How our Q Exchange 5 projects are approaching the issue of delays

In 2023, we sought to fund improvement projects that would reduce delays sustainably and equitably, focusing on one or more of the following areas:

Redesigning care to best use the time and skills of those using and providing services
Understanding and improving how different parts of the system work together to meet patient/service user needs in accessing services
Improving the way waiting lists are prioritised and managed and supporting patients to wait better
Empowering and engaging the workforce to collaborate and use improvement methods in reducing waits.

The responses from the successful projects are creative, inspirational and include some striking outcomes that are emerging as the projects unfold.

While they share many similarities, the obstacles and challenges these projects are encountering need solutions suited to their local health care system and cultural context.

Our review of the mid-project reports has uncovered three themes common across our projects: sustainability, collaboration for equity, and building in co-design. Below we draw on examples from the ongoing projects, highlighting their challenges and achievements so far.

1. Creating a project that is sustainable for the longer term

As sustainability was part of our criteria for Q Exchange 5 it’s no surprise that it is showing up across the projects. We wanted to see examples of improvement that could be sustained over the longer term, combining creativity with technical skill to trigger system-level change without the need for more resources. What’s been interesting to see is how several of the projects have created practical – and sometimes very bold – ways of using what they already have. In practice, this sometimes means stopping doing things one way and starting to do them another.

We are seeing power shift from staff to patients, resulting in more effective self-care, reducing the need for patients to repeat their stories to professionals and using digital tools to support isolated young people.

Shifting the paradigm – from managing illness to promoting wellness

A combination of health coaching and peer support is aiming to empower young people in the East Midlands and London to improve their own rheumatological health. The clinical team has established and sustained a strong connection with a group of young people with lived experience of rheumatology. These young people are providing peer support and health coaching to other patients, who are also their peers. This is part of an incremental power shift to facilitate knowledge sharing between patients, allowing them to become independent and knowledgeable about their own self-care.

Access to Psychological Support and Transition Improvement for Diabetic Teenagers

A pre-moderated digital tool is being used in Somerset to ease the transition to adult care for young people with diabetes. Somerset has a relatively large cohort of teenagers living in isolated rural areas who need intensive education, support and motivation to manage their diabetes effectively. Using a digital tool known as Tellmi, young people are anonymously sharing their experiences and getting support in a way that feels safe and familiar to them. The information young people share on the digital tool has been pivotal for health professionals gaining insights into the needs of teenagers with diabetes. This is helping the improvement team to develop a more holistic, integrated approach to caring for young people with diabetes as they transition to adulthood.

2. Collaboration for equity

It’s becoming increasingly clear from the projects we’re supporting that improvement of every kind requires collaboration across clinical boundaries, and often geographies. The Q Exchange 5 projects that focused on equity – whether for British Sign Language users, patients with experience of homelessness, or for people with learning disabilities – all had strong elements of collaboration.

Improving Outcomes, Access & Waits for Deaf British Sign Language Users

A collaborative project in Newcastle is surfacing fresh insight about how complex it is for British Sign Language (BSL) users to access care, and the barriers they face across the system. These include the need for improvements to staff training and awareness, access to interpreters, and information services that empower BSL users to make informed decisions about consent to treatment. The project is targeting outcomes, access and waiting times for these patients, to reduce an identified trend of inequitable access. Two Health Navigators with expert knowledge of the local health landscape offer a personalised, integrated service for patients engaging with primary care, acute care, administration and appointment services, and other areas of care.

Reducing Inequitable Delays for Procedures for Patients with Learning Disability

A team developing a care support package for people with learning disabilities is using system-wide collaboration to draw on patient, clinical, QI and academic expertise. In their scoping study, University Hospitals Plymouth discovered that patients with learning disabilities consistently experience delays to their care and identified a lack of literature in this area. Through engaging directly with a wide stakeholder population that includes patients, families, carers and community health and care partners, the project team is building their own body of primary research.

3. Building in co-design

Co-design with patients is also emerging as key to ensuring equity while tackling delays, with many projects finding experts by experience to contribute their insights and solutions to the underlying issues driving health inequalities.

My Story, My Words, My Voice

We referenced My Story, My Words, My Voice in the two themes above but the overriding theme for this project is co-creation. A cultural inclusion project for people with experience of homelessness, it is co-creating a digital solution for vulnerable adults who are often required to repeatedly relate the soundtrack of their lives to health and care professionals. Participants with experience of homelessness have been advising the Project Board about their experience of the “repetitive story situation” and have produced videocasts of their life experience for sharing digitally with care professionals ahead of appointments.

Additionally, they have co-created a logo with the project team to be used on lanyards and medical communication alerts. The logo lets care professionals know that they need to listen to the patient’s digitally recorded story and ensure that the patient is made to feel ‘Safe, Respected and Heard’.

A Co-produced Approach to ‘Waiting As Well As Possible’

Waiting As Well As Possible is seeking to understand what people who are waiting for psychological care in South Wales would find most useful to help them to wait well. It aims to improve support for those waiting for psychological intervention, reducing feelings of hopelessness and improving wellbeing. Building on an existing community of practice, the team is made up of those with lived experience, clinical expertise, partner agencies, and the local health board. The support package includes a peer support worker with lived experience and an assistant psychologist.

The project has so far highlighted the value of recruiting people with lived experience, with patients reporting that they receive a greater level of reassurance from them than from other professionals.

The team has also found that having a weekly huddle has been crucial to progressing this work. Even though not everyone can always come, meeting together each week has created and sustained a sense of team cohesion and momentum.

Challenges

One of the key challenges projects outlined was gaining uptake and ongoing engagement from target patient groups. While projects recognise that this is to be expected when working with difficult to reach groups, they are grappling with how to ensure projects focused on equity are reaching the people who need them most.

Other challenges include project management support to take the burden of administration away from project leads, and service pressures reducing the ability of teams to provide the necessary support to patients taking part in projects.

Find out more and follow the teams’ progress

Q Exchange is our £800,000 collaborative funding programme, supported by the Health Foundation and NHS England. We offer Q members the opportunity to develop and submit project ideas for up to £40,000 funding.