Quality improvement in practice: lessons from mental health

Quality improvement is a systematic approach to enhancing patients’ safety, their outcomes and their experience of care. It generally involves applying a method systematically, but it’s also a way of working that engages everyone working in an organisation; it’s about a continuous effort to make and test improvements.

We’ve seen a growth in the use of quality improvement approaches in the NHS, and The King’s Fund wanted to learn more about the opportunities to use those quality improvement approaches in mental health care settings as well.

Two of the case studies featured in our report are Tees, Esk and Wear Valleys NHS Foundation Trust, and East London NHS Foundation Trust. And they’ve both been doing this for some time, and we’ve asked them share some of the key insights into what they’ve learnt along the way.

My response to people who ask ‘why should we be interested’ is always to flip that around and say ‘why wouldn’t you be interested’. So at the moment most services have massive challenges, unprecedented challenges. How do you maintain quality in the face of rising demand?

I guess the most satisfying bit to see is that things are getting better for the people we serve. So we have lots of evidence of outcomes improving: whether that’s a ward being a safer place; whether it’s people being treated at home rather than in hospital and reducing the need for inpatient admissions; whether it’s a community team seeing people quicker; making sure that people feel engaged with the treatment that they’re being offered. There’s so many stories of people receiving a better experience and outcome of care.

Even though over recent years we’ve had increased demand on services – particularly our children’s services – through our improvement work we’ve been able to make sure that we continue to make sure that people aren’t waiting for care and treatment, because we know that waiting really makes people worried and can make things worse; whereas getting in early can really help people. So we’re really proud that we’ve been able to do that.

I think a lot of the work we’ve done around sharing of information with patients and their families has been really important, so people are informed and communicated with about their conditions. The new advent of our recovery college online – which empowers people to take control of their own recovery journey through an online resource which is open access, and they can sign up to it as learners on the online recovery course – and also the sharing of information we’ve done with GPs, I think has really benefitted service users, their families, and our other partners in health care.

The staff here also, I think, have a different experience of working here than they maybe did 10 years ago. I think people feel like they have a way to contribute; they have a bit more control over their workplace; people probably feel like they are working in stronger teams, rather than in separate disciplines and silos. All of our improvement work is done in whole teams.

I think all of those things make the place a more fun place to be, make it a place where you actually can change things, and I think that gives people a lot of satisfaction in their day-to-day work.

At the heart of quality improvement is all about service user and carer involvement. When we’re running quality improvement activities we provide the same training to experts by experience and service users who would be part of quality improvement work as we would to staff; and that’s really the joy in all of this, so when you see a group of staff, service users and their families all working together on the same project – making improvements together – that’s where you know that things are really moving and shaping, and that we’re really focusing our quality improvement activity in the right place. So that’s a must – a big yes for that one.

Every single project here, we make sure right from the very beginning that, first of all, the thing they want to work on is something that actually matters to the people receiving the service and the people delivering the service; that’s very important. And from that point onwards there would need to be a way for people to be part of the work; the people delivering the care, but also the people receiving the care. And then you need to think about, when you have work happening at scale, how you spread from one place that’s solved a problem – trying to take that learning to other places. And again the beauty of the method is it gives you a way to do this – systematically, and thinking about the core components that are going to lead to success; spread, from one place to another, to another.

It’s not a project; it’s not a piece of work that’s going to last for two or three years – it’s really something that organisations need to think about for the long-term. So maybe 10 or 20 years, maybe even 30 years, for organisations that really take this seriously. So boards do need to buy into that, and believe it’s the right thing to do for their organisation.

We’re trying hard to find ways to make this work; part of the way that our teams function, not an extra add-on that people do if they have time, or just the super keen people take part in, but the way that all of our teams function.

And I think the only real way to do that is to think differently about what you do as a team; rather than add it on to something, it’s got to be about taking things away as well. So I hope our teams are starting to now think: do we still need all of our business meetings; do we still our governance meetings to function in the same way, or can part of that now be about rapid-cycle improvement, and bringing your team together to solve a complex problem?

So our research has shown that quality improvement is one way to improve the quality of care, and with the right conditions and a commitment from the leadership, there is scope for quality improvement to be applied across all types of health care settings.