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Our quality improvement could be much improved

Hello, my name is David McNally. I’m Head of Experience of Care with NHS England. Our Team’s role is to support the NHS to improve people’s experience of care and we believe that should be done as an integral part of any quality improvement or clinical transformation work and should be undertaken through coproduction with patients, users, carers and staff. 

In the course of our work we engage with a lot of NHS provider Trusts and what follows amalgamates some of the things we hear and highlights some of Trust’s common challenges. Does this sound familiar? Do get in touch if you’d like to share your experience davidmcnally@nhs.net

An imaginary conversation that could have taken place on a visit to an NHS Trust near you

Thank you very much for arranging my visit to the Trust today.

We’re really pleased you could come. We are proud of our work and are always willing to share what do and how we do it. So, what would you like to know?

I’m interested in hearing about how your Trust approaches quality improvement, improving patient experience and also how you go about involving patients and carers.

We are doing lots in each of those areas. We have a corporate Trust-wide approach to quality improvement, led by our Director of Quality. We have a patient experience lead, at Band 7, in our Nursing Directorate who looks after FFT and our feedback surveys and reports to the Deputy Director. And we have a PPI group and patient reps on most of our committees. 

Does your approach to quality improvement include a focus on improving experience as an integral part of each improvement project?

As I said, quality improvement and patient experience are in different Directorates, so we mostly deal with them separately. We mainly focus on clinical outcomes and patient safety, and only usually have a patient focus in response to high-profile complaints or issues raised by Healthwatch or CQC.

Are improvements made in response to suggestions from front-line care staff and are they involved in co-designing improvements?

We did try to get staff to suggest improvements but the things they came up with didn’t address our performance challenges, so the Exec Team decides on what improvements are needed and the Quality Team leads implementation on the ground. 

Are patients and carers involved in co-producing quality improvement projects from start to finish so there is a consistent focus on what matter most to the people who use the service?

We don’t have the resources to involve patients in all our improvement work but in most quality improvement projects we will arrange a focus group with a small group of patients to get their views on what we’re planning to do and we report outcomes to our PPI group. I think coproduction with patients sounds like a great idea but I think it’s hard to do. Staff just aren’t used to working in that way – I don’t know where we would start.

What are the Trust’s main challenges?

As a Board we are really proud that we are meeting our performance targets and our finances are really healthy. Our real challenges are that despite all our efforts both our In-patient Survey and Staff Survey results aren’t very good and haven’t improved at all over the last few years. We have struggled to understand why that is the case or to know what we can do to improve things. Have you got any ideas about what we could do?

To find out more information about our upcoming quality improvement in healthcare conference click here.

Thank you to David McNally for providing us with this insightful content ahead of speaking at the Quality Improvement in Healthcare Conference.

Follow the conversation on 23rd January with #QIHealthcareConf

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