Staff involvement in a multi-professional approach, as well as patient and family engagement, are crucial to ensuring that QI efforts are directed to the things that matter to people. How you communicate improvement work is key to its success. Staff engagement is essential to be able to deliver QI work and to embed what works to be practice as usual.
Staff need to be convinced that this is the right thing to do. Often the best way to achieve this is through a co-production approach that takes patients and staff on the journey of exploring the issues, designing the intervention and being part of the implementation team.
The success of a quality improvement project is often more dependent on getting the engagement of the staff who will need to be involved to make the change happen than the particular technical approach taken to quality improvement.
The core enablers for successful implementation can be summarized as:
- Engaging the staff team
- Clarifying the aims, ensuring this relates to what matters to patients
- Choosing the most appropriate QI tools
- Understanding the resources that are available for the work and;
- Learning as a team through practical experience.
This example from the IMPROVE UK Advanced Ovarian Cancer Pathway project shows how the team realised the importance of involving staff and responded to this:
The IMPROVE UK project based at Gateshead was able to rapidly arrange a steering group to finalise the advanced ovarian cancer pathway (ACOP) which was the core of the project intervention. Anaesthetics were supportive of changing job plans to facilitate additional cardiopulmonary exercise slots. However, as biopsies could only be discussed at the main MDT along with their imaging, some patients were deemed unsuitable for surgery and clinicians not on the steering group would cancel appointments at short notice, referring the patients directly for neoadjuvant chemotherapy. The knock-on effect of this was that precious anaesthetic slots were going vacant with no ability to fill at short notice. It was not anticipated that some patients would not be suitable for full anaesthetic exercise test assessment and this also resulted in inefficient use of appointment slots. The team responded by drawing up a clear protocol which was circulated to all relevant clinical teams to follow. The project team then ensured that a member of the AOCP steering group attended all central MDTs to provide updates and answer queries.
As the pathway continued to be implemented, a number of changes were made to the triaging of patients for face to face clinic appointments, determining suitability for exercise testing, and the tasks for staff in the clinic appointments. This worked OK when there were a small number of clinicians involved in developing the pathway and responding to how it was going by making necessary changes. However, once other staff were involved and project team members were absent due to sickness or holiday, it became clear there were problems around lack of information relayed to patients about what to expect in the pathway, patients not having bloods taken or being sent home without being signposted for anaesthetic assessment. In response to this, the project team developed a clinical SOP which was circulated to all the team with updates and amendments circulated as needed to the team. These are presented at monthly team meetings, MDT business meetings and on a weekly basis in clinic. AOCP champions were identified who could be approached for any queries, so that any problems could be identified, discussed and resolved as they arose, without any impact on the patient or pathway.
The project team assumed that other staff would be aware of channels to raise issues around the AOCP project. However, there was a perceived barrier for staff not on the project team to raise issues. Clinic staff felt that they were ignored. This was tackled through introducing a team huddle at the beginning of clinic including anaesthetic, admin and clinic staff to discuss the flow of patients through the service on that day. Built into this was the opportunity for staff to bring up any problems. This led to staff feeling that they were heard, and some great ideas came forward from all groups of staff.
Below are two examples of how IMPROVE UK Pilots engaged and successfully involved patients.
- Enhanced Case Study: Patient Engagement in the HICO Project
The HICO project stood out for its robust patient-centric approach, aiming to improve treatment for older women with ovarian cancer. A highlight was the formation of a Patient Advisory Group (PAG), comprised of five patients who were actively involved throughout the project. The project's commitment to patient engagement was evident in its weekly allocation of dedicated time for patient interaction.
Feedback was solicited at multiple points via structured assessments and focus groups, which led to an improved patient experience. For instance, global health scores saw a statistically significant improvement from an average of 4.4 to 5, reflecting a better quality of life during treatment. About 54.8% of patients reported an improvement in their global health, attesting to the project's effectiveness.
However, there were challenges. Despite positive initial assessments, only about 40% of patients completed multiple follow-up assessments. This was attributed to issues like fatigue, numerous appointments, and disease progression, suggesting a need to streamline follow-up protocols for better data consistency.
Furthermore, although 90% of patients were seen by a physiotherapist, some declined further assessments, leading to incomplete longitudinal data. For example, while 82.7% of patients could complete the 6-minute walk test initially, only 33 patients could be assessed over time. The drop-off in patient participation in these assessments indicates areas where engagement could be strengthened.
In summary, the HICO project successfully implemented patient engagement strategies, leading to measurable improvements in patient experience and quality of life. However, the drop-off in follow-up assessments signifies room for improvement in sustaining long-term engagement and underscores the need for a more streamlined approach to data collection.
- Patient Engagement Triumphs: Breaking Language Barriers in the DEMO Project:
The DEMO project placed a strong emphasis on patient involvement, particularly from minority and BAME groups, to address disparities in ovarian cancer care. Through consultations, virtual events, and consensus meetings, patients had a direct role in shaping the project's focus and activities, making the approach genuinely co-produced. Educational materials were developed not just in English but also translated into multiple languages like Punjabi, Urdu, Bengali, Polish, and Romanian to overcome language barriers, which is critical as 54% of the women diagnosed in Birmingham were non-English speakers.
These efforts resulted in a 100% uptake rate for genetic testing when offered. While the initiative successfully created a sustainable co-production model, focusing on equity, it did face challenges such as late engagement with networks and limitations due to staffing issues. Nonetheless, the patient-centric approach stands as a testament to what can be achieved with meaningful, inclusive engagement.
Links to references:
Batalden M, Batalden P, Margolis P, et al, Coproduction of healthcare service,
BMJ Quality & Safety 2016; 25:509-517
Coalition for Personalised Care Co-production Model