The Capuchin training was

designed to:

• Enable you to deliver your

quality improvement

initiative

• Provide you with individual

learning and personal

development so that you

can support service

improvement in your

organisation

• Enable you to share

learning in the wider

organisation and support

the development of a

culture of continuous

improvement

Service Improvement is at the heart of the cost and quality agenda

with the ambition for all health care organisations to provide patient-

centred, safe, sustainable and effective care at all times.

As an organisation we are looking to build staff knowledge, skills

and competencies to innovate and continually improve the services

we provide. We also want to use our role to influence and support

the learning of others working in healthcare.

The Capuchin Quality Improvement Programme is key to “Building

capacity and capability for service improvement in the East

Midlands”. This is one of HEEM’s Strategic Priorities

Capuchin aims to contribute to an organisational culture which

empowers and equips every member of staff to improve the quality

of care through small service change and continuous improvement.

The Capuchin programme was developed following a survey of

HEEM staff to identify levels of knowledge and expertise in Quality

Improvement techniques. The main themes from the survey were:

• A desire amongst staff to gain knowledge and skills around

quality improvement and methodologies (the core fundamentals

with a shared language and set of tools for QI);

• How to incorporate QI into roles, day to day work and working

with and across teams;

• Acknowledge QI work already being carried out by

individuals/teams;

• The application, implementation and sustainability of QI;

• Measuring for QI;

• Quality agenda within the NHS.

“Every system is perfectly designed to

get the results it gets. If we want

different outcomes, something must

change in the system.”

The pre-programme survey showed there was

an opportunity to increase expertise in Quality

Improvement among HEEM staff.

0 5 10 15 20

Novice

Beginner

Competent

Proficient

Expert

How would you rate your current knowledge and skills in relation to quality improvement?

The Model for Improvement

How will we know that change is an

improvement? Measurements

What are we trying to accomplish? Aims

What change can we make that will result in

improvement? Change ideas

Testing ideas

before implementing

changes

Langley, G., Nolan, K., and Nolan, T., 1994. The

Foundation of Improvement, Quality Progress, June 1994

Use SMART to aid in goal setting

S Specific Clear-cut objectives

M Measurable Capable of being measured

A Achievable Can get a result

R Relevant Applicable to what you want to

achieve

T Time-bound Clear dates for reviews and end

of project

What is Quality

Improvement?

Improvement involves:

• Aim-setting

• Measurement

• Idea generation

• Testing

With continuous

reflection and on-going

effort to build a new

culture.

When invited by the HEEM team to be involved with the Capuchin Programme, I googled Capuchin = A Monkey! I

thought; “Now that is very novel” but when you take the time to examine and understand something, it really makes

more sense. Capuchin monkeys are renowned for being adaptive, resourceful, clever, and full of curiosity. In many

ways the very behaviours we want to have when improving the quality of what we do!

From the off, I discovered that the teams in HEEM were ambitious to bring quality improvement thinking to “the way we

do things around here” and create a culture of learning both gaining insight and understanding from what works, as well

as what has not gone to plan.

The Sessions were filled with energetic discussion and debate on how we use QI tools to support small cycles of

change, set SMART aims, and appreciate the importance of measurement to aid our learning and understanding of

improvements made. Many times colleagues reminded each other about how the work of HEEM is central to the

delivery of quality care for the patients and users of the NHS in East Midlands. As the group tackled and discussed

challenges faced in delivering sustainable quality improvements – what this meant for the NHS workforce and its impact

on services was never far from mind.

Having colleagues from all levels and across the whole organisation also brought some unexpected insights, and raised

understanding of how we are all integral to the system we work in. It emphasised that similar challenges are faced by

different parts of the business, and how teams have developed innovative ideas and solutions to manage some of these.

All helping to create active sharing and collaboration.

On a personal note, I would like to extend my thanks to all the participants of the programme, the Capuchin design team,

and Champions for creating an open and receptive atmosphere. I believe this helped create the environment to share

stories, bringing to light how our life experiences can inform the way we approach change. As well as enabling us to

draw upon what we do outside of work, to help innovate what we do in work.

Alice O’Neill, The Quality Improvement Healthcare Company

Alice’s Reflections on Delivering Capuchin

Resources QI resources from the training can be found online at: www.vle.eastmidlandsdeanery.nhs.uk

102 HEEM staff have taken

part in the Capuchin

programme.

Participants have so far made 84

quality improvement pledges and

used tools covered in the learning to

initiate a small service change within

their area of work.

“Can Foundation Trainees really impact on

quality improvement in patient care in 8 weeks?

Before I became involved in the BaSIS course I

was a real sceptic. I watched people struggle

over the years to change something in the NHS

‘which we do like that because we always have’.

The BaSIS course altered my perception

completely – everyone can really make an

impact and improve quality of care for all

patients. Over the past 4 years I have been

inspired by the commitment of Foundation Year 1

trainees to identify small changes that can have

a huge impact on patient care and then

implement changes through the PDSA cycle.

This year was no exception and the BaSIS

celebration event was fantastic – well done to

everyone.”

Dr B T Langham

Director of Foundation Training for the East Midlands

Health Education East Midlands

Building Safety Improvements Skills (BaSIS) For the past three years the Building Safety

Improvements Skills (BaSIS) programme for junior

doctors has been running within the East Midlands.

The programme delivered a hub and spoke model of

trained safety improvement champions in the foundation

years of Postgraduate Medical Training.

This initiative supports several healthcare agendas

currently at the forefront of developments in the NHS

and, if rolled out to all healthcare professionals and

allied workers within the East Midlands, would embed a

culture of patient safety.

The Process

Dale Surgery is a busy inner city GP surgery whose team supports the health needs of the

local population of the Sneinton area Nottingham. The Quality Improvement Development

Programme was initiated by Dr Prit Chahal and Health Education East Midlands to provide

support in the delivery of quality improvement and innovation for all of the Dale Surgery team.

The programme was co-designed with the lead GP and local team and QI colleagues

commissioned by HEEM. Its purpose was to meet the needs across the whole of Dale

surgery’s team. By building on the teams’ existing knowledge and practical know–how skills

the programme worked at developing their ability to create a culture of continuous quality

improvement and innovation for patients and users. The delivery was highly participative,

with the emphasis upon all sharing experiences, as well as gaining knowledge on quality

improvement and innovation tools/techniques.

The programme also shared a range of useful resources, including the range of NHS

Improvement tools and access to a dedicated site on HEEM’s virtual learning environment

(VLE) to support sharing of the resources and ideas. The programme was commissioned by

NHS Health Education East Midlands and delivered by Quality Improvement Healthcare

Company and At Last Training.

Programme Content

The programme included applying innovation tools and techniques alongside core quality

improvement approaches and was designed to meet the needs of staff who had not

previously been involved in quality improvement or used innovation approaches in their

practice.

The programme was delivered in four half day sessions over a 6 month period with the team

identifying improvement projects to carry out between sessions.

Session 1: What is quality improvement?

• Identifying areas for Improvement

• Introduction to Model for Improvement including measurement for improvement and PDSA

Session 2: Innovation and Sustainability

• Drawing on innovation to shift thinking

• Sustainability – why it is important?

Session 3: How are you getting on?

• Managing transitions

• Sharing progress

Session 4: Review

• ‘All Change’ - group activity to explore the effect of changing established procedures

• Skills for facilitation

• Managing difficult/challenging behaviours

Areas Identified for Improvement

Three broad areas for improvement were identified and it was proposed that all changes

would be complete by October 2014.

• Enhancing the working environment

• Consolidating and developing good relationship and communication between the members

of the practice staff

• Examining the patient’s journey from deciding to seek help to contact with an appropriate

healthcare professional

The Quality Improvement Development

Programme Dale Surgery