New BEH Quality Improvement Alumni Directory · 2019. 6. 14. · Barnet Liaison Psychiatry Team...

QUALITY IMPROVEMENTALUMNI DIRECTORY

TABLE OF CONTENTS

AboutPages 4-5

QUALITY IMPROVEMENT AT BEH

CELEBRATING COHORT ONE

INTRODUCING COHORT TWO

Case StudiesPages 6 - 14

BARNET LIAISON PYSCHIATRY

ENFIELD DISTRICT NURSES

HARINGEY CRHTT

HMP WORMWOOD SCRUBS

SUFFOLK WARD

Profi lesPages 16 -23

Index Pages 24 -29

AVON WARD

BARNET CRHTT

BEACON CENTRE

FORENSIC

CSRT

MHSOP

SPECIALIST CHILDREN SERVICES

PHOENIX EATING DISORDERS

FACULTY

COHORT ONE TEAMS

COHORT TWO TEAMS

02 03 0401

the improvement programme with an understanding of how to identify and implement affordable interventions which improve population health and reduce inequalities whilst also improving quality and maximising efficiencies in health care.

The programme is designed around the structure of a Breakthrough Series Collaborative (BTS)2, a well-established model for accelerating the pace of change and developing a learning system.

In year one, clinicians and professionals were brought together to participate in a 12-month programme during which teams concentrated on improvement projects of strategic importance to the three Trust objectives:

• Excellent care: Providing harm-free care• Happy Staff: Improving staff experience• Value for Money Services: Enhancing patient experience

The programme comprises three workshops during which participants learn how to apply the principles of improvement science to their projects by expert faculty. Support is provided by an expert faculty via site visits, virtual meetings and subject-specific webinars.

The BEH QI Faculty includes members representing different areas of expertise within the BEH system. This is a multi-discipline approach, which guides and drives improvement throughout the organisation.

Cohort OneFifteen teams joined the first cohort of the QI collaborative in October 2016, beginning a 12 month journey up to graduation (pictured in profiles) in September 2017.

Each team has submitted a profile for the alumni directory, with an additional focus on five teams featured as case studies. To find out more about any project please contact the faculty or the team lead listed in the index.

Cohort Two The collaborative has developed in the second year, with improvers from cohort one becoming faculty members and taking a key role in coaching year two teams. QI alumni have joined the Haelo team in shaping the collaborative and teaching at learning sessions.

The second cohort of teams began their collaborative journey at the launch event in September 2017. We hope to provide updated profiles following their graduation in 2018. To familiarise yourself with cohort two teams please see the index at the end of this document.

1 The King's Fund. (2017) Quality improvement in mental health. The King's Fund, London (Available on www.kingsfund.org.uk)2 Institute for Healthcare Improvement. (2003) The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improve-ment. IHI Innovation Series white paper. Boston: (Available on www.IHI.org)

ABOUT QI at BEHBarnet Enfield and Haringey (BEH) Mental Health NHS Trust has worked hard to improve safety and provide quality and compassionate care for service users and in 2016 the Trust Board agreed to take their focus on quality improvement (QI) to the next level.

BEH teamed up with Haelo, the Innovation and Improvement Science Centre founded at Salford Royal NHS Foundation Trust, as part of their world-renowned quality improvement programme.

Committed to becoming the most efficient, innovative and quality driven organisation it can possibly be, BEH had a number of existing quality initiatives in place and the improvement programme would aim to align them.

Now into the second year, Haelo are working with the faculty to continue to embed QI into the culture and identity of BEH. An expert team of improvement consultants provide support in three key areas:• leadership and development support• assessment of the quality improvement expertise within the organisation• building capability

Why QI?BEH is one of the larger mental health Trusts in England and, according to national figures, also one of the most efficient. Years of continual innovation and reduced funding from commissioners has ensured that efficiency is part and parcel of BEH. Over time it becomes more difficult to maintain patient care with limited resources without doing something radical, that’s why BEH believe our focus on quality improvement is so important.

Quality improvement is a systematic approach to improving health services based on continuous change, testing and measurement.1 Quality improvement is not a simple, technical fix to add on to existing practices. Fundamentally, it involves empowering frontline teams to understand quality problems and develop effective solutions.

Improvement CollaborativeThe partnership saw the launch of various improvement projects across the Trust via a team-based improvement collaborative. Through this process, the improvement collaborative aims to not only improve the quality of healthcare but also build momentum, resilience and capability among staff to help them continue and embed a culture of improvement.

The collaborative, now into its second year, aims to equip front line teams with the tools required to improve the delivery of health care services. Participants graduate

Barnet Liaison PsychiatryTeam members Dr Amy Enfi eld-Bance, Consultant Liaison Psychiatrist

Jabu Chikore, Service Manager Zippy Kamau, Liaison Psychiatric NurseSavannah Greenaway-Bailey, Healthcare Assistant

PROJECT: To improve staff morale across Barnet Liaison Ward by 50% by September 2017.

SUMMARY: The Barnet Liaison Psychiatry team are a multi disciplinary adult mental health service to the emergency department and wards of Barnet Hospital, covering 24 hours a day. An away day revealed some team members were not feeling valued and felt that the workload was not spread evenly. We made numerous changes to improving working conditi ons and recorded response via a daily sati sfacti on questi onnaire and use of the ‘friends and family' test.

CASE

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DY 1

CHANGES IMPLEMENTED: We have introduced a team diary and shift lead system to allocate workload and keep on top of referrals, which is shared amongst team members. We have improved the offi ce environment by having new windows installed, we have increased compliance with punctuality and ensured staff take breaks and receive regular supervision. We have also split the monthly team meeti ng into two fortnightly meeti ngs and introduced a ‘bring and share’ lunch.

PROJECT OUTCOMES: We have increased the average score on the ‘friends and family’ test by 44% from 6.11 to 8.80. The team have been reporti ng fewer problems in daily feedback and have been positi ve about the changes so far.

PROJECT CHALLENGES: One of our project challenges has been engaging the whole team to take part, this is sti ll an ongoing issue and requires some changes to how staff are rostered for shift s, something we are taking forward. We ensured that all our team members had a role and ownership of the project.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: We have started a daily mindfulness group session before handovers, with positi ve feedback so far. We have also adjusted the rota so staff start and fi nish earlier.

We are taking this work, using the methodology and our outcomes, to conti nue our QI journey. The project will be regarding improving the service to achieve nati onal accreditati on again in October 2018. Accreditati on standards encompass policies, procedures and documentati on, as well as staff , pati ent and referrer experience.

ADVICE FOR FUTURE TEAMS: Get the whole team involved as early as possible! Don’t worry if things don’t work at fi rst, use the process to review and make gradual changes as you go along.

Nihinlola Akinyemi, Area Manager District NursingAbisola Bakare, Area ManagerMerris Gordan, Specialist District NurseKadi Kamara, Specialist District Nurse

PROJECT: To increase the number of newly referred pati ents to the District Nursing Service who are supported to self-care by 50% by September 2017. To promote self-care and empower pati ents and/or family and carers to look aft er their health care needs in their own home.

SUMMARY: A pilot study was commenced with the North Southgate and South Southgate District Nursing (DN) Teams from February 2017 to support service users to self-care. Extended pilot to North Middlesex University Hospital with the permission of the Hospital Director of Nursing who gave consent for the pilot to be implemented on a ward (Ward T7)

CASE

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DY 2 Enfi eld District Nurses

Team members

CHANGES IMPLEMENTED: • Changing the culture from the source of referral. Auditi ng new referrals and redefi ning criteria• Previously DN will be visiti ng to do it for you, it is now to do it with you• Eff ect on DN case load. Every day, for every pati ent, you have to have self-care on your mind• Pati ent informati on materials, visual management board and data collecti on• Built relati onship with hospital staff , met with Care Home Managers and trained carers• Presentati on and att ending Hospital discharge meeti ngs

PROJECT OUTCOMES:• Empowered pati ents with knowledge about their health and confi dence to cope with their

conditi on. Enabled the pati ent to manage their conditi on or need as early as possible• Allowed the pati ent to make the most of their ti me at home• Stopped unnecessary wait for appointments or District Nurse visits unless they encounter a

problem• Increased numbers of new staff in each team has led to a reducti on in use of agency staff , improved

recruitment and retenti on of staff and enhanced staff morale.

PROJECT CHALLENGES: Heavy workload and staff shortages prevent team managers att ending project meeti ngs. This was overcome by forward planning and involving more staff in the project. Changing the culture of hospital staff engagment in the project was overcome by att ending the hospital team leaders away day, where we were able to present the benefi ts of supporti ng pati ents to self-care, reducing the number of referrals to DN, which in turn will release more ti me for community nurses to provide quality care to pati ents with more complex needs.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME:• Extending self-care to residenti al care homes in East Enfi eld DN area of coverage. Ongoing work

with the residenti al care home managers to promote pati ent and staff enablement• Extend pati ents self-caring project to all the DN Team • Pati ent and staff feedback questi onnaires and informati on provided on constructi ve feedback• Data collecti on template possibility on RIO• Redefi ne District Nursing referral criteria and referral form • Protocol developed to assess pati ent or carers competencies to self-administer medicati on• Include self-care secti on in the referral form to the District Nursing Service to identi fy if pati ent is

able self-care and to give brief explanati on why pati ent is not suitable to self-care

ADVICE FOR FUTURE TEAMS: • It’s bett er to refocus than stay working on a topic that doesn’t work• Someone needs to lead, it requires ti me, consistency and eff ort to make it a success• Get all members of the team involved and sell the need “a tree does not make a forest”• Involve the team in data collecti on, once they see the data they will become moti vated• Having a visual management board display in each team will make the project come alive• Staff awareness of the project and to be included as a standard topic in all team meeti ngs• Liaise and share your ideas at every stage of the project with the Trust supervisor

HaringeyDr Gareth Jarvis, Consultant PsychiatristKelly Sullivan, Team ManagerPrince Acheampong, Deputy Team Manager

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DY 3 Crisis Resoluti on Home Treatment Team

Locati onTeam members

PROJECT: To reduce the number of unsigned 'supervised medicati on' charts to zero by the end of July 2017.

SUMMARY: Through a series of team workshops, analysis of incident reports and review of the complaints received by the team, it was identi fi ed that bett er management of medicati on was a key area for development. One functi on of the team is to facilitate the supervision of medicati on. Service users commonly complained that their morning medicati on was someti mes not arriving unti l the aft ernoon. As with all medicati on there are signifi cant risks to the safety of service users if there is not good practi ce around delivery and record keeping. The HCRHTT identi fi ed that it was experiencing around 11 incidents per week where medicati on charts were not signed. The charts are designed such that there is a code for every eventuality, so not signing in these circumstances is a 'never event'.

CHANGES IMPLEMENTED: The HCRHTT established a weekly QI meeti ng for one hour. To communicate to the rest of the team unable to att end, a diary was kept on a shared drive accessed by all the team and a visual display of QI acti vity kept in the team room. These meeti ngs were used to develop an understanding of the issues involved and suggesti ons to overcome them. These developed into our tests of change.

Measuring whether a change was an improvement became a key moment for the team’s

understanding. We had previously relied upon the pharmacy department monthly audit. This data proved inadequate for our needs as it was lacking in detail and too slow in being returned for it to be sensiti ve enough to detect response to changes implemented. Haelo suggested the use of a ‘safety cross’ which served as a useful visual reminder to the team (displayed by the medicati on charts) and gave us locally collected, accurate, rapidly available data.

The weekly meeti ng was the venue where the team would review the last week’s data. A genuine engagement with the data began to emerge once the team saw the impact of changes they had suggested. The data was more meaningful than anything they had previously experienced as it was ti mely (within one week, and so within memory of events) and focused (only three run charts used). Over ti me the team implemented ti ghter PDSA cycles (Plan, Do, Study, Act).

PROJECT OUTCOMES: was The fi rst primary outcome measure was the number of supervised medicati on charts unsigned per week. The chart shows that there was signifi cant variati on from week to week, but overall the trend was for reducti on in errors over the period March to October 2017. By July 2017 the team achieved its fi rst ‘state shift ’ where errors were shift ed down to a new average low with six consecuti ve data points. The second outcome was average caseload. It had been identi fi ed that diffi culty completi ng tasks was associated with high work volume for staff . This fell from September 2016 to a new average caseload 30% lower than before. This was achieved through bett er planning of care and closer partnership working with community teams. The third outcome was the team’s average sati sfacti on scores on the Service User and Carer’s Survey. Whilst not the primary outcome of our project, all team acti viti es are directed towards improving this most important feedback. Our data shows a signifi cant increase with the average score increasing by 16 percentage points, sustained over eight months.

PROJECT CHALLENGES: The process of carrying out a QI project was at diff erent points rewarding, frustrati ng and challenging. One of the big learning points for our team has been to develop resilience in the face of those cycles. We are trying to implement change in a highly complex and resource restrained context. In such circumstances Quality Improvement work rarely goes smoothly.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: Overall there was signifi cant success in reducing medicati on recording errors over this period. It took a series of tests of change to discover a combinati on that provided some sustained improvement. An absolute key element to any success we had was the use of ti mely, relevant data that was not the end, but the start of conversati ons within the team. We have not reached a point where we can say we have successfully addressed this issue as it sti ll shows levels of errors that must be reduced. As such there will need to be on-going focus within the team on this project.

Madeleine Ryan, Modern Matron for Mental HealthSue Bell, Service Manager

PROJECT: To reduce appointment DNAs across the Seacole Centre by 35% by September 2017.

SUMMARY: The Seacole Centre is a health and wellbeing centre located within HMP Wormwood Scrubs. It off ers a number of therapeuti c interventi ons, including group work and 1:1's. Historically there were a high number of DNAs recorded at the centre, which impacted on staffi ng resources and the running of the centre. Working within a prison presents with a number of challenges that impact on the provision of services.

As part of our quality improvement project at the Seacole Centre, DNAs were identi fi ed as something we could look at. This focused piece of work could improve health outcomes for our pati ent group as well as improve staff sati sfacti on of those working in this environment.

CASE

STU

DY 4 HMP Wormwood Scrubs

Team members

PROJECT OUTCOMES:• Reduced DNA rate from 61% to 26%. • Identi fi ed further steps that can be taken to improve the att endance rate • A bett er understanding the QI methodology and processes • The importance of collati ng data and use as a visual aid

ADVICE FUTURE TEAMS:I would encourage future teams to fully embrace the experience. Use the PDSA cycles and ensure that all the team are on board and involved with the processes being implemented or changed.

CHANGES IMPLEMENTED: One of the fi rst steps we took was to process map the pathway between an appointment being made and the pati ent att ending the appointment. We identi fi ed a complex pathway that we had very litt le control over, but was heavily dependent on, other providers and the prison service. There were 11 steps for booking and att ending a healthcare appointment and our team were only involved in the fi rst three steps. By mapping the process and analysing each step of the process we were able to identi fy areas of change through the PDSA cycles that should improve the att endance rates within the centre. Staff and pati ent sati sfacti on surveys were used to capture people's views before the changes were implemented. We also introduced a follow up appointment for pati ents who didn’t att end so that they feel supported.

The biggest challenge was convincing myself and the team that small changes and agreed ti mescales would work but the Haelo team persevered with us. Within a very short ti me we began to see the changes and we became QI converts.

CASE

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DY 5 Suff olk Ward

Locati onTeam members

Chase Farm Hospital, Enfi eld Kirk Hopewell, Ward ManagerSean Edwards, Inpati ent Manager Michael Salfrais, Service Manager Jackie Stephen, Deputy Director of WorkforceLeigh Saunders, Assistant Director

PROJECT: Reduce violence and aggression rates by 20% on Suff olk Ward by September 2017. SUMMARY: Suff olk Ward is a female acute ward, where violence and aggression rates were high and in excess of 100 incidences (of diff erent categories) in a year. The team felt that by using quality improvement methodology, these rates could be improved by 20%. This would be a positi ve reducti on for service users, and staff working within the environment. We achieved this by using the Model for Improvement methodology, with the assistance of the wider team and pati ents to get things moving ahead. We wanted to make innovati ve improvements to our service and did this by using our specifi c aim, feedback from service users and the change model as we connected all the elements of Deming’s Lens of Profound Knowledge (psychology, systems, and variati on and theory) and put these into acti on. The team uti lised a PDSA-approach to testi ng the ideas for change, while measuring if the changes were eff ecti ve with safety crosses, Dati x, seclusion, restraint, pati ent experience, staff sickness, vacancy and complaints. The team uti lised ideas to test change on a busy ward environment which informed our theory for change.

CHANGES IMPLEMENTED: • The ward implemented a new pyramid nursing structure to manage staff and pati ent altercati on• Ward reviews were ti metables and displayed to pati ents so they could see when they were going

to see the consultant or a medic• Complex care group for staff including Ward Manager, Psychologist, Occupati onal Therapist,

Medics and Nurses once a week• Ward improvements to the environment and use of colour and art work• Increased acti viti es on the ward by nursing staff • Applicati on for funding to develop a snooze room ("Dragon's Den Bid") to reduce violence and

aggression by an extra 10% • Welcome pack hosti ng ward informati on for pati ents

PROJECT OUTCOMES:• Reducti on of violence and aggression by 80% • Improved the environment for service users and happy staff • Reducti on is staff sickness and improved vacancy rates• Improvement in service users sati sfacti on and carers experience• Reducti on in restraint and seclusion • Improved leadership and management within the nursing team • Increase in staff att ending training and development• Sharing successes with others across the whole Trust• Working within the cohort two of the QI collaborati ve

CHALLENGES FACED: Building bridges when there is resistance to change. Enabling people to be empowered and proud of what they do and how they do it.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: We used the successful BEH "Dragons' Den Bid" to develop a snooze room on the ward to gain stabilisati on of violence and aggression rates. We also want to work towards staff development days to train staff to encourage them to uti lise the QI methodology into future practi ce on the ward. The team will develop and conti nue to test ideas while working in partnership with pati ent to enhance recovery and pati ent safety.

ADVICE FOR FUTURE TEAMS: Working to Trust values is a complete must. It's paramount for the team to take ownership of quality improvement.

Avon Ward, Psychiatric Intensive Care Unit (PICU), BarnetJamie Komeh, Inpatient Team LeadSamantha Bennett, Avon Ward ManagerDaniel Skehan, Clinical PsychologistMartha Jaso, Acting Deputy Ward ManagerIona Crawford, Associate Mental Health Worker

PROJECT: To reduce violence and aggression on Avon Ward by 50% by the end of 2017.

SUMMARY: The aim of implementing QI on Avon this year was to reduce incidents of violence and aggression on the ward. We began in January 2017 by deciding how we would categorise and measure such incidents. We decided on using Datix data to measure severity, safety crosses to measure frequency and the monthly heat map thermometer to gain an idea of the trend in data over a series of months. Some incidents of aggression are more common than others, for example verbal aggression occurs daily whereas physical violence on staff is thankfully a less frequent occurrence. Consequently, the safety crosses measure the number of incidents of the following:

• Verbal aggression from patients to staff• Physical aggression from patients against staff• Physical aggression from patients against patients• Damage to ward environment• Patients found smoking on ward (this allows us to ensure room searches are being conducted)

We are seeing a downward trend in the number of incidents of violence and aggression. As we did not see consistent enough recording of incidents until summer 2017, we have extended our 50% reduction goal to June of 2018.

CHANGES IMPLEMENTED: Following PDSA cycles we have implemented changes such as:• Using a number system to allocate a time for patient’s to get their lunch/dinner. This has

reduced incidents occurring at meal times• Written expectations for S17 leave and mobile phone use. These exist as part of care plans

however are also used independently as reminders for patients and staff• Weekly staff development group. Space for staff to talk openly about difficult cases, positive

and negative events on the ward, etc.

ADVICE FOR FUTURE TEAMS: Get measuring as soon as the project begins, run a monthly QI meeting to keep staff up to date and the monthly newsletter has been successful on Avon.

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1 Avon WardLocation

Team membersDennis Scott Unit, Edgware Hospital, BarnetDr Richard Parkin, Consultant Psychiatrist East Locality Team and Trust Appraisal & Revalidation LeadChukwueloka Otue, Deputy CRHT Manager

Crisis Resolution Home Treatment TeamLocation

Team members

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PROJECT: To improve patient experience to a 90% satisfaction score by 31st July 2017.

SUMMARY: The Barnet Crisis Resolution Home Treatment Team (BCRHTT) works with people in mental health crisis. It can be difficult to establish a good outcome measure for people using our service. We wanted to look at a number of possible change ideas that may impact on patient satisfaction and measure it using a simple satisfaction rating questionnaire.

CHANGES IMPLEMENTED: We developed a patient information leaflet including a care plan and crisis contingency plan. This was followed up by a separate question of all our patients to find out if this was helpful. We had to ensure that there was documentation of the questionnaire being given to patients and that we regularly reviewed the clinical documentation. This level of scrutiny/measurement was a challenge as it needed to be done diligently on a very regular basis. Our changes were all implemented successfully whilst also helping to raise the profile of the quality improvement project within the team as we had to keep revisiting this test of change with clinicians on a regular basis.

PROJECT CHALLENGE: The main challenges have been to bring other members of staff into the project although this has been successful; to maintain a clear focus on our quality improvement Project including regular reporting, to get meaningful visual display of measurements/outcomes; and the biggest challenge of all has been that the clinical lead for the project, Dr Parkin, effectively moved out of the team in April 2017 due to service reconfiguration. He still maintains a much reduced clinical role within the team and is no longer in the same building and therefore the leadership has fallen solely on the day-today lead, Deputy Team Manager, Chukwueloka Otue.

ADVICE FOR FUTURE TEAMS: Establish a SMART aim, get a big enough core group of interested clinicians in order to keep a critical mass of leadership and enthusiasm, keep the profile of QI high with weekly feedback in team meetings, ensure that the core group meets on a regular basis to support each other and maintain focus on measurements supporting and refining tests of change. Ensure sure that there is good visual display through consistent data collection/run charts and maintain regular report updates to ensure ongoing shared leadership.

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3Edgware Community Hospital, BarnetBen Mensah, Service Manager for Low Secure Services and CAMHS tier 4Ayla Mammodova, Assistant Clinical PsychologistSuzie Maclennan, Ward ManagerLaura Voyce, Occupational Therapist

Beacon CentreLocation

Team members

PROJECT: To increase patient involvement from 71% to 90% by September 2017.

SUMMARY: ‘Patient involvement’ in this instance refers to patients being involved in their care by knowing about what meetings take place in the unit. We started by asking the patients if they understood the terms ‘Ward Round’, ‘MDT’ amongst other terms for the same meeting. From our initial discussion with patients, it was evident that there was several different expressions for the same meeting and that the terms used were quite medical. The patient’s also didn’t really understand why these meetings took place or how these meetings can influence their care.

CHANGES IMPLEMENTED: Changes we have introduced after the initial ideas were tested:• Informed young people of the meetings that staff attend on a weekly basis• Refer to Tuesday and Thursday meetings as ‘Ward Round’ alone to avoid confusion• We introduced information about Ward Round meetings into the welcome pack• Had Ward Round meeting feedback forms for young people, this also helped to generate

different change ideas we could test. Including a process to follow up forms with young people

CHALLLENGES FACED: • We had several staffing changes and this was not easy as we lost some momentum • Due to the length of stay for each patient, the patient group did not remain constant so it was

hard to look at the impact of the test of change• Some young people might have been unwell to register the test of change or uninterested to

know about it. In some cases, the patients refused to take part in the project• Data collection is limited due to the small patient group, however this made us think

differently about how we could measure the project

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: We have joined the second QI cohort to continue the project. We are really passionate about our patients and the quality of care that the Beacon Centre provides, so we have more ideas we want to test.

ADVICE FOR FUTURE TEAMS: Think really carefully about your problem area and make sure that you have a defined focus on what it is you want to improve. As a team, we needed to take it back down and restructure our aim and our project before we could really progress. Have a patient on your team and make sure they have a say. We presented at a learning session with our patients and this was really rewarding.

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Canning Crescent Centre, Haringey EastDr Priya Bajaj, Consultant PsychiatristMultidisciplinary staff in CSRT and team administrators at CCC

Community Support & Recovery TeamLocation

Team members

PROJECT: To increase staff satisfaction through the effectiveness of the current ‘duty’ system by 40%.

SUMMARY: The duty system is a key function of a community mental health team focused on timely intervention to urgent phone calls and patient reviews. A ‘duty’, ‘back-up’ worker and manager are rostered to allow adequate support for unforeseen absences. The current service was causing stress and inappropriate duty calls from reception. A process mapping exercise illustrated the service complexity and co-created a ‘back office’ role and function. Regular feedback surveys alongside PDSA cycles of distributing protocol, charting duty phone pick-up time from reception and logging inappropriate calls provided the data. Duty service satisfaction amongst staff transitioned from a baseline effective score of 17.6% to 80%.

CHANGES IMPLEMENTED: • Improving internal communication. With each test of change and feedback received, there

was a better understanding of practices that consolidate improvement. QI became a stand-ing agenda item in the monthly clinical multidisciplinary team meetings to allow duty work-ers to share information with the team and managers in on-going efforts to improve.

• Focus on training for reception staff. A copy of all inappropriate calls logged were sent to the admin manager and guidance for reception was drafted and distributed to all admin staff. Monitoring of inappropriate calls was continued along with gathering feedback and sharing of visible measurements in scores of staff satisfaction scores.

PROJECT OUTCOMES: • Clarity on duty worker’s role • Increased confidence and consistency in dealing with duty calls • Improved communication between reception and duty workers

CHALLENGES FACED: The biggest challenge was in gathering open and honest feedback from staff across disciplines and roles. Team meetings were not used to complete surveys, instead all staff were actively encouraged to give feedback in their own zone of comfort.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: The change achieved has been consolidated by on-going data capture and review.

ADVICE FOR FUTURE TEAMS: • Co-produced solutions lead to an increase in staff satisfaction • Open and honest staff feedback is the main driver for change • A high satisfaction score can be achieved with team effort and buy-in

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EnfieldBen Mensah, Service Manager for Low Secure Services and CAMHS tier 4Alie Daramy, Ward Manager, Blue Nile House

ForensicLocation

Team members

PROJECT: To increase understanding of patient feedback and retention of information from ward rounds for patients by 50% by July 2017.

SUMMARY: Patients often cannot remember what was discussed during their ward round visits and struggle to retain information as there is no document for their reference. We really wanted to see patients retain but also understand the conversation.

CHANGES IMPLEMENTED: • We devised a retention/information sheet which the patient could use within the ward

round. The patient can then retain the information and refer back to it when they need to.• Patients can have a discussion with the nurse/key worker before the meeting and decide

what they want to ask before the meeting. So it’s an opportunity to plan ahead, so that the patient does not forget when they are in the meeting.

PROJECT OUTCOMES: It’s really important that patients have their say on their care, we found that this worked really well. It also allowed us to continue to work with our patients and ask them questions in relation to developing the form further; co-designing the prompts so that they can get the most from their ward round meetings.

CHALLENGES FACED: Patients like different things, so the form isn’t suited to everyone. A change we started to work upon was to ask if the form had the right information on (in terms of prompts). Our reason for doing this was to ensure that the form could be applied to all ward rounds, giving patients the same opportunities.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: We have successfully implemented the changes and they continue to work well. We have shared this information with other teams in the collaborative - pleased to see our change ideas can be shared to other settings.

ADVICE FOR FUTURE TEAMS: The key learning for us was to ask patients. Find out what works for them. The second piece of advice our project taught us; is to share. Talk to colleagues, even if they are working in a different setting, it’s amazing what you can share and test. QI is all about testing, if you fail, start again and try and find a way to improve things!

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EnfieldDr Anna Sobel, Consultant PsychiatristMounir Bassou, In Patient Lead Nurse

MH Services for Older PeopleLocation

Team members

PROJECT: To improve satisfaction measures for ward staff working in Mental Health Services for Older People (MHSOP) by increasing the proportion of staff who feel valued at work by 10% in six months.

SUMMARY: We have experienced difficulties with recruitment and retention to MHSOP inpatient wards. An excess of bank and agency staff has resulted in significant financial deficit and can also affect the high quality care we deliver. There is a wealth of evidence showing a direct association between staff wellbeing, feeling valued at work and staff retention. Semi-structured interview data taken across the three inpatient wards and exit interviews showed a need to improve staff satisfaction.

CHANGES IMPLEMENTED: Results extracted from semi-structured questionnaires were used to identify change ideas influencing primary and secondary drivers:

• Recognition and appreciation of the effort made by staff• Offer greater training opportunities • Improve therapeutic relationships between patient and staff through activities• Increase 1:1 time between staff and patients

Improvement in staff satisfaction levels were tested through a number of PDSA cycles introducing a daily “how was your shift” meeting and a new programme of therapy on the ward.

PROJECT OUTCOMES: There were significant improvements in measures of staff feeling valued with the introduction of the Namaste training programme. There were direct benefits to patients as well in therapeutic activities and 1:1 time.

CHALLENGES FACED: Ward closures and other factors affected morale therefore we concentrated on cycles that would provide staff with changes that they had identified as important to them.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: We are currently running a QI project in cohort two within the older adults CMHT to contribute to formal accreditation with the Royal College of Psychiatrists.

ADVICE FOR FUTURE TEAMS: Trust the QI methodology. Small changes can result in significant improvement and draw attention to other factors that influence the bigger picture.

PRO

FILE

7

Pheonix Centre, HaringeyDr Karen Townend, Service LeadRachel Clancy, Operation ManagerAshton Dublin, Ward Manager

Phoenix Eating DisordersLocation

Team members

PROJECT: 100% of risks reported on Datix are recorded as risk incidents and are reflected in the risk summary by July 2017.

SUMMARY: It was highlighted that some risk incidents on Datix were not reflected on Rio as risk incidents, or in the risk summary, following a CQC inspection. This limits staff awareness of incidents and recognition of what to improve upon.

CHANGES IMPLEMENTED: • The team carried out a process map excercise to identify gaps that now serves as a

standardisation tool• Qualified staff were trained on risk assessment specifically on the reporting • Weekly audits were executed to check that risk assessments were appropriately recorded

and has remained in place since

PROJECT OUTCOMES:• Staff knowledge on risk assessment recording processes has increased• All risk assessments are reported in the right systems in a timely manner

CHALLENGES FACED: Initially we set out to do a project on increasing patient satisfaction, specifically around meal times. However, due to a CQC inspection that coincided with the launch of this collaborative, our priorities changed and we wanted to keep using the methodology to address identified quality issues, therefore we changed our focus.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: We’ve gone back to the original topic of patient satisfaction at meal times and have started work ensuring weekly 1-1's with a nurse.

PRO

FILE

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Physiotherapy and Occupational Therapy, EnfieldHelen Tanyan, Service LeadHeather Holgate, Operational ManagerAnna Spiteri, Senior PhysiotherapistFiona Kingsley, Children’s Occupational Therapy Clinical LeadZofia Helfer, PhysiotherapistBronwyn Roane, Senior Occupational TherapistXanthe Hodgson, Children’s Physiotherapy Clinical Lead

Specialist Children ServicesLocation

Team members

PROJECT: All children with a) U5 with complex neuro-developmental disorders, and b) Children with motor coordination difficulties, will start on an integrated pathway by 1st August 2017.

SUMMARY: Our cross discipline project (OT & PT) was to see children with complex neurological difficulties and developmental coordination difficulties more efficiently and effectively.• Therapists worked together to implement new pathways in response to perceived need• One new pathway was introduced which resulted in fewer appointments for a child (more

joint appointments) with the potential to improve patient journey and satisfaction• The possibility of a joint referral form for OT & PT was explored and trialled – this continues

CHANGES IMPLEMENTED: New joint pathways in place when none previously existed, stakeholder feedback is positive, conversations about QI taking place across teams, the admin hub came on board and admin processes were drilled, understood and fixed.

PROJECT OUTCOMES: • Teams are actively engaged and have learnt a methodology toolkit to continue applirg. Frontline

staff are choosing their next QI initiative for 2018• Integrating care pathways provides a better experience of care and delivers better outcomes

and efficient deployment of staff resource• Therapists working together and sharing knowledge, resulting in better understanding of roles

and highlighted opportunities for sharing knowledge and resources

CHALLENGES FACED: Securing active engagement of the full teams - all staff chose which work group they would support and their roles. Collaboration is a long process and takes time.

PROJECT UPDATES SINCE COMPLETION OF PROGRAMME: Continuing to review the referral form, collecting data to analyse and refine pathways and learning from similar teams.

ADVICE FOR FUTURE TEAMS: Choose your programme of work carefully, it needs to be doable but also intrinsically motivating and sustainable. Be clear in your purpose and do not try to do too much at once, especially while learning the skills of QI.

Directory

Avon WardBarnetJamie Komeh, Patient Team Leader To reduce violence and aggression on Avon Ward by 50% by September 2017

Beacon CentreBarnetBen Mensah, Service Manager for Low Secure Services & CAMHS tier 4 and Laura Voyce, Occupational TherapistTo increase patient involvement from 71% to 90% by September 2017

Children and Young People EnfieldHelen Tanyan, Service Manager All children with a) U5 with complex neuro-developmental disorders, and b) Children with motor coordination difficulties, ill start on an integrated pathway by 1st August 2017

Community Rehab HaringeyDr Khaver Bashir, Consultant Psychiatrist10% reduction in admissions from those care homes that have the highest number of admissions

Community Support and Recovery TeamHaringey EastDr Priya Bajaj, Consultant PsychiatristTo increase satisfaction through the effectiveness of the current ‘duty’ sys-tem by 40% by September 2017

Crisis Resolution Home Treatment Team BarnetDr Richard Parkin, Consultant Psychiatrist East Locality Team and Trust Appraisal & Revalidation LeadTo improve patient experience to 90% satisfaction score by 31st July 2017

Team BoroughTeam leadProject aim





Team BoroughTeam lead

Project aim

Directory Cohort 1

Richard MilnerDirector of [email protected]

Dr Jonathan BindmanExecutive Medical [email protected]

Nina van MarkwijkDeputy Director of [email protected]

Jackie StephenDeputy Director of Organisational [email protected]

Simon HarwinHead of [email protected]

Jethro RoughtonData Systems [email protected]

Clare ScottDeputy Director of [email protected]

Margaret Southcote-WantDeputy Director of [email protected]

Faculty

Crisis Resolution and Home Treatment TeamHaringeyDr Gareth Jarvis, Consultant PsychiatristTo reduce the number of unsigned 'supervised medication' charts to zero by the end of July 2017

District Nurses Enfield Nihinlola Akinyemi, Area Manager District Nursing To increase the number of newly referred patients to District Nursing Service who are supported to self-care by 50% by September 2017

Finsbury WardHaringeyLazarus Ndhlovu, Ward ManagerTo reduce and aggression on the ward for both patients and staff by September 2017

Forensic InpatientsEnfieldBen Mensah, Service Manager for Low Secure Services and CAMHS tier 4To increase understanding of patient feedback and retention of information from ward rounds for patients by 50% by July 2017

HMP Wormwood ScrubsAssociated service, Hammersmith and Fulham Madeleine Ryan, Modern Matron for Mental HealthTo reduce appointment DNAs across the Seacole Centre by 35% by September 2017

Liaison ServiceBarnetDr Amy Enfield-Bance, Consultant Liaison PsychiatristTo improve staff morale across Barnet Liaison Ward by 50% by September 2017

Directory Cohort 1







Mental Health Services for Older PeopleEnfield Dr Anna Sobel, Consultant PsychiatristTo improve satisfaction measures for ward staff working in Mental Health Services for Older People (MHSOP) by increasing the proportion of staff who feel valued at work by 10% in six months

Phoenix WardHaringeyKaren Townend, Service Lead100% of risks reported on Datix are recorded as risk incidents and are reflected in the risk summary by July 2017

Suffolk WardEnfieldKirk Hopewell, Ward Manager Reduce violence and aggression rates by 20% on Suffolk Ward by September 2017

Directory Cohort 1




Adult Community Mental HealthEnfield Basit Hussein, Consultant Psychiatrist

CAMHSEnfield Natallija Lytrides, Interim CAMHS Service & Transformation Manager

EIPEnfieldChukwueloka Agu & Simon Clark, Manager, Early Intervention in Psychosis Service

OP CMHTEnfield Stephen Godfrey, EIS Haringey Team Manager

SCANEnfield Rehana Shakir, Consultant Psychiatrist

CAMHS CHOICESHaringey Fuad Buraimoh, CAMHS Open Access / Triage Team Manager

EISHaringeySteven Livingstone, Clinical Psychologist

LD Team HaringeyBhathika Perera, Consultant Psychiatrist

Substance MisuseSpecialistSerena McCabe, Clinical Services Manager

HMP PentonvilleSpecialist Junaid Dowool, Team Leader for Mental Health Services

HMP SpringhillSpecialist Lynn Glassup

Directory Cohort 2












Directory Cohort 2










Finance CorporateHelen Newport, Finance Manager

Learning and DevelopmentCorporateEliana Chrysostomou, Senior L&D Manager

WorkforceCorporatePat Savage, Workforce Analyst/Payroll Liaison

Beacon CentreBarnetBen Mensah, Service Manager for Low Secure Services and CAMHS tier 4and Suzie Maclennan, Ward Manager

CAMHSBarnetMark Carter, Child and Adolescent Psychotherapist

East LocalityBarnetEamon Walsh

Intensive Enablement TeamBarnetBelinda Silva-Tully, Manager

Personality Disorder TeamBarnetDavid Harty, Lead Specialist Practitioner

Psychology hubBarnetRichard Rushe, Consultant Clinical Psychologist

Staff Experience

Patient Involvement

Directory Cohort 2











Assessment WardHaringey Bessie Laryea, Ward Manager

Avon WardBarnetSamantha Bennett, Ward Manager

Dorset WardEnfield Daniel Dwomoh, Ward Manager

Fairlands Ward Haringey Alfred Muana, Ward Manager

Juniper WardEnfield Annette Woods, Ward Manager

MHSOPEnfieldChristine Kapopo, Nurse Consultant

Suffolk WardEnfieldKirk Hopewell, Ward Manager

Sussex WardEnfield Richmond Opoku, Ward Manager

Thames WardBarnetClaire Walsh, Ward Manager

Trent WardBarnetJonathan Apeawini, Ward Manager

Violence and Aggression

Version one|February 2018

New BEH Quality Improvement Alumni Directory · 2019. 6. 14. · Barnet Liaison Psychiatry Team...

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