Spotlight on... the Quality Improvement team

Quality Improvement provides a consistent, systems thinking approach to solving problems and reduce variation, ultimately improving outcomes for patients and organisations. QI is important to the Trust to help us identify key improvements, to ensure we are making our environment safer for staff and patients. As a Trust we aim to provide excellence in Neuroscience – improving quality utilising the tools and techniques available to us through a QI lens can help us achieve our aims of timely, patient centred, efficient and equitable care.

Who is in the Quality Improvement team and what are your roles?

Rebekah Phillips – Associate Director of Operations -  Operational and transformation background with over 20 years NHS experience; Associate Director leading on Quality Improvement and change.

Sam Holman – Deputy Head of Operations - Over 10 years NHS experience in operational practice and performance and an Advanced QI Practitioner.

Clare Moore – Service Improvement Clinical Lead - Over 25 years NHS experience, Clinical specialist with senior nurse experience and an Advanced QI Practitioner.

Craig Stanton – Sustainability Lead - Healthcare sustainability specialist (SusQI), operational background with over 12 years NHS experience.

Hannah Hewson – Quality Improvement Programme Manager, with a psychology background and over 5 years NHS experience.

Zoe Grierson – Quality Improvement and Sustainability Admin Assistant, operational background with over 3 years NHS experience

What projects are the team working on?

We currently have 3 major priority programmes of work:

Digital Health Records

This programme of work will see the Trust transition from a largely paper-based system to a largely paper-lite system. With over 90k case notes, this programme of work is a challenging and protracted task, however, we are approximately 50% complete and we are aiming to be 100% complete by March 2025, which is a huge a achievement for the teams involved in this work! The transition from paper to digital case notes will give clinicians access to patients records, all in one place, to improve quality of care and clinical decision making. This project will also have positive sustainability impacts on the environment and free up estate within the organisation to be re purposed into a staff break room. The Medical Records team have been restructured to support an in-house scanning facility (which is in the process of being set up and tested) so there will be a whole new way of managing paper clinical documentation in the organisation – we know each team are enthusiastic about achieving this. 

Theatre Optimisation

Due to the scale, this programme of work has been broken down into separate phases, with the ultimate aim to increase theatre utilisation and decrease cancellations. This programme of work began, concentrating on the pre-operative pathway and optimising our digital systems to support patients being fit and ready for surgery. Projects within this programme have been the implementation of a one-stop bloods and swabs pathway, optimisation of the high-risk anaesthetic clinic pathway and patient communication via digital means. Successful outputs have been gained already from this work, with patients being seen quicker in clinics and re-visits to the hospital reduced.  

Electronic consent – a pilot of electronic consent has been started with Spinal Consultants and Spinal patients to enhance the information and time required to provide robust and compliant consent for surgery. This involves patients having the time to read, watch videos and digest information at home, with family and friends, before deciding to consent for surgery. Patients are watching videos 5-6 times on average to make sure they are fully informed of the risks and benefits of surgery, which is enhancing our patient experience, reducing anxieties and improving overall Trusts legal compliance when it comes to surgical consent. This will be rolled out further to Cranial, Neurology and Pain patients later this year.

Outpatient Optimisation

Again, due the scale of this programme, there are a number of projects underway to transform outpatients;

Patient Engagement Portal – patients now have access to their own patient portal to access information about their appointments, outpatient letters, maps, contact details and text reminders about their appointments. Patients can now opt to make changes to their appointments via the portal, which reduces the need for patients to wait in a call centre queue to make clinic appointment amendments. The introduction of this portal has seen a 35% reduction in our missed appointments (Did Not Attends DNA) and over 100 new patients seen in clinics every month, which were previously unattended by patients.

Patient Access Centre (PAC) optimisation – a full restructure of the corporate teams (PAC, Medical Records and PAS) has taken place to ensure that the teams have the correct structures and team support to meet the demand of referrals and appointment bookings required. This has been a huge change for the teams who have approached this positively. It has been challenging and still isn’t where we need to be due to recruitment of new posts, however improvements are already being seen and the team have been tremendous in the making of this!

Digital Dictation of clinic letters – Introducing technology to enhance clinical correspondence will result in improved and controlled turnaround times for letters, significantly reduce and potentially eliminate typing backlogs, streamline working practices, improve information governance and support the Trusts paper-lite project. These identified deliverables will allow the Trust to achieve an efficient and sustainable process, enhancing patient and user experience.

Referral Management – it has been recognised by the organisation that efficiencies can be made in how referrals (externally and internally) to the Trust are managed and triaged. A project is underway to address the referral pathways and digital solutions that are currently used to make referral pathways more efficient, safer and robust. Demonstrations are currently taking place with clinical and operational colleagues by an external provider of digital software to support us in doing this. 

Who and what is at the heart of Quality Improvement team?

The team have built a team vision, strongly aligned to the overall Trust vision and aims:

• To build a robust environment conducive to continuous improvement
• Never stop looking for ways in which to improve
• Keep the patient at the heart of every improvement programme

What has been your favourite project you have worked on?

The bed re purposing programme - although this was one of the largest and most difficult projects we have been involved in, the benefits to the multiple cohorts of patients made it so worthwhile. As it was so multi-faceted it gave us the opportunity to work collaboratively with so many different stakeholders both internally and externally, building professional relationships and allowing us to have a better understanding of the importance of each persons role in quality improvement.

What should we expect to see from the team in the next year?

The team will never stop looking for ways in which to improve – whether that be more efficient pathways, better patient experiences or patient safety improvements! There will be some strong outputs from the Outpatient Transformation work that will have benefits realised and showcased, along with a largely digital patient record (and no green case notes).  Patient Portal will be advanced further with the ability for patients to make direct changes to their appointments themselves and the ability to have clinic letters available on the Patient Portal. Voice recognition technology will be embedded and will be starting to be used on ward rounds and within EP2; clinical teams will be supported for the improvements including patient safety incidents and medicines management. We are sure there will be many more exciting things to come for our team!