From 2019 until 2023, University Hospitals Bristol and Weston (UHBW) ran the QI Gold training programme, as the top-tier of training in our QI Academy.

As the QI Gold programme has now ended, I wanted to take the opportunity to reflect on and share our learning for others interested in establishing a similar level of training.

Background to the course

This course offered advanced-level improvement, project management, and change management training to teams working on divisional projects.

The intention was to build the capability of staff working within the divisions to be able to deliver large and complex projects, which didn’t meet the threshold for support from the corporate improvement team.

We delivered three cohorts over three-and-a-half years, which saw 97 staff attend the training, working on 19 projects.

The training itself received excellent feedback, yet many of the projects still failed or struggled to deliver the intended benefits.

This was in part because of the COVID-19 pandemic, but also because of the usual challenges of implementing change.

Teams need time to work on their project

Most of the staff working on projects did not have protected time to work on their QI Gold project outside of the training, so progress between training sessions could be slow as people juggled other commitments.

This meant that the time working together as a project team during the training days, away from the hospital, was invaluable.

Some teams found it useful to have ‘action meetings’ to work collaboratively in a weekly or fortnightly huddle, rather than using meetings to set actions that couldn’t realistically be done outside of the meetings.

If the course was continuing, I would be considering how divisions could try to free up the time and other commitments of the project team members, or how else we could protect project team time. This is increasingly challenging as industrial action and operational pressures continue.

Another consideration is that perhaps as a Trust we were trying to do too much.

A question for us is: how can we ensure that these projects are absolutely the priority for the division? This leads us to the next learning point.

Divisional ownership and governance is key

Although QI Gold was intended to be an opportunity to build the improvement capability of divisional staff, for some divisions and team members it became ‘another thing to do’.

Sometimes ‘nice to do’ projects were put forward by divisions rather than their ‘must do’ projects, and this meant that some project teams struggled with having the leadership and governance they needed to drive their project forward.

It helped to shift our training timeline to align with the operating planning process and timeline of April-March.

If we were continuing I would want to work with divisions to understand what would make the programme desirable to put through their must-do projects, and make it a worthwhile investment of their time.

As a Trust we are also trying to prioritise our work more, do less, and do it better.

Effective team working is an important as ever

Some teams were newly formed for the QI Gold project, others knew and worked with each other before the programme. Either way time for the team to develop trust, set clear goals, and agree roles and responsibilities was important.

In later cohorts of the programme we spent time on the first training day discussing this, sharing their strengths, and what their ‘team superhero’ might look like; strengths, weaknesses, and mission.

Balancing information needs and information overload

We tried to front-load the training for our first cohort, to give attendees all the information they needed at the start.

In later cohorts we changed the cadence to deliver monthly sessions touching on some topics, such as project management, across multiple sessions to try to drip-feed the information. A downside of this approach was attendees saying, ‘I wish I’d known this sooner,’ to topics on the later sessions.

All project teams were supported by mentors, which helped some of the training to be embedded into the project, but sometimes project teams found that time was a barrier to using this support.

So, what’s next?

UHBW has started implementing the Lean-base continuous Improvement approach Patient First, which is a whole Trust approach to organising, aligning, and communicating ourselves towards improvements.

Over the last year we’ve trained almost 400 leaders in Patient First tools and methodologies, and started training the first teams in January 2024. Many of these tools are the same or similar as we’ve been teaching on QI training, so we aren’t starting from scratch.

Patient First has a huge emphasis on doing less, and doing it better ‘Inch-wide, mile-deep’ which we hope will help to focus and prioritise people’s time to work on improvements.

Share your QI training tips

Do you have experience of QI training or running improvement training programmes? Share your top tips in the comments below.