Photo by Mei-Ling Mirow | Unsplash
Amy Chidley is a Quality Improvement Advisor with Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) in Birmingham, England, a member of the Institute for Healthcare Improvement (IHI) Health Improvement Alliance Europe. As an “Expert by Experience” — a patient who offers invaluable perspective as a user of the Trust’s services — Chidley’s focus is on perinatal services. In the following piece, she describes why the QI training she participated in was “one of the best things [she] ever did.”
Five years ago, I suffered from severe postnatal depression. It was complicated by other physical problems I was experiencing and medications I was using at the time. I ended up in a mother and baby psychiatric unit (MBU) for seven months, which was a long and distressing time. However, being in that environment gave me specific insights into mental health issues.
After I was discharged from psychology services, I was invited to join two groups, one of which was BSMHFT’s Friends of the MBU, which involves former patients and staff members. In addition to offering support for each other, we advise on new ideas about activities, review documentation or revised policies, and take part in staff recruitment interviews for the Trust.
I also became a peer support worker for By Your Side, a charity which offers support to parents who are struggling with their mental health during pregnancy or after having a baby. I leapt at this opportunity straightaway. I knew I wanted to sit alongside mums who were in similar situations to the one I had been in because I remember that the first time I had felt some hope in my recovery was when I met a peer support worker. She was not a health professional telling me, “Yeah, you will get better. Everyone else has.” Having a previous patient of the MBU say, “This is my story. This is how poorly I was. And I’m out the other side now” was a transformative point in my recovery journey. These stories are vitally important for patients, but health professionals also need these insights to remind them that people do get better.
Sometime later, someone at the Trust invited me to a training course on Quality Improvement for Experts By Experience. I thought, “Anything that I can do to increase my skills to improve services has got to be a good thing.” It was a four-day course online, and it’s one of the best things I ever did.
Suddenly, the world of QI was opened up to me. Instead of isolated patients expressing, “When I was in this service, this didn’t happen, and they didn’t listen to this, or that could have happened. I wish they’d do this,” it was, “There’s a method to make improvements. There’s a process for working these things through.”
It wasn’t just filling in a feedback form and hoping it’s going to do something. Being part of a QI project is about getting to know people in the health care profession and building a team with them to discover those small changes that might make a difference. I felt like if I took part in this QI project, then maybe some of the ideas I have might get a voice. Maybe changes would happen. And it suited my brain because I like methods and systems – to work with logic and not just wishy-washy ideas.
As soon as I completed my QI training, there was a perinatal project already underway that needed a QI-trained Expert By Experience. It’s been a great example of a QI project working well in which true co-production has been taking place. Looking at PDSA cycles and run charts showing real results has been brilliant.
Kindness On Its Own Isn’t Enough
BSMHFT’s organizational values are Compassion, Inclusion, and Commitment. That compassion element is vital. When I was very ill, if anyone asked me what’s the most important quality for someone to demonstrate, I always responded, “kindness.” If somebody is kind, we’re getting somewhere. If there’s no kindness, you might as well go home.
No amount of medical training can replace kindness. You need compassion to sit with someone and say, “We want to help you get better. We’re doing what we can, but this is tough, isn’t it? This is not where you wanted to be. We’re here for you.”
Whoever you are — whether you’re a peer support worker, clinician, or simply a friend — kindness goes a long way. But kindness on its own is not going to change policies. You need some kind of strategy to take that kindness forward. If I, as a peer support worker, for example, sit with another mum and we talk, and I offer empathy, I might help that one person that day. But if I’m not there tomorrow, what happens next? I need to take that compassion and find tools that can change things further up the system so that, when I’m not there tomorrow, there’s something else that’s going to help.
You can’t transform complex issues by just being kind, but QI gives you tools to solve complex problems and achieve tangible results. For people in health care, QI empowers them to take their caring further than individual patients.
In addition, for anyone who might assume that QI methodology might lack human elements, let’s blow that misconception away. For example, we can divide team members’ knowledge crudely into two types: a) codified or technical knowledge (which we would find in databases, toolkits, etc.) and b) intuitive or human knowledge what we have gained through experience, learning, interactions, practical applications, etc. This second type can account for about 80 percent of what is most innovative and proven most likely to lead to breakthrough. I believe this is why QI is so empowering and emotionally rewarding.
Amy Chidley is an Expert By Experience with Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) in Birmingham, England, and holds several other EBE posts at NHS England and Improvement and at the UK Royal College of Psychiatrists.
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Quality Improvement Essentials Toolkit
Why Do We Fear Co-Producing Health with Patients?