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NELFT Quality Improvement Handbook

The NELFT Quality Improvement Services have developed a Quality Improvement Handbook, which offers both an introduction to quality improvement, as well as takes you through a possible quality improvement project flow, providing broad guidance, tools, templates and worksheets that you and your team can either work through step by step, or dip in an out of, using the tools as and when appropriate. These tools have been created by compiling a range of resources, all of which are referenced within the handbook and links to the sources supplied.

This is an interactive document, meaning the worksheets can be filled in on your computer without the need to print. You can also download the worksheets seperately by clicking on the green box in the top right hand corner of each sheet.

Further guidance and an introduction to the handbook can be found in the first few pages, but of course contact us via qi@nelft.nhs.uk if you have any further queries with regards to the handbook or quality improvement as a whole.

Click here to download the NELFT Quality Improvement Handbook

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Support for Leaders

The NELFT Quality Improvement Services are developing a series of guidance specifically for managers and leaders to support them embed quality improvement and clinical audit into their teams and services. 

The first of these are a guide to including quality improvement within leadership team meetings.

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Clinical Audit and NICE

Once you have decided on your topic you should register your audit project using the latest version of the Clinical audit proposal form with the Trust Audit Facilitators. This will need to be agreed with the Audit Supervisor prior to sending the form to the team. Please see the guidance for help in completing your proposal.

Below are a range of support tools, resources and templates to help you through each stage of your clinical audit.

For a general introduction to clinical audit we suggest watching this video: 

Tools for undertaking a Clinical Audit 

Ecass registration:  Clinical Audit Proposal Form - Clinical Audit System NHS NELFT

  • The implementation of our Electronic Clinical Audit Support System has allowed NELFT staff to register their clinical audit proposal forms electronically and enable staff to access completed clinical audit projects undertaken by clinicians across the Trust.

  • Allows on-line registration of clinical audit projects

  • Allows auditors to search for completed audits

  • Enables auditors to see what the current status of their audit is and allows them to monitor their progression

Online data collection tool: SNAP XMP – Surveys

  • SNAP is an innovative survey solution software that will help you produce online, paper and mobile versions of your questionnaire and combine all your results into one data set for analysis.

  • All audits supported by the Clinical Audit and NICE Team will be carried out using the SNAP software package. This is a web-based system on which data collection tools can be designed and staff can submit the data via the web.

  • SNAP will allow you to design an interactive audit tool or survey and provide a unique and personalised experience every time you use it.

Clinical Audit Templates and Guidance:

Additional External Support

 

Quality Improvement Projects

Wider Project Support

The following three sections offer support and reading resources for completing a quality improvement project (e.g. funding, platforms, wider reading). Move to the following section to find support to guide you through each stage of a project in the form of specific tools/templates etc.

Tracking your quality improvement work through the Life QI Platform

Life QI is and online quality improvement project management system that you can use to track your improvement project work, and easily share with colleagues.

The Quality Improvement Services can offer licenses to NELFT staff or those on NELFT courses. Follow this link to register for a license: https://uk.lifeqisystem.com/login/.

Funding through the Innovation Cave

Do you have a project or an innovative idea that requires some funding to get started?

The Innovation Cave could help you!

NELFT recognises the importance of encouraging innovation and improvement across the organisation. The Innovation Cave is a means of financially supporting staff and services in seeking new ways to improve the services they provide and helps to put into practice ideas to benefit patients and deliver care more effectively.

How do you apply?

We are now accepting applications!  Download the application form and please submit your application form to: QI@nelft.nhs.uk. 

Innovation Cave Application form:

Innovation Cave Application Form

What do you need to know?

  • You can apply for any amount from £500 - £10,000. However, please come and speak to us, if you have an idea that exceeds this amount - we may be able to help you explore other funding opportunities!
  • The focus of the Innovation Cave is on innovation and improvement, as opposed to service gaps.
  • Interviews are held for those projects that meet the requirements and this date will be advised in advance to enable you to hold it in your diary.

What support do you have?

  • You are also welcome to come to attend our QI drop-in clinics if you have any questions or would like some guidance with your application:

What happens next?

  • There is a limited budget available, therefore bids will be assessed, and funds awarded to those which appear to offer the greatest benefits to patients or staff.
  • If your application is shortlisted, you will be invited to an interview to discuss your project. If successful, you will be required to attend a NELFT QI Foundation Day if you have not already attended.
  • If you are successful, you will be required to submit monthly reports of project progress and to share the results of the project at future internal and external Quality Improvement events. All funds must be used by 31 March of each financial year that the money is awarded, although the project does not have to be completed within this time.

Innovation Cave Flyer

Check out our Innovation Cave Flyer: Innovation Cave

Innovation Cave Projects

  1. Conners project case study review
  2. Waltham Forest Memory Service Audiology Project for QI microsite

QI Recommended Reading and Resources

Resources

QI monthly Evidence Update

QI tools and guides:

Articles (click through):

Videos – overview of QI

Videos - measurement

NELFT Bitesize Video Modules:

Books (for purchase/loan from your NHS library):

  • The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, by Gerald J. Langley, Ronald D. Moen, and Kevin M. Nolan.
  • The Health Care Data Guide: Learning from Data for Improvement, by Lloyd P. Provost and Sandra Murray.

 

Online training

Free NHS QI training:

NELFT Training:

 

QI sites and networks

QI networks:

Sharing your learning
Squire guidelines for writing articles

Awards and funding you can apply for:

Resources to guide you through each stage of your project

The following eight sections different elements of quality improvement projects. Although we encourage you to dip in and out of this, using the tools you require at the time, if you wish to complete an entire quality improvement project this flow is a suggested way to work through the project. Click on the sections you wish to access.

1. Creating the Conditions for Improvement

This is the first stage of a quality improvement project. This stage is vital to ensuring that the issue is correctly identified, the project has support from all though affected by the project, the correct stakeholders are involved in the process, and there is a clear roadmap for the project.

The below formula will help you and your team ensure that the correct conditions are in place to ensure your improvement project has the best chance of success.

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2. Understanding the System

Before you can change a system or a process within a system, you need to understand the current workings of the system. This will help ensure that you are addressing the best part of the system to make improvements to, to better improve the outcomes of the system as a whole.

A system is “an interdependent group of items, people, or processes working together toward a common purpose” (Healthcare Improvement Scotland).
 Systems can be:

  • Simple:
    • This is a system that as a single pathway or process which results in a single answer. It is easily replicated.
  • Complicated:
    • This is a system with multiple pathways or processes which result in a single answer. Replication is more complicated as you have the choices to make along the pathway.
  • Complex:
    • This is a system with multiple pathways or processes which can result in multiple answers. Replication is complex as there are multiple choices and no single outcome. The more complex the system you are trying to improve the more complex the quality improvement project will be.

 

NELFT Templates and Worksheets:

 

NELFT Video Tutorials:

  • QI Bitesize module: Understanding Your Systems (click here)
    • Learn about how the systems you work within will influence and help determine the direction of your quality improvement work in this video tutorial.

  • QI Bitesize module: Introduction to Stakeholder Engagement (click here)

    • Involving stakeholders is an extremely important element of any improvement work. Use this video tutorial to learn more about identifying who your stakeholders are and how to work with them.

  • QI Bitesize module: Measurement, data and variation (click here)

    • Understand the importance of accurate measurement in your quality improvement work, and how to use this to inform your improvement work in this video tutorial.

  • QI Bitesize module: Understanding SPC Charts (click here)

    • Learn how to interpret and use Statistical Process Control (SPC) Charts and how they are involved in quality improvement projects in this video tutorial.

3. Identifying the Problem

Once you have understood the system you are working in, it is time to identify which problem you can address. This is an important stage to take time over and fully
understanding what is happening and why it might be happening is the first step of moving towards improvement.

A large part of understanding what is happening is through using data. Working with data is an essential part of any quality improvement project from the start to the end of the project.

Data and measuring data helps identify a problem and the current situation. Measurement of this data then helps to set the project aim making it measurable, and hopefully specific and attainable. Data then helps you monitor how an changes made are impacting the project aim, and then finally whether the improvement target set in the project aim was reached.

There are two different types of data that can be collected to help you identify the problem, and therefore this will impact the way in which you analyse and present your data.

  • Qualitative Data

    • Qualitative data comes in the form of words. This is often gathered through interviews, questionnaires, feedback etc.

  • Quantitative Data:

    • Quantitative data comes in the form of numbers. This is often gathered through surveys, observational tools, document review, and sampling.

 

NELFT Templates and Worksheets:

 

4. Developing the Aim and Change Theory

Once you have understood the system you are looking to improve in, it is time to develop a clear project aim and theory of change. This helps the improvement team clearly define what they are looking to improve and how they aim to do this.

 

NELFT Templates and Worksheets:

 

NELFT Video Tutorials:

  • QI Bitesize module: Setting the aim (click here)

    • Learn more about the vital step of setting your aim in your quality improvement project in this video tutorial.

  • QI Bitesize module: Driver Diagrams (click here)

    • In this video tutorial you will learn all about driver diagrams, from how to create them to how they help you determine your measures and change ideas.

5. Defining Measures

The family of measures helps you define exactly what you will be examining with regards to the impact of your improvement project. It is important not just to examine the outcome you are looking for, but the processes that contribute towards this, as well as ways in which the improvement methodology might have an impact (positive or negative) on other areas of working that do not seem directly related to the improvement work.

 

NELFT Templates and Worksheets:

 

6. Testing Change

Testing change is an essential step of any quality improvement project. Change won’t always result in an improvement, therefore testing the change, adopting, adapting, or modifying where necessary will ensure that any change implemented really does result in an improvement.

All changes made need to come from a thorough understanding of the system you are working in, as well as a clear theory around how changes will result in improvement. Therefore, we would recommend working through the sections of understanding the systems and project aim and change theory before moving onto this section.
 

NELFT Templates and Worksheets:

 

NELFT Video Tutorials:

  • QI Bitesize module: PDSA Cycle (click here)

    • The Plan Do Study Act cycle is key to quality improvement project, and this video tutorial will teach you all about them and how they are used for testing change ideas.

7.  Implementing Change

Testing change is just one element of using change ideas to improve quality. Once you have tested the change you will want to implement the change, ensuring that it is sustainable and, in some cases scaling the change up to a bigger scale.

Without culture and therefore commitment to the change, the change will not be properly implemented and therefore the outcome of improvement will not be possible.

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NELFT Templates and Worksheets:

8. Spreading and Sharing Work

Spreading and sharing improvement work not only allows your team and the trust to celebrate the success’ of the work, but also means that other teams can benefit from the
improvement work. It is important when carrying out improvement work not to reinvent the wheel, therefore sharing your improvement work could help another team by learning from the changes made and the quality improvement outcomes.

Be sure to track the lessons you have learnt as you move through your improvement work. These may be in relation to the process, the tools used, the outcomes, etc. All information stored around lessons learnt will help you and others in future improvement work.

Learn more about this here:

  • https://www.england.nhs.uk/wp-content/uploads/2022/01/qsir-lessons-learnt.pdf

 

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NELFT Templates and Worksheets:

 

NELFT Video Tutorials:

  • QI Bitesize module: Scale up and spread (click here)

    • Use this video tutorial to learn about how to sustain positive change obtained from a quality improvement project, and how this can be spread across teams, the Trust, and the wider NHS.

  • QI Bitesize module: Sharing your improvement work (click here)

    • Learn about how you can share your improvement work, both internally within the Trust, and externally through publications and blogs etc.