AQuA 2017/18 Leadership for Improvement Fellows Announced

The Advancing Quality Alliance (AQuA) is pleased to announce its 2017/18 cohort of our prestigious Leadership for Improvement Fellows programme.

(L-R) Caroline Greenhalgh, Elaine Whittaker, Caroline Poole, Deborah Lyon, Paula Simpson and Helen Lee

Now in its third year, the programme offers senior improvement leaders from across AQuA membership the exciting chance to develop their role around quality improvement, gain an international perspective on improvement with access to global experts, and receive support to put their learning into practice.

AQuA Chief Executive, David Fillingham, said:

“Our Leadership for Improvement Fellows programme is a fantastic opportunity for members to further their ambitions as leaders for improvement.

“The programme offers them the chance to learn from and meet some of the leading experts from around the world, and use this learning to develop and improve health and care across their own role and organisation.

“We’re delighted to welcome our new 2017/18 Fellows, and I’m pleased to see such a variety of roles and backgrounds. Last year’s Fellows found the programme hugely beneficial in supporting them to improve care, and I look forward to working with our new cohort as the year progresses.”

Fellows will tailor their studies to help them to meet a specific improvement aim or project within their organisation.

Our 2017/18 Fellows and their projects are:

• Caroline Greenhalgh, Head of Quality Improvement, Wrightington, Wigan and Leigh NHS Foundation Trust
  Increasing capability to deliver continuous quality improvement by expanding the Trust’s quality champions programme
  Follow her on Twitter @cargreenhalgh
• Caroline Poole, Clinical Improvement Lead, Pennine Care NHS Foundation Trust
  Delivering person centred care and the enablers / barriers for system-wide adoption
  Follow her on Twitter @caroline123_NHS
• Deborah Lyon, Head of Service Transformation - Community and Social Care, The Pennine Acute Hospitals NHS Trust
  Exploring support for system transformation and capability building for sustainable, system-wide improvement
  Follow her on Twitter @DeborahLyon14
• Elaine Whittaker, Senior Service Reform Manager, NHS Stockport Clinical Commissioning Group
  Improving commissioning in social care and nursing homes
  Follow her on Twitter @WhittakerElaine
• Helen Lee, Head of Quality Improvement and Experience, Lancashire Care NHS Foundation Trust
  Understanding the key components for building improvement and co-design capabilities and empowering people to create a culture of continuous improvement
  Follow her on Twitter @helenlee321_lee
• Paula Simpson, Deputy Director of Nursing, Wirral Community NHS Foundation Trust
  Creating an environment to facilitate system level change - supporting development of Wirral's Accountable Care System (ACS)
  Follow her on Twitter @nhs_paula

We’ll have more news and updates from our new Fellows throughout 2017/18 as they start the programme and explore their individual projects in more detail.

To find out more about the programme please visit our website, or contact Robert.Stoker@srft.nhs.uk.

Blog - Thinking Safety at the Quality Forum

Andrea McGuinness is AQuA’s Programme Lead for Safety & Mortality. Here she shares her some of her early points from April’s International Forum on Quality & Safety in Healthcare Conference.

Andrea McGuinness

Even as I write this just half a day through the conference, I am already overwhelmed with the sheer volume and brilliance of health and care staff from across the globe.

The passion and ingenuity of people and most importantly, the pride with which they continue driving safety and quality, humbles me.

Here I just wanted to share with you a few key themes picked up from the conference so far…

Doing care with, not to

We need to make it the norm to have patients and families leading safety improvement. After all, who has most to lose when care goes wrong?  We have endless possibilities available to us once we get over doing to, and move to doing with patients and families.

Quality improvement and safety culture

The second theme making a massive impact on me is the power of quality improvement to provide safer cultures within all teams and across all aspects of health and social care. 

Speakers here are sharing how QI with leadership support releases staff to make services safer. It creates purpose and meaning for staff who are often frustrated and caught in a spiral of dissatisfaction about the services in which they work.

We have to choose to make a positive experience

My final theme is around the value and passion, commitment and concern that our staff have for the services they work in. What role do we have in creating positive environments for all those who experience health and care? Those who use and those who work within them?

Leadership, influence, permission and values are something every single one of us can affect. We all have the choice to do this. We can choose to make a positive difference   No one chooses to make a negative impact but do we sometimes choose not to bother?

What we see and hear from AQuA members, and from the international safety community, is that when we learn and share together we make it easier to make a positive difference, and we’ll be sharing more of our learning from the conference in the coming weeks.

You can find more about our work to improve safety on our website. Please do drop us a line if you’d like to discuss this, or anything in this blog further, at either @1McGuinness on Twitter, or via andrea.mcguinness@srft.nhs.uk.

The REsTRAIN YOURSELF programme has been shortlisted for a prestigious national Patient Safety award

The University of Central Lancashire (UCLan) in partnership with the Advancing Quality Alliance (AQuA), have been shortlisted for a prestigious national Patient Safety award following their programme to reduce restraint in acute mental health, known as ReSTRAIN YOURSELF.

Paul Greenwood, AQuA Improvement Advisor

The Patient Safety Awards, which are now in their 9^th year, continue to recognise and reward outstanding practice within the NHS and independent healthcare organisations. UCLan and AQuA have been nominated in the Mental Health category. The REsTRAIN YOURSELF programme, which was funded by a grant from the Health Foundation, enabled UCLan as the lead partner and AQuA to work closely with mental health wards across the region to test and adapt an evidence based model called the 6 core strategies in the UK with a strong focus on trauma informed care. The evaluation work of this programme was undertaken by UCLan and together they have recently published a toolkit to support other organisations to reduce the use of restraint.

Paul Greenwood, Improvement Advisor at AQuA and lead for the REsTRAIN YOURSELF programmes said:

“I’m delighted that this work has been recognised by the Patient Safety awards. The partnership between AQuA and UCLan has started to build a really strong evidence base through the hard work of staff across the Trust’s in the region in reducing restraint in challenging environments. We hope that the toolkit we have recently developed will enable the learning to be spread across the UK and beyond.

“It’s an honour to be recognised alongside some other fantastic work in Mental Health and I’m looking forward to finding out the winner!”

Following their shortlist, the team will be travelling to London to present to the judges with the winners announced as part of the annual Patient Safety Congress which is being held in Manchester on the 4^th and 5^th July. 

We'd also like to congratulate the following members who also reached the awards shortlist:

• Blackpool Teaching Hospitals NHS Foundation Trust 
• Cheshire and Wirral Partnership NHS Foundation Trust 
• East Lancashire Hospitals NHS Trust 
• Lancashire Care NHS Foundation Trust 
• Lancashire Teaching Hospitals NHS Foundation Trust 
• Liverpool Community Health NHS Trust 
• Liverpool Heart and Chest NHS Foundation Trust 
• Mersey Care NHS Foundation Trust 
• NHS East Lancashire CCG 
• Salford Royal NHS Foundation Trust 
• St Helens and Knowsley Teaching Hospitals NHS Trust 
• Stockport NHS Foundation Trust 
• The Christie Hospital NHS Foundation Trust 
• University Hospitals of Morecambe Bay NHS Foundation Trust 
• Warrington and Halton NHS Foundation Trust 
• Wrightington, Wigan and Leigh NHS Foundation Trust

Useful Links:

Blog by Paul Greenwood on the work of the programme

RestraintReduction Toolkit

Advanced Improvement Practitioner - Applications Now Open

We are now welcoming applications from members to take part in the next round of our Advanced Improvement Practitioner (AIP) programme.

Running from November to May 2017, this in-depth course is designed to support senior staff to develop their skills and capabilities to lead and facilitate improvements across their organisations, and health and care systems.

The programme is ideal for members who are leading services or tasked with service transformation, including roles in quality, assurance, improvement, or even organisational development.

Participants will take part in modules on:

• Quality improvement theory and practice -  including key policy contexts, models and methodologies for improvement, systems thinking and organisational strategies, person-centred transformation, and developing theories for large-scale change
• Approaches and execution of change and engagement - models and principles for successful change, testing and implementation, improvement culture, how to build engagement, and managing and engaging people, communities and stakeholders
• The role of an improvement leader - covering the key habits of improvers, how to create conditions for learning and improvement, resilience, and system leadership

Full information about the programme is available in our information pack. 

To apply, please complete our application form and return to lucy.davies@srft.nhs.uk by 12pm on Wednesday 12 October.

Applicants must have the support of an Executive Sponsor or their line manager in order to apply.

If you would like a further discussion about the programme, please contact liz.twelves@srft.nhs.uk.

Blog: Outlearning the Competition: The Building Blocks for Improvement - Dr Peter Chamberlain

What do highly performing organisations have in common? From Team Sky to Salford Royal, growing evidence suggests that it’s organisations’ ability to run a slick and effective ‘learning system’, providing the mechanism to sustain continual improvement. As put by Professor Steve Spear of MIT, “today’s leading organisations outrace their competition by outlearning them.”

Dr Peter Chamberlain, GP &
Commissioner at NHS South
Sefton CCG

But before we rush to think that having a super learning system guarantees success, the system itself is only one of three factors needed to maximize improvement. Also needed is the right cultural and infrastructure ingredients, such as compassionate leadership and the integration of clinical work with informatics. Organisations then need to base these essentials on the right principles, most notably in healthcare that their work is firmly person-centred.

​How organisations develop across all three areas is what’s fascinated me across my career. It’s what I’ve learnt from my time as a GP and clinical commissioner on Merseyside, as well as my time studying 15 high performing organisations as part of a fellowship at the Institute for Healthcare Improvement in Boston, Massachusetts.

What I've seen time and again is how hard it can be for organisations not at the leading edge to translate what can be quite abstract concepts into reality. What specific, pragmatic initiatives can and should an organisation be doing to bring these ideas to life?

To try and help, I devised the Quality Improvement Building Blocks Framework, shown below. The aim being simply to support organisations to think through how they need to develop in order to improve. Underpinning the 3 layers and 12 building blocks are 60 specific pragmatic development areas (not shown) which organisations can focus on.

The framework draws on interviews and iterative presentations to quality experts around the globe, as well as a range of other frameworks and training programmes in quality improvement. It’s now been tested with a range of organisations in the North West, working with the Advancing Quality Alliance (AQuA).

It’s not a silver bullet: it focusses on organisational development to facilitate continuous quality improvement and can’t negate the need for adequate funding, staffing, clinical training and due diligence procedures.

However, it’s striking how often struggling organisations will not have the middle layer of the framework (cultural and infrastructure essentials) in place. In such circumstances, regardless of best intentions, quality assurance processes (such as performance management and regulation) simply don’t achieve the intended results. As a consequence, commissioners, provider leads and staff at the point of care get increasingly frustrated and desperate.

​It’s in situations like that where the framework can be helpful to steer an organisation’s development. Through trial and error, we’ve found three different ways for organisations to use the framework, ranging from the (relatively) quick, to the long-term:

1. ‘Dialogic’ / jigsaw – framing the conversation in helping everyone understand what key concepts exist and how they fit together.
2. ‘Directive’ / explanatory guidance document – unpacking core concepts of each building block with evidence and examples of application to deepen awareness of those in responsibility eager to progress.
3. ‘Diagnostic’/ full framework – pragmatic longitudinal organisational development tool to complement coaching and a quality strategy in contributing to achieving high performing status. 

In true quality improvement fashion, the framework is still undergoing testing and support information is building. Our learning is that a number of prerequisites are required for the framework to gain full impact. These include valuing of quality improvement methodology, executive support, senior leadership capacity to address development areas, and the mechanisms throughout with the organisation to facilitate readiness for change.

Many of the concepts in the framework will be new to NHS clinicians and managers for whom such aspects never made it to part of their core training. As a result we have found quality expertise and coaching helpful and in some cases essential to guide those new to the respective concepts. However, the framework also takes organisations from where they are at and can flexibly work and walk alongside the improvement journey.

We believe the framework is fit for real world organisations that experience real world pressure and hope that with further collaboration alongside regional and national bodies that it will be scalable for use across the NHS.

Interested in knowing more? Get in touch with either myself - I'm on twitter at @drpjchamberlain, or my colleague at AQuA Liz Twelves on liz.twelves@srft.nhs.uk or @Lizzie12s.

Please feel free to send us your comments. We'd love to know if this rings true for your organisations' experience. We need to learn as much as anyone else!

This blog was originally published by the UK Improvement Alliance (UKIA). To find out more about their work please visit their website, or follow them on Twitter @theUKIA.

The King's Fund Improving Quality Publication

On 23 February, The King’s Fund published a paper called ‘Improving Quality in the English NHS’ in which it called for an overarching quality improvement strategy for the whole of England.

In the report, The King's Fund highlighted AQuA's work as a regional quality improvement organisation and how we support NHS organisations through shared learning, as well how AQuA's work might support the development of a national strategy (pages 19 and 21).

Chris Ham, Chief Executive of The Kings Fund, also published a blog, again identifying AQuA's existing support on improvement collaboratives, and also referenced the newly established UK Improvement Alliance (UKIA), of which AQuA is one of the founding members. 




We are delighted to receive this national recognition from The King's Fund and will continue to develop our work in Quality Improvement on both a regional and national level.

Response to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Report for Sepsis

The Advancing Quality Alliance (AQuA), a quality improvement body based in the North West of England, welcomes the findings of the recent NCEPOD report, ‘Just Say Sepsis!’

Sepsis is a severe and life threatening illness caused by the body’s exaggerated response to an infection. It is a significant cause of death and long-term health problems.  In the North West sepsis is responsible for around 13,500 hospital admissions and 3,500 deaths every year. Early recognition and prompt management can improve survival and reduce the risk of long term complications. 

The Advancing Quality (AQ) Team, based within AQuA began working with 14 Acute Trusts across the North West in September 2014 to help to improve care for patients with sepsis. To support this, a measure set was developed with 9 measures that cover the key steps in management of patients with sepsis. The measure set has 5 main aims:

1. Ensuring patients with infection have an early triage and assessment for sepsis.
2. If sepsis is present, a series of investigations and treatments are carried out.
3. If sepsis is present, the severity is graded.
4. If there are signs of severe sepsis, a senior doctor should assess the patient.
5. Ensuring ongoing monitoring of patients with sepsis.

Dr Emmanuel Nsetebu

Dr Emmanuel Nsutebu, AQ Sepsis Clinical co-lead and AQuA Patient Safety Fellow who participated in the NCEPOD review process is pleased with progress in the North West:

“The work being done in the North West is already addressing a number of recommendations which were included in the NCEPOD Report. By working with a number of Trusts across the North West, this allows us to undertake a collaborative approach to ensure that patients, no matter which hospital they visit, receive the same high standard of care for sepsis. Following the publication of the report, the AQ sepsis programme will review the recommendations and I am confident that we are in a strong position to deliver on most of these.

Organisations which are part of the AQ sepsis programme are regularly monitored on their performance in delivering all AQ sepsis measures. The data is shared amongst participating organisations on a monthly basis. Externally audited performance data is also published bi-annually at www.advancingqualitynw.nhs.uk. In addition to improving care, the AQ sepsis programme aims to improve clinical coding of the condition.

Dr Conor McGrath

Dr Conor McGrath, Clinical Co-lead for AQ sepsis and Consultant in critical care medicine explains:

“We are working hard to make sure that clinical coding for sepsis in the North West is improving. The programme aims to raise awareness of the condition and how to accurately reflect this in medical documentation. The programme also works with clinical coders to ensure a consistent approach to coding across participating organisations. Our data has shown that organisations that are part of the AQ sepsis program already have a higher level of coding for sepsis compared to the hospitals that are not participating.”  

The work of the Advancing Quality team continues to drive improvement to patient care in the North West, through strong clinical engagement, implementation of best practice, high quality data and working in collaboration across a number or conditions. More information about the team and the work that they do can be found at www.advancingqualitynw.nhs.uk.

- ENDS -

• For further information or to request an interview please contact, Katie Stephenson, Head of Communications and Marketing at AQuA on katie.stephenson@srft.nhs.uk or 0161 206 8025
• A full copy of the NCEPOD Sepsis report ‘Just Say Sepsis’ can be found at www.ncepod.org.uk/2015sepsis.htm