Ensuring that our services are safe, responsive and provide quality care is really important. The best way for us to do this is by continually making improvements.

Our Quality Improvement (QI) Team works creatively to support a culture of continuous improvement across the Trust. Their aim is to support and enable individuals and teams by coaching, sharing skills and by developing improvement experience and practice.

The team works alongside service users, staff, carers, families and partner organisations, to identify areas where changes can be made that will benefit everyone.

The QI Team leads on embedding the Microsystem improvement methodology as the prime approach to continuous improvement across the organisation.

Microsystem improvement methodology

SHSC is one of the four key partners in the Sheffield Microsystem Coaching Academy, along with Sheffield Teaching Hospitals, Sheffield Children's and Sheffield Clinical Commissioning Group. The microsystem improvement methodology, which has been adopted and adapted from The Dartmouth Institute, USA, incorporates key elements of Lean, the Model for Improvement and strongly promotes coproduction.

A microsystem is essentially a team, described as a ‘small group of people who work together on a regular basis to provide care to discrete populations of service users’.

Microsystem improvement involves engaging members from that team, along with service users, carers or family members, to work together as a group to improve the quality of care. It’s that simple.

A trained microsystem coach facilitates the team through a structured improvement process, known as the microsystem improvement ramp, empowering teams, service users, carers and family members to influence change from the front-line.

Many services across Team SHSC are now using the microsystem methodology on a regular basis and it has played a key role improvements we have made across the organisation. 

In addition to microsystem work, the team supports a range of bespoke improvement projects across the Trust, working closely with teams such as Engagement & Experience, Organisational Development, the Programme Management Office and the Research Department to ensure improvement evolves as a result of true collaboration.

Furthermore, a variety of training opportunities are offered on a continual basis seeking to embed QI within everyone’s role.

Training

We run a 2-day Introduction to Quality Improvement course. This is a free course for anyone involved with the Trust (whether as a staff member, service user or carer) who is interested learning more about quality improvement.

Due to the current COVID-19 restrictions our face-to-face course is on hold and is being adapted to be delivered online.

Improvement Stories

Please click on the boxes below to read some examples of improvement stories from SHSC where you can see how we've tested and implemented changes in real settings. If you would like more information about any of this work please get in touch with the QI team.

COVID-19 evaluation - How services listened and adapted in response to the pandemic

Issues:

  • Legal restrictions resulted in many face-to-face services rapidly needing to change the way they offered care
  • Unsure of impact on staff and service users/carers

Changes:

  • Staff and service user surveys collaboratively developed with 15 teams with themes of support, access and communication
  • Over 1300 service user responses
  • Over 800 staff responses
  • Feedback analysed and fed back to individual teams to inform ongoing service changes/developments

Impacts/Outcomes:

  • All teams developed action plans and have shared ‘you said, we did’ via the SHSC website and/or letters/posters
  • Some examples include:
  1. Exploring permanent option of online appointments
  2. Development of online peer support groups and socially distanced walking groups
  3. Working from home = reduced travel time for staff = time reallocation to improve admin processes

For more information about this work please click here.

South Recovery - Collaborative care plan work

Issues:

  • Staff and service users identified issues with Collaborative Care Plans (CCPs) in relation to: quality/consistency/content/access/availability/storage/relevance

Changes:

  • Creation of goals template and supportive prompt sheet to help develop consistent and quality CCPs
  • Development of guidance to support writing of collaborative goals
  • Creation of flowchart/timeline to encourage consistency and help set expectations
  • Development of ‘About Me’ page to help improve quality of care according to individual need

Impact/Outcomes:

  • Service user involvement from project initiation, continuing at all stages of the improvement process
  • Increased service user satisfaction improvement through true coproduction
  • Increased quality of CCPs (although early stages so evaluation and monitoring continues)
  • Direct alignment with ‘Back to Good’ patient centred care records workstream

STEP - Work on responding to changing needs of clients to increase attendance rates and satisfaction

Issues:

  1. Changing needs of clients
  2. Commissioner requests for increased service offer
  3. Low attendance rates
  4. Impact of COVID-19

Changes:

  1. Review of content and curriculum for courses to improve and reflect changing needs of clients
  2. Developed and established new groups such as Carers Group and Insomnia to meet new demand
  3. Revised processes such as course access, criteria and enrolments
  4. Adapted courses from face-to-face to online via Microsoft Teams

Impact/Outcomes:

  1. Improved user satisfaction, detailed through better use Qualtrics
  2. Development of new Insomnia and Carers Course
  3. Improved attendance rates e.g. from 45% to 82% at most recent REP course
  4. Continued access to courses during the pandemic, offering a total of 21 online courses since July 2020

Older Adults CMHT - Creation of duty email for unplanned care referrals

Issues:

  • Admin staff managing difficult telephone conversations with service users/families/carers
  • Admin staff ringing clinical staff to alert to referrals/requests/crisis
  • E-mailed referrals sitting in personal email boxes
  • Uncertainty whether a referral has been dealt with
  • Missed email referrals

Changes:

  • Creation of duty email facility for unplanned care referrals
  • Clear process/system for receiving and dealing with referrals for unplanned care

Impact / Outcomes:

  • Increased efficiency in responding to service users’ needs/risks
  • Improved communication to ensure all unplanned care referrals dealt with appropriately and promptly
  • Reduced stress for admin staff
  • Significantly reduced room for error
  • Improved clarity around roles and responsibilities for the unplanned care process

Pharmacy - Introduction of Senior Pharmacist in Single Point of Access/Emotional Wellbeing Service and Decisions Unit

Issues:

  • Increased demand for pharmacy input in Single Point of Access (SPA)/Emotional Wellbeing Service (EWS) and Decisions Unit (DU) from clinical and medicines governance perspective, including increased contact with service users

Changes:

  • New role of Senior Pharmacist for SPA, EWS and DU introduced in Jan 2020
  • Role involves:
  1. Supporting medicine optimisation, e.g. responding to staff queries
  2. Participating in MDTs
  3. Directly responding to referrals with medication advice
  4. Direct service user contact re medication queries
  5. Additionally in EWS - a minimum of five pharmacy led medication reviews per week

Impact/Outcomes:

  • Increased pharmacy contact with service users
  • Increase in safe, effective and service user centred use of medication
  • Increased number of pharmacy enquiries recorded – easing the pressure of enquiries to the main pharmacy team and the doctors
  • Fielding medication related questions from GPs
  • Positive staff and service user experience feedback

Day one ready team - Work on smoother, more efficient process for new starters

Issues:

  • New starters frequently not in a position to work in the most efficient and effective way from day one of their employment
  • No forum in place to bring required range of services together to address issues

Changes:

  • Updated paper 3-in-1 form used for requesting new IT accounts to an easy access electronic form
  • Recognised once IT account set up, all other things can happen (i.e. book on Trust induction, create ID badge etc)

Impact/Outcomes:

  • Removal of paperwork erasing opportunities for lost forms/delay in form submission
  • Increase in number of new starters with IT account on day one
  • Increased recruiting manager and day one ready team satisfaction
  • Enabled next element of process to progress – ID badge

How you can get involved

The Quality Improvement Team are always looking for service users, carers, families and members of the public to get involved in quality improvement projects.

If you would like to find out more about getting involved in quality improvement work just drop an email to QIteam@shsc.nhs.uk and one of the team will get back to you as soon as possible.

This approach has been very beneficial to me. I often have ideas and thoughts but have not always felt confident or able to share them. This approach has helped me to bring forward ideas and feel valued. People always allow time for me to explain my thoughts and are respectful.

Being involved in the Microsystems work has enabled me to feel part of a team and given me a sense of value that allows me to see that I have a voice worth listening too and something positive to contribute to the world. This is from a person who can go weeks and weeks without publicly speaking to anyone.

Quotes from service users/carers/staff who have been involved in quality improvement work
Related content
Coronavirus service user survey
How to leave feedback
Quality Improvement Week 2020

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