-16 04-Oct-16 07-Oct-16 10-Oct-16 11/29/2016 Incidents 40 Control Chart: Number of recorded red incidents (physical violence) every 3 days on Safety Cross - Conolly, Gardner, Joshua, Ruth Seifert & Brett 35 30 25 UCL 53 % 20 16.9 15 10 7.9 5 LCL 0 13/04: Testing started Conolly 13/05: CHVRC* 3 24/06: CHVRC* 4 01/08: CHVRC* 5 30/09: CHVRC* 6 01/04: Testing started on all wards except Conolly 01/04: CHVRC* 2 ^ 05/09 X transferred *CHRVC = Meetings of the City and Hackney Violence Reduction Collaborative Newham Violence Reduction Collaborative 49

AVERAGE WAITING TIME Testing begins Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Average Waiting Time / Days 11/29/2016 PRESSURE ULCERS October 2016 - Baseline data 1 70 65 60 55 50 45 40 35 UCL 60.66 LCL Average waiting time from referral to 1st face to face appt (Collaborative, 10/12 teams) - X-bar Chart 53.17 44.51 16% 51.23 16/02 27/07 03/09 25/11 05/01 2 new teams 3 teams leave join collaborative Set 1 Set 3 Set 4 Set 6 Set 7 collaborative 28/03 01/10 16/02 10/05 Set 2 Set 5 Set 8 Set 9 Average Waiting Time from Referral to 1 st face to face appointment I Chart Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets) 57.46 51.52 39.85 36.45 45.56 31.44 Psychological Therapy Service (City and Hackney, Newham & Tower Hamlets) MHCOP Memory Service (City and Hackney, Newham & Tower Hamlets) 103.87 88.80 53.77 50

REFERRALS Testing begins Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 No. of Referrals DID NOT ATTEND (DNA) Testing begins Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 DNA / % 11/29/2016 October 2016 - Baseline data 3 40% 38% 36% 34% 32% UCL 32.21% % of 1st face to face apptsdnas (Collaborative, 10/12 teams) - P Chart 19% 30% 28% 26% LCL 25.23% 26.30% 24% 22% 20% 16/02 27/07 03/09 25/11 05/01 2 new teams 3 teams leave join collaborative Set 1 Set 3 Set 4 Set 6 Set 7 collaborative 28/03 01/10 16/02 10/05 Set 2 Set 5 Set 8 Set 9 % of first appointment non-attendance I Chart Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets) 29.96% 40.08% 29.61% 22.05% Psychological Therapy Service (City and Hackney, Newham & Tower Hamlets) MHCOP Memory Service (City and Hackney, Newham & Tower Hamlets) 23.86% 28.32% October 2016 - Baseline data 2 1700 No. of referrals received (Collaborative, 10/12 teams) - I Chart 1500 1300 UCL 1,331.17 1100 1,021.71 1,213.13 900 700 LCL 30% 16/02 27/07 03/09 25/11 05/01 2 new teams 3 teams leave join collaborative Set 1 Set 3 Set 4 Set 6 Set 7 collaborative 28/03 01/10 16/02 10/05 Set 2 Set 5 Set 8 Set 9 No. of Referrals Received I Chart Child and Adolescent Mental Health Service (Tower Hamlets) Community Mental Health Teams (City and Hackney & Tower Hamlets) 716.00 126.43 414.21 556.50 646.60 Psychological Therapy Service (City and Hackney, Newham & Tower Hamlets) MHCOP Memory Service (City and Hackney, Newham & Tower Hamlets) 145.82 211.86 51

41% reduction 80% reduction 103 41% reduction 19% reduction 80% reduction 104 52

Number of days 07.08.14 13.08.14 18.08.14 28.08.14 16.09.14 17.09.14 30.09.14 06.10.14 13.10.14 20.10.14 27.10.14 13.11.14 17.11.14 18.11.14 03.12.14 04.12.14 04.12.14 15.12.14 17.12.14 05.01.15 12.01.15 26.01.15 24.02.15 27.02.15 16.03.15 24.03.15 21.04.15 23.04.15 24.04.15 11.05.15 28.05.15 05.06.15 10.06.15 17.06.15 29.06.15 06.07.15 20.07.15 28.07.15 01.08.15 21.08.15 25.08.15 11/29/2016 Medication safety across all 6 older adult mental health wards 95% Improving clozapine results handling in City & Hackney Improving clozapine results handling in City & Hackney Number of days taken from request for Serum level to receipt of results 50 Transitional Phase starts 45 UCL 40 35 30 New clinic established 54% 25 20 15 10 5 0 LCL 53

DAYS 05 Jan 15 20 Jan 15 13 Feb 15 03 Mar 15 17 Mar 15 30 Mar 15 21 Apr 15 11 May 15 19 May 15 04 Jun 15 16 Jun 15 25 Jun 15 15 Jul 15 04 Aug 15 18 Aug 15 25 Aug 15 10 Sep 15 18 Sep 15 02 Oct 15 09 Oct 15 23 Oct 15 08 Nov 15 11/29/2016 Reducing waiting times for products from NHS supplies for patients in the community 250 Length of time from referral to delivery of products (Whole Pathway) 200 61% 150 Shift 100 UCL 50 46.5 34.1 18.4 0 LCL Date of referral Reducing time taken to complete disciplinary investigations 33% 54

qi.elft.nhs.uk qi@elft.nhs.uk @ELFT_QI Service User and Carer Quality Improvement with Paul Binfield (Head of People Participation) Leigh Bell (People participation lead) 55

What do you need to think about when involving service users & carers in your QI project? ELFT People Participation Team Paul Binfield Head of People Participation Ann Lacey Volunteer Co- Hannah Mellor Health - Development Coordinator Marica Wainner Executive Assistant David Kreikmeier-Watson - Patient & Carer Experience Manager ordinator Elena Trivelli - Volunteer Coordinator PEOPLE PARTICIPATION LEADS Zaffran Jami City & Hackney John Kauzeni CHN Helena Maine MHCOP Alan Strachan CAMHS Leigh Bell Newham Suzanne Goulding - Tower Hamlets John Southam Luton William Fitzpatrick Central Bedford Kamila Naseova Bedford Sophie Akehurst Forensics 56

Getting team structure right from the start Team leadership Stakeholder involvement (patients, carers, staff)l Team Diversity Successful QI team Subject matter expert Different Types of Involvement Little i Big I Regularly consulted during lifetime of the project Service user forum Surveys Act as a full member of the QI project team Community meetings Focus groups 57

To achieve % service user/carer involvement in QI across ELFT 11/29/2016 Communication (in and out) Advertising Access to information Support structure Service user/carer specific role in project team Change Ideas from strategy meeting 29/10/15 Booklet outlining all information about involvement in QI Clear structure outlining different levels of support and outlining responsibilities Service user/carer involvement in QI forum Service user/carer lead in QI central team and each project team Big I Little I Overview of service user/carer involvement Training Structure/process outlining how service users/carers get involved Payment Service user/carer led or co-led projects Service user/carer feedback Partnership working between Quality team and QI Team Monitoring & reporting Regular Reviews Role descriptions and contracts Incorporate QI into recovery syllabus Buddying up Regular support sessions for service users/carers similar to coaches. Training not focused on methodology more focus communication skills and role plays. Service user/carer bespoke group similar to support QI coaches receive. Induction to team and/or trust induction. A trust wide survey service users/carers can complete about quality of service and/or QI project on that ward/in that team similar to friends and family test. Regular steering group/oversight meeting. Monitoring informatics system that reviews service user/carer involvement at all different stages of the QI project. Dashboards 58

Role description Reward and recognition http://qi.elft.nhs.uk/engaging-service-users-and-carers/ Board leadership for improvement with Dr Navina Evans (Chief Executive) Marie Gabriel (Chair of the Board) qi@elft.nhs.uk https://qi.elft.nhs.uk @ELFT_QI 59

qi.elft.nhs.uk qi@elft.nhs.uk @ELFT_QI 60