East London NHS Foundation Trust responds to the "outstanding” rating they received from the UK’s Care Quality Commission. They were one of the first NHS providers of mental health services to be given the top rating.
Based in one of the most culturally diverse and economically disadvantaged inner city neighborhoods of London, the hospitals and community centers of East London NHS Foundation Trust (ELFT) offer mental health and community services to a population of about 1.5 million residents. Despite the challenges they face, the first thing you notice about ELFT’s staff — numbering 5,000 spread across more than 150 clinical sites — is their energy and excitement about their quality improvement (QI) work.
Paul Binfield, head of people participation at ELFT, attributes this to patient engagement.
“Every project includes one or two users with lived experience, and they’re given the same freedom to lead projects,” he says. “Instead of having QI staff say to patients, ‘Come help us with our project,’ they let patients start their own projects and tell staff what they need from them. For me, that’s the story of our success.”
Through a program begun in February 2014, ELFT has transformed inpatient and outpatient facilities into laboratories of quality innovation by investing in training in improvement science for staff members across the board and giving them the tools and confidence to turn that knowledge into better care for their patients.
The training opportunities, offered in part through a strategic partnership with IHI, are designed to meet staff members’ varied needs: from six-month intensive quality improvement (QI) training programs to multi-day workshops, access to IHI Open School online courses, and a self-designed “Pocket QI” overview tool.
The broad aims of ELFT’s QI initiative are to reduce harm by 30 percent each year and to ensure ELFT patients receive the right care in the right place at the right time. The program targets four priority areas: reducing violence, avoiding pressure ulcers in the community, improving access to community services, and improving the physical health of people with severe mental illness.
To learn more about what makes ELFT unique, we asked three staff members, including Binfield, what stands out for them about their QI experiences.
Binfield, who directs ELFT’s approach to involving service users (patients), carers (their caregivers), and families in all QI work, points to the unique culture of the organization: “There’s a high level of trust leadership has in staff and service users. They’ve given up a lot of traditional control. Instead of telling front-line staff what to do, they let them choose and run every QI project themselves, acting almost as a support service for the front line.”
Dr. Dinesh Sinha, consultant psychiatrist and associate medical director of general psychiatry, reflects on his pride in seeing for the first time the “We’re Quality Improving” video presented at the 2016 International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden: “I was so impressed that a member of our Trust staff, who is local to where I work clinically, had the drive to take on this project and the skill to create something really powerful, with such an emotive quality.” Sinha notes, “It sounds corny, but it’s about love of the system, finding joy in your work. It’s an example of engaging people in something beyond what their job role is; finding a way to excite staff.”
Dr. Tamsin Black, QI Lead and joint head of a secondary care psychological therapies service, describes the attraction of QI for her colleagues: “At the heart of every clinician in the UK NHS is a drive and commitment to make things better for our service users. The QI programme at ELFT taps into that.”
Black points to a QI Collaborative working to reduce wait times for mental health services, a long-standing challenge for ELFT. “When a person bravely seeks a talking therapy and manages to end up sitting opposite a psychological therapist,” she says, “a process of engagement begins. We’re working to create motivation, an atmosphere of trust and optimism that will help build momentum for change and recovery.”
While pressures across NHS to reduce costs and cut services can be dispiriting to the workforce, Black says, “QI is an invitation to innovate and to contribute to increased efficiencies for the benefit of service users.” It’s an opportunity that inspires confidence, she says.
“I am really proud that as I am developing my confidence as a leader, it seems that other team members are feeling more confident to approach me with their ideas and to take charge of their own PDSAs (Plan-Do-Study-Act improvement cycles). They know I will support them to learn honestly from our mistakes and champion our successes.”