Wessex PSC Quality Improvement Hub (QIHub) is a resource for health and social care staff using quality improvement approaches as a core part of their work.
What is Quality Improvement?
Quality Improvement (QI) helps us identify what works well and where we can make changes. In primary care, we don't have time or resources to spend on things that don't work, don't serve our patients, and that could be done more efficiently or effectively. QI is a commitment to continuously improving the quality of healthcare, focusing on the preferences and needs of the people who use services. (Royal College of General Practitioners 2017)
“In order to practise medicine in the 21st century, a core understanding of quality improvement is as important as our understanding of anatomy, physiology and biochemistry. (Stephen Powis, Medical Director, Royal Free London NHS Foundation Trust, 2015. Academy of Medical Royal Colleges)
This webpage will help you locate and access QI resources from:
Selected resources developed or promoted by Wessex PSC can be downloaded from the Resources Link on the right hand side of this webpage.
Looking for QI Training or Improvement Coaching support to help you with a QI project in Wessex?
To discuss how we can support you to pilot or spread Quality Improvements in your organisation please contact Geoff Cooper via the link at the bottom of this page.
QI Training Providers and Materials
This collection of links includes materials and links from from the following Training Providers:
Patient Safety Resources
The Game Guide (New York Department of Health AIDS Institute)
The "Game Guide" can also be downloaded from the resources zone on the right hand side of this webpage.
Improvement Toolkit (North East and North Cumbria AHSN)
The Improvement Toolkit is for staff who work in healthcare, leading teams/directorates/departments involved in culture and/or quality improvement work.
It is split into two main sections:
Culture: This section aims to share with you practical ways you can evaluate the culture in your team and the steps you can take to make and sustain improvements
Quality Improvement: This section provides you with an approach to help you improve quality, measure its success, and ensure improvements are sustained
Both sections are supported by an additional section which shares some useful quality improvement tools and techniques which you may wish to use when looking at culture and/or quality improvement work.
The following documents are referenced in the toolkit:
The Improvement Toolkit can be downloaded from the NENC website or from the resource zone on the right hand side of this webpage.
Patient Safety Repository: In Safe Hands (Heath Education England)
In Safe Hands is Heath Education England's (HEE) new patient safety resource produced in response to the recommendations made in the 2016 report ‘Improving Safety Through Education & Training’.
In Safe Hands is a constantly evolving resource where the content will be updated and added to as work in patient safety is progressed. HEE invite the submission of additional materials in respect education, training and development activities in healthcare to support patient safety to complement that already gathered.
The latest version of "In Safe Hands" can be downloaded from the HEE website v6b (Oct 2019) can be downloaded from the resource zone on the right hand side of this webpage.
BMJ Resources to improve Patient Safety
The British Medical Journal (BMJ) welcome viewers to browse their collection of resources intended to help improve patient safety.
If you have a suggestion for a new resource or want to share some feedback let them know via their webpage.
Improving is an element of all of our roles; from the top of the organisation through to the front line. Hertfordshire Partnership's approach to improvement seeks to use the talent, knowledge and skills of everyone in the organisation and ‘do’ the improvement work in structured, repeatable and consistent ways.
The pages of this website take you through using the Model for Improvement in order that you can complete your own improvement project using a ‘project charter’ which will help you and your team to capture the key components of your project.
Supporting Better healthcare, transformed care delivery and sustainable finances. NHS Improvement supports foundation trusts and NHS trusts to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable.
Use the Improvement Hub to select a theme to access improvement tools, resources and ideas from across the health sector. Use it to collaborate and explore your ideas with colleagues, share your own improvement stories (lessons learned and successes) or tell the NHSI about improvement resources you've seen elsewhere.
Specific NHSI sponsored and downloadable resources for QI teams include:
A practical, interactive guide suitable for those working at all levels in the NHS, from ward to board, which demonstrates how to make better use of your data. Analysts and decision-makers are encouraged to work together to ensure the most relevant data is presented in the most effective way.
The collection of resources helps with the construction and interpretation of statistical process control (SPC) charts and includes working scenarios and exercises.
Statistical process control (SPC) is an analytical technique that plots data over time. It helps us understand variation and in so doing guides us to take the most appropriate action. This downloadable excel spreadsheet from NHSI will enable you to:
Central London Community Healthcare NHS Trust has designed this simple tool to help teams document their basic driver diagrams/action effect diagrams in a graphical format. It is useful for anyone who is looking to create or document a theory of change for an improvement project.
This tool can be downloaded as an excel spreadsheet from this NHSI webpage.
The Wessex based Academy of Research and Improvement is committed to supporting people to undertake activities which can improve the care provided to patients at Solent NHS Trust. The Academy works alongside Solent staff, the people who use the Trust's services and their various partners to identify and investigate new ideas and different ways of working and aim to share the learning and impact of this work in open and accessible ways.
The Wessex School of Quality Improvement (QI) is designed to bring together, make visible and co-ordinate the current range of initiatives within all portfolios of Health Education England (Wessex), as well as create new opportunities which build on these successful initiatives.
LIFE is a Quality Improvement and Networking platform developed by Seedata Ltd in conjunction with a collaboration of AHSNs and PSCs across NHS England. It is aimed at supporting improvement work across the NHS.
Life is built around the Model for Improvement - a framework for accelerating improvement.Life also promotes transparency and learning making it easy to learn from the progress of others and connect with the community locally and nationally.
LIFE also includes a Learning Centre with a comprehensive, and developing, collection of resources to help the reader understand the LIFE system and QI science.
Access to the LIFE application by Wessex users can be requested from ourselves here. You will be asked to complete an initial short survey which enables us to understand your requirements and to help map people and projects across Wessex.
The RCEM QI webpage collates some of the most useful quality improvement resources and links for Emergency Department Practitioners. Their Quality Improvement Guide is a useful guide to anyone engaged in QI projects and can be downloaded from the Resources Zone on the right hand side of this webpage.
Quality improvement activity should be supported at all levels, locally, regionally and by royal colleges and specialist societies in the form of enabling ‘core' quality improvement support aligned with existing educational structures to permit expert facilitation, coaching, mentoring and inter-professional learning, with protected time to undertake it. (Royal College of Physicians 2017)
The RCP webpage lists a number of Quality improvement (QI) tools to download, along with links to other organisations and initiatives concerned with QI in healthcare. Their "Quality Improvement - training for better outcomes" (Academy of Medical Royal Colleges) can be downloaded from the Resources Link on the right hand side of this webpage.
The RCGP clinical toolkits have been developed in partnership between the RCGP Clinical Innovation and Research Centre (CIRC) and partners. The resources have been created for primary healthcare professionals, patients and carers. These toolkits can be used to assist in the delivery of safe and effective care to patients.
The RCGPs Quality Improvement Toolkit for Diabetes Care is a good example of the use of QI within clinical practice and contains information about: Useful QI tools; Data sources; Displaying data; QI Guides; QI and Diabetes Training materials; Project Management tools; Project reports; Evaluation tools.
The QI tools section contains information about Assessing Project Context; Process Mapping; Fishbone Diagrams; Model for Improvement and PDSA cycles. QI Guides are available for a number of topics including: Run Charts; Process Mapping and Model for Improvement / PDSA cycles.
As improving the quality of services is a key requirement within the NHS the RCR has added quality improvement projects to their training curricula as an alternative to audit.
The RCOG is committed to advancing the science and practice of obstetrics and gynaecology. As part of this work, we undertake national audits and other quality improvement projects on a range of topics in women’s health care through the Lindsay Stewart Centre for Audit and Clinical Informatics.
The Healthcare Quality Improvement Partnership (HQIP) was established in April 2008 to promote quality in healthcare, and in particular to increase the impact that clinical audit has on healthcare quality improvement. They are an independent organisation led by the Academy of Medical Royal Colleges, The Royal College of Nursing and National Voices.
HQIP aims to improve health outcomes by enabling those who commission, deliver and receive healthcare to measure and improve our healthcare services.
This guide brings together twelve quality improvement (QI) methods, providing an overview of each and practical advice on how and when to implement them, with illustrative case examples.QI methods covered include clinical audit; Plan, Do, Study, Act; model for improvement; LEAN/Six Sigma; performance benchmarking, process mapping and statistical process control and it is aimed at all professionals with an interest in QI.
This resource sets out the basics of statistical data analysis and presentation for those involved in local clinical audit and improvement projects. It uses illustrative case examples to:
These guides, and many other resources, can be downloaded from the HQIP website.
WoE AHSN has identified Quality Improvement as a key focus of their work is to create a culture of evidence-led best practice across their healthcare community.
East London NHS Foundation Trust (ELFT) is a provider of mental health and community services, to a population of approximately 1.5 million people, mainly across East London, Bedfordshire and Luton.
ELFT aspire to provide care of the highest quality, in collaboration with those who use our services. ELFT is an organisation that embraces CONTINUOUS IMPROVEMENT and learning.
The NHS Scotland Quality Improvement Hub website provides a range of resources to support organisations to improve the quality of healthcare and aims to be a one-stop shop for knowledge and implementation support to QI.
The Knowledge Centre provides access to Quality Improvement Tools, case studies and evidence. The QI Tools section alone contains nearly 60 NHS relevant QI topics including Driver Diagrams; Model for Improvement; Run Charts; Stewhart Charts (SPC); Situation, Background, Assessment, Recommendation (SBAR).
The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization based in Cambridge, Massachusetts, is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide.
They have a vast array of QI resources on the QI zone of their website which reflects their expertise in QI in general and their particular role in developing the Breakthrough Series Collaborative concept based on the Associates in Process Improvement‘s “Model of Improvement.
Their collection of audio video resources, including their Science of Improvement "Whiteboard" videos are well worth a visit.
Their website also includes a Patient Safety Toolkit which includes tools to help improve teamwork and communication; identify and address root causes of errors; and build reliable systems. Each of the nine tools includes a short description, instructions, an example, and a template to assist with implementation. The tools are available for downloading and include:
The NHS Institute was a special health authority of the NHS. Their archived website can still be accessed and contains a large number of QI resources which remain relevant today and are available online in their searchable library, available free of charge to the NHS in England.
Many of the resources were compiled into a Handbook of Quality and Service Improvement Tools which brought together 75 proven tools, theories and techniques for quality and service improvement. This handbook can be downloaded as a pdf document from the Wessex PSC resources on the right hand side of this page.
National Quality Board
The NQBs "Shared commitment to quality" describes the The quality challenge facing the NHS as "Quality must be the organising principle of our health and care service. It is what matters most to people who use services and what motivates and unites everyone working in health and care. But quality challenges remain, alongside new pressures on staff and finances." The full document can be downloaded from the Wessex PSC resources on the right hand side of this page.
Information on NHS England workstreams delivering the vision of a modernised NHS – driven by a clinically led commissioning system – focusing on improving quality outcomes for patients.
Improving quality is about making healthcare safer, effective, patient centred, timely, efficient and equitable.
The Sustainable Improvement Team (formerly NHS Improving Quality) is one of the driving forces for improvement across the NHS bringing together a wealth of knowledge, expertise and experience from across the NHS. It works to improve quality of care by achieving large-scale transformational improvement and change.
The Wessex General Practitioner Educational Trust has been a registered charity since 1990 supporting GP education in the Wessex region.This website aims to signpost all events and resources supporting education and development for local GPs.
Represent GPs and practices across the counties of Dorset, Hampshire & the Isle of Wight and Wiltshire. This website provides Education, Training and Development for GPs, Practice Managers and Clinical Staff.
HQQ has over 20 years' experience serving healthcare organisations providing educational and consultancy services to public sector healthcare organisations, government bodies, Royal Colleges, private sector healthcare organisations, and others. They also have experience working in university hospitals, community hospitals, primary care settings including individual general practices, mental health care settings for a full range of mental health services, services for people with learning disabilities, and other healthcare services.
Whilst HQQ is a commercial (non-NHS) organisation it is another great source of Quality Improvement resources which can be accessed via their website.
Into Practice Guide
The NICE "Into Practice Guide" has been developed for people involved in commissioning or providing high quality care and improvement in health and social care organisations. The guide provides practical advice on how to use NICE guidance and related quality standards to achieve high quality care. This includes:
The guide covers topics such as the best ways to assess the extent to which your organisation is implementing NICE's recommendations - and how to address any gaps if you find out it is not. It includes helpful tips, links to other resources and case studies from our shared learning examples describing how other people have used NICE guidance and quality standards in similar situations to yours.
If you want to ensure your organisation has an effective process for implementing NICE guidance and using NICE quality standards to improve care and outcomes, then this guide is a must-read.
Hard to categorise this one but well worth a visit, I'll leave the founder Roy Lilley to explain...
I want to make the Academy the first port of call to show off (why not), to make us proud and put a smile on the faces of the people working right across the NHS; to make services better, more efficient and above all fun. If you have a problem you can bet someone else is facing the same challenge. You can almost guarantee, somewhere in the NHS somebody has an idea or a solution that will help. The Academy will only work if we share the good stuff and I’m guessing we want to. Five years of writing editorials for nhsManahers.net has filled my in-box with people offering readymade solutions, ideas and answers to the questions we all face. It’s time to pass them on.
Blogs & Articles
We often overcomplicate improvement. Sometimes people think these skills are all about a mysterious language and set of tools. It can seem inaccessible, but improvement is innate. We all do it in our daily lives. We just don’t necessarily call it “improvement.” For example, when we try a recipe and it doesn’t work out quite the way we wanted — say it was too salty or too watery — we tweak it a little bit the next time we make it. Or when it takes too long to get out the door in the morning with two kids, we try different ways to organize our morning routines. We innately do these things to make something better.
The challenge is how to tap into that natural tendency at work. It’s hard because you’re often working with many people in complex systems that are often invisible. That’s where improvement tools, methods, and concepts can be helpful.
This article presents our reflections on the full potential of using PDSA in healthcare, but in doing so we explore the inherent complexity and multiple challenges of executing PDSA well. Ultimately, we argue that the problem with PDSA is the oversimplification of the method as it has been translated into healthcare and the failure to invest in a rigorous and tailored application of the approach.
Their paper can be downloaded from the resource zone on the right hand side of the webpage,
When W Edwards Deming (1993) was describing the skills and knowledge required in service improvement, he introduced the ‘system of profound knowledge’. This system consists of four areas that form ‘lenses’ with which to view any service improvement activity. They are typically described as:
This article by Jim Leonards is an excellent explanation of Deming's work.
What do Renaissance painting, civil-rights movements, and Olympic cycling have in common? In each case, huge breakthroughs came from taking tiny steps. In a world where everyone is looking for the next moonshot, we shouldn't ignore the power of incrementalism.
Click on the link above to listen to the podcast or read a transcript of the Freakonomics episode.
How to attribute causality in quality improvement: lessons from epidemiology (Poots et al. bmjqs-2017-006756)
Quality improvement and implementation (QI&I) initiatives face critical challenges in an era of evidence-based, value driven patient care. Whether front-line staff, large organisations or government bodies design and run QI&I, there is increasing need to demonstrate impact to justify investment of time and resources in implementing and scaling up an intervention.
The full article can be downloaded from the Resources are on the right hand side of this webpage.
The Framework for Safe, Reliable, and Effective Care provides clarity and direction to health care organizations on the key strategic, clinical, and operational components involved in achieving safe and reliable operational excellence. It comprises two foundational domains — culture and the learning system — along with nine interrelated components: leadership, psychological safety, accountability, teamwork and communication, negotiation, transparency, reliability, improvement and measurement, and continuous learning. Engagement of patients and their families is at the core of the framework — the engine that drives the focus of the work to create safe, reliable, and effective care.
Three things which may play out to have significant implications for quality in the NHS over the coming years.
It seems that much discussion about innovation in healthcare focuses on new technologies, but innovative behavioural change is essential if their promised benefits are to be fully realised.
The patient safety movement is at a critical turning point, according to one leading figure in the field. And if hospital leaders want to continue making progress, they need to recalibrate their efforts, or risk sliding backward.
The Plan-Do-Study-Act (PDSA) cycle is a fundamental tool in the quality improvement tool belt. PDSA cycles are used to test, implement and spread change ideas in a systematic way. Regardless of your improvement framework—collective impact, the breakthrough series, etc.—PDSAs can be used. Here are five tips for testing to optimize your next PDSA cycle.
If you have any questions about the Wessex Patient Safety Collaborative's Quality Improvement Resource Hub (QI Hub) or any other aspects of the Wessex PSC, please contact us via the link below:
Quality Improvement as described by Imperial College Healthcare NHS TrustBrowse all videos