Quality Improvement
Quality Improvement
Quality Improvement (QI) is a systematic and coordinated approach to solving problems in health and social care. There are a number of methods and tools which can help to understand systems and the areas where improvements are needed. These tools enable testing and measurement of your improvement ideas.
The image below shows the QI journey through an improvement project. This journey is not linear and is an iterative process.
At each stage of the improvement journey you should involve key staff from across services and stakeholders, including people with lived experience of mental health and substance use conditions.
Below you will find information about the tools which can be utilised at each stage of the improvement process.
Further QI based tools and information on the Improvement Journey are available on the NHS Education for Scotland Quality Improvement Zone.
Creating conditions
Early collaboration with staff and stakeholders is key to creating the conditions for implementing change within your system.
A Project Charter should be done alongside your improvement team. This should include a concise summary of the improvement aim, the scope of the project, ideas for change, how the improvement will be measured, who will be involved and any risks associated. It should also address the rationale or business case for the work and therefore is an important tool in creating the conditions.
Resources:
Understanding systems
If teams want different outcomes they need to understand how their system is currently working. They can use this knowledge to help them identify the right improvements to make changes where they are needed. There are a number of tools and methods which can be used to help understand your system, and therefore any problems which need to be addressed. These tools should be done with your improvement team and any relevant stakeholders.
Resources:
Developing aims
Once you have identified the improvements that need to be made you will want to develop your aims for the improvement work, and the measures you plan to use to understand if the aim has been met. Your improvement team should be involved in developing your logic model, measurement plan and driver diagrams.
A logic model will help you to focus on your aims, activities and planned outcomes. From this you can create your measurement plan, which will outline how you will measure your outcomes. Driver diagrams visually present a team's theory of how an improvement goal will be achieved, and will help to define your change ideas.
Resources:
Example driver diagram MHSU: IoR Inverclyde Discharge Planning
Testing changes
Testing the changes you want to make requires evaluation and reflection to determine if the change has made any impact. You can then amend any aspects before rolling out. You will study the data before and after implementing changes to determine the success.
A Plan Do Study Act (PDSA) method is helpful for considering what you want to find out from a test of change, what predictions you have about what will happen and reflect on learning from the test. This should be completed with your improvement team.
A Run Chart is a helpful way of displaying data and analysing the effectiveness of introducing your test of change.
Implement
Implementation planning templates can support your team to consider the impact of change ideas, enablers and barriers to change, roles and responsibilities, and immediate next steps.
Implementation planning guidance
Spread
Once your change idea has been successfully tested it may be time to spread to new areas, teams or other parts of your system.
Successful spread involves developing a spread plan and a spread aim to measure and evaluate progress. Using the “Readiness for Spread” checklist can help you to assess if your change idea is ready to spread. Also have a look below at the questions to ask as an improvement team which will help to spread improvement.