Paul Binfield is a busy man. As Head of People Participation at the East London NHS Foundation Trust (ELFT), he receives a continuous flow of emails, calls, visit requests, and speaking invitations from around the world.
Paul is in such high demand because a growing number of health care organizations are interested in learning how ELFT integrates patients and their caregivers — who ELFT calls “service users” and “carers” — as equal contributors into quality improvement (QI) teams. ELFT are pioneers in providing special QI training and support for patients and families.
What some might consider innovative, Paul considers business as usual. “It’s a bit sad that people around the world are not routinely including service users and carers in QI,” he says. “I think health care organizations are missing out.”
Paul is eager to help others and, in an interview with IHI, he shared his advice to organizations interested in co-designing QI with patients and families.
Don’t Skimp on Resources
Paul Binfield (PB): Most organizations I’ve come across don’t resource [people participation] well, so it’s often added on to someone else’s job description as a bit of an afterthought. This doesn’t give staff the time to focus on this work effectively. We started off as a small team of just three staff members, and now we're up to 12.
Be Willing to be Challenged
PB: Quite often in health care services, any sort of challenge ignites defensive behavior. We’ve learned that if you want to run a quality service, you need to get the service user viewpoint. So, when someone challenges us, we welcome it. It’s an opportunity. We don’t pretend everything is fine. This work is about a culture change. It is about listening. It is about being challenged and accepting that challenge. If you don’t welcome honest, constructive feedback, I would really question how you can deliver a quality health service.
Don’t Create Policies and Procedures Too Quickly
PB: I get contacted by a lot of organizations who want our policies and procedures, but I often tell them that the first thing they need to do is just get people in a room. Put staff, service users, carers, and families together and say, “This is what we want to do. How do we do it?” That conversation will then over time develop into policies, strategies, and procedures.
Make Sure Your Improvements Benefit Both Staff and Patients
PB: If you’re trying to improve a system or a process, you have to make sure that everyone involved is involved in the improvement. You could take a process in health care and improve its efficiency, cost, staff time, or staff experience, but if the new process makes the patient experience worse, is it really an improvement? We’ve seen projects that have changed a process and made staff happy, but then the service users have said, “It’s now taking us longer to get through this part of the system,” so we had to keep adapting it. You use what you know about QI, and make small changes and test them.
Some organizations are wary of making patients and families equal QI partners. But once people start to do it, they often say things like, “Why didn't we do this sooner? They’re helping to make the work easier.”
You may also be interested in:
Building a Culture of Improvement at East London NHS Foundation Trust
The Evolution of Patient-Centered Care and the Meaning of Co-Design