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CQI training supports improved CQC rating at NHS Trust
Lincolnshire Partnership NHS Foundation Trust (LPFT) provides mental health, social care and specialist community services across Lincolnshire and is committed to promoting recovery and quality of life through effective and innovative care.
The Trust introduced a new Quality Strategy in 2017 which aligned with national NHS priorities for continuous quality improvement (CQI) and it approached Skills Training UK to deliver apprenticeships training which would help drive the strategy forward. The Apprenticeship Levy was used to fund the training.
“Skills Training UK were already working with neighbouring trust the United Lincolnshire Hospitals NHS Trust which was important to us because it was clear that they had the expertise to tailor and deliver a programme that was suited to a complex and often challenging NHS environment.
"Staff are at the heart of our culture and the Apprenticeship Levy has enabled us to provide more opportunities for staff to learn and develop within their role so that they can continue to provide excellent care to our patients.”
Kay Gilman, Learning and Development Manager, Lincolnshire Partnership NHS Foundation Trust
Staff were selected from clinical, administrative and financial teams for the CQI Level 2 training which took place over 13 months at LPFT’s training and development centre as well as in the workplace. Individual support was always available during the training to help staff members with less experience of project management.
During the first six sessions the focus was on the principles and techniques of CQI as well as effective team working, workplace organisation, visual management and safe working practices. The second half of the CQI training involved the team identifying and tackling workplace projects which directly addressed an inefficiency they had identified in their own area of work.
The staff involved have learnt to apply a structured approach to problem solving which means they can identify, implement and evaluate quality improvement projects. leading to savings in time, cost and ultimately an improvement in patient outcomes.
The success and completion of the CQI Apprenticeships has supported LPFT in receiving a ‘Good’ rating during their latest CQC inspection. The CQC report gave positive endorsements of how LPFT has empowered staff to be heard and become part of the culture of change.
Quality Improvement Project: The SHED (Shared Hub and Events Depot)
A previous study had identified a direct link between the provision of meaningful therapeutic activities and PMVA (prevention and management in violence and aggression) at LPFT’s older adult inpatient wards. Using this evidence, the project team used a Fish Bone diagram to explore barriers that prevented staff on the wards from running themed activities for patients.
The project team identified a lack of storage space as the main problem, which meant that the resources for delivering activities for patients were scattered across various wards.There was also a limited budget for funding activities or purchasing new resources.
The SHED was introduced as a central storage space for all the activity resources. All the resources for activities are now readily available to be borrowed in an organised way across the service.
5S methodology was applied to the storage space and a resource inventory was created with costs assigned to resources, making it easier for staff in different wards to book and see budget allocation.
Staff now understand the value of therapeutic activities, leading to more thematic events across the various wards.
The outcome has been the steady fall in the number of PMVA incidents as a result of the increased numbers of meaningful therapeutic activities.
Quality Improvement Project: Physical Observation Assessment
A lack of reported information on physical observations had been identified which has caused difficulties in managing the patients’ health needs and patient pathway due to a lack of information. A fish-bone diagram was used so the project team could identify the possible reasons why patient observation information was not available. Staff were then able to discuss potential solutions to the barriers.
From the cause/effect activity it was identified the that time of day when patients were being offered the physical observation had an effect. Additional research was completed which concluded patients were most likely to refuse physical observations when approached by staff in the morning. The study also identified the lack of a formal procedure to record visual observations in the absence of a physical observation.
Staff have continued to gather evidence about why a patient might refuse a physical observation and are documenting their findings on a regular basis.
By identifying the reasons why patients are declining observations, staff can create tailored care plans for patients, to directly improve patient outcomes and satisfaction.
The team also created a new process to formalise a visual observation procedure for patent care.
A new form was produced to record the monitoring of patients health in the absence of physical observations and to help signpost vital care from visual cues of health deterioration. Due to the success of the project, staff are looking to scale up the programme across the trust to other wards and departments.
What our learners said...
Jacqueline Tyson, Care Quality Champion at Witham Court
“The training was excellent and we were able to instantly implement what we had learnt through the development of improvement projects. It has been amazing to see how small changes to the trust can make a big difference, both to staff and patients.
“Staff are now more aware of the resources available within the organisation and the benefits of running themed events for patients.”
Carol Rogers, Occupational Therapist at Witham Court
"I've worked for the NHS for 36 years, and have previously run projects off of enthusiasm and passion. The training provided the systems, tools and procedures so that I can bring structure to that enthusiasm, which will make it easier to evaluate the difference we are making to patients.
"Staff are now measuring the increased amount of therapeutic activity against inceidents and falls, which are expected to decrease as a result of the project."
Natasha Stacey, Finance Assistant
“Being relatively new to the trust, the training has allowed me to work directly with members of the clinical team so I could understand the bigger picture of the organisation, discover new ways of working and ultimately learn the benefits of collaboration.”
Terri Birkett, Staff Nurse at Francis Willis
"The planning tools that we learnt from the programme were extremely useful and showed the benefits of documenting everything with a structured approach. It's also a great feeling to know that something you have done can have a wider impact than you ever imagined."
To find out more about our training programmes for NHS Trusts and specialist Healthcare organisations, click here.