Aim: To achieve a reduction in non-fatal overdoses and drug-related death with the use of a community engagement tool

Approach: Despite incremental improvements across Scotland the number of Drug-Related Deaths in the Highlands continues to rise. This project will first create local improvement by testing and implementing the use of a Trigger Tool that was designed to identify and outreach those at risk. We will then generate transferable learnings by collaborating with staff to create a policy of best practice for the Trigger Tool. Evidence suggests that engagement with services has a protective effect for this vulnerable group.

This work will build on existing relationships between the Caithness Drug and Alcohol Recovery Service, emergency department staff and academics, and will make use of both the Model for Improvement and realist evaluation approach. We will interview key stakeholders to test and refine the theory of implementing the Trigger Tool and Assertive outreach within the emergency department.

Aim: To develop and deliver a high-quality transition health service for care experienced young people.
 
Approach: Children and young people who grew up in care are as much as four times more likely to suffer poor health 30 years later than those who grew up with parents. Looked After Children health team services do not routinely extend to care leavers, and this period of transition is a time of uncertainty and vulnerability.

Our project will develop and deliver a high-quality transition health service for care experienced young people, ensuring that they receive support, guidance, and advocacy around health needs during this critical phase of their lives. We will include an element of co-design to review what a young person approaching leaving care age wants or needs and to ensure that they are not lost between health services.

Aim: To assess environmental impact and cut down on medication waste in care homes through collaboration between staff from care homes, general practices, and pharmacies.

Approach: Medicines comprise 23% of the overall NHS carbon footprint and care homes dispose of approximately £50 million worth of unused medicines each year. While the financial cost is well documented, environmental and social impacts are less well understood. Exploring the organisational infrastructure of care homes, we will use the SusQI framework to measure the environmental, social and financial cost of medicines waste. We will then generate innovative and implementable solutions in line with CQC environmental sustainability exceptions and NHS net zero targets. We will produce educational resources, disseminate learning and engage with Integrated Care System and care home providers to embed guidance into staff training.

Aim: To address deprivation in South Wales valleys through working in partnership to shift NHS resources into communities.

Approach: Our communities in the South Wales valleys have experienced embedded deprivation over generations, which results in some of the worst health and wellbeing outcomes in Wales. This project will develop an analytical framework to shift NHS resources from secondary/acute services to the community, streamlining processes and enhancing collaboration among partners. It will empower our staff to make brave decisions, encouraging a culture of learning and improved relationships among health, social services and third-sector workers.

We will change the relationship we have between our partners building trust, compassion and empathy. We anticipate this project will have wider benefits for all cross-system working, which would create a strong legacy.

Aim: To improve services for children and young people with mental health and other complex needs not being served well by existing systems.

Approach: A cohort of children and young people typically access A&E in crisis and are put in an acute bed to receive treatment. Once their needs are resolved, owing to their complex social situation, they are not able to be discharged, sometimes for months.

To improve the service for these patients, we will collaborate across Harrow Council and Northwest London Integrated Care Board to carry out a longitudinal study about the system-wide care experience of these patients. Looking at presenting factors, patterns of service contact, risk factors, and accessing of urgent care, we aim to design a risk model to improve our methodology, and develop more personalised, effective and evidence-based support for these patients.

Aim: To co-produce a ‘wonderlist’ of the best ideas to help to improve waiting times in the NHS as a way to share improvement in as many settings as possible across the UK and Ireland.

Approach: While there are many examples of successful projects to tackle waiting times in the NHS, often they are not shared or spread beyond their local setting. Our project aims to significantly improve mechanisms for sharing these ideas to better capitalise on this resource.
Using a co-design approach we will deliver this project in three phases over a two-year period:

Phase 1: outreach to identify improvement work and development of a website to house the wonderlist

Phase 2: develop and promote guidance for spreading change

Phase 3: implementation and promotion of the wonderlist with ongoing evaluation and feedback.

Aim: To develop a tiered training and resource hub to support those working with neurodiverse people with eating disorders.

Approach: There has been an increase in people who are neurodiverse that have an eating disorder. Specialist staff working in eating disorder services have expressed their lack of confidence in providing the best care for such patients, due to their lack of knowledge about neurodiversity. Likewise, specialists working in neurodiversity services haven’t felt confident in supporting patients with an eating disorder.

Our project will work with clinical experts and people with lived experience to:

• train and build confidence of staff who are likely to meet neurodivergent people with an eating disorder
• develop an accessible online resource hub including case studies and toolkits
• improve neurodiverse patients’ experiences of eating disorder services.

Our learnings will be shared first in South Yorkshire and then nationally.

Aim: To co-create a Systems QI Practitioner programme through a national community of practice

Approach: There is a growing recognition nationally that we need to focus our efforts and energies more on system improvement and working across boundaries. We will co-create a new training programme to improve health and care systems, providing free resources by 2024/25 to help systems and organisations develop capability and capacity. Resources and guidance will include facilitation slide sets and templates for trainers, a Systems Improver handbook for delegates, and detailed advice for programme leaders on set up, delivery and evaluation.

These resources will be developed by a national community of practice, with oversight from NHS Elect, and when completed will be available for free to Q members. Given the importance of addressing health inequalities, this resource can also play a key role in tackling disparities in care.

Aim: To reduce mental health A&E admissions in Sheffield by improving the use of Psychiatric Decision Units, ensuring patients are seen by the right person at the right time.

Approach: Nationally, mental health patients account for 16% of all 12-hour waits in A&E and approximately 3% of overall A&E attendances. This project will make better use of Sheffield’s Psychiatric Decision Unit (PDU), improving patient experience and reducing pressure on mental health support within A&E. Patients will be directed straight to the PDU, avoiding the hectic A&E environment and allowing for quicker assessment by mental health professionals.

The project will also seek to address these health inequalities among the LGBTQI+ community and ethnic minority groups through increased involvement of service users and carers.

Aim: To develop an improvement academy in Sheffield, focused on mental health, for patients and voluntary and community sector organisations.

Approach: QI training can often be expensive which can make it less accessible to patients and front line workers. To address this, we want to use our experience in QI and our working partnerships with voluntary and community organisations to make QI training more widely available.

This project will be delivered through a supported application process. Successful applicants will get intensive training in quality improvement, measurement, bid writing and dissemination. We want to help organisations to better monitor their improvement and share their work, drawing support from more established voluntary and community sector organisations that have experience in this area.

Aim: To expand wound care services to reach vulnerable, hard-to-engage patients in community settings, such as those experiencing homelessness or substance misuse issues.

Approach: Our project will offer accessible and effective wound care to the most vulnerable members of the Kirklees community, reducing healthcare inequalities. By extending our services beyond traditional healthcare settings into community spaces like The Mission in Huddersfield and Change Grow Live, we will ensure that hard-to-reach patients receive care in environments where they feel comfortable and safe.

This approach will provide timely and appropriate wound care, leading to lower emergency department visits and better patient outcomes. With mobile health technology tracking patient care and outcomes, we will have efficient coordination among providers. This adaptable model is designed for expansion, encouraging feedback from patients and community partners to refine and improve service delivery.

Aim: To collaborate with local partners to co-design governance practices for local NHS trusts in response to patient safety incidents, using a human factors approach.

Approach: The project team will collaborate with local and national partners to co-design a guide for NHS organisations to respond to patient safety incidents in maternity services, using a human factors and ergonomics approach. This will include working with system users to understand if current practices examine safety incidents, identify systemic concerns and share learning appropriately.

We aim to embed improved local governance systems and processes that foster a more positive learning culture with a view to reducing avoidable harm. We believe our key output delivers a ‘pathway to impact’ in that it could be deployed by governance teams across and possibly beyond the UK, using our extensive clinical network.

Aim: To develop the skills of health care professionals in managing demand and capacity to support system-wide integration of care services.

Approach: Integration of services across partner organisations and system boundaries requires services to have a clear understanding of their pathways, flow, demand and capacity, and be able to apply this knowledge to integration of services. Those in operational roles are often clinicians by background, and do not always have these skills and knowledge.

Working with voluntary, clinical and local authority services, we will create a training and support programme for front line teams to give them the skills to manage demand and capacity. Once the programme is implemented, we will publish our work to encourage system-wide learning to support other organisations engaged in integrating their systems.

Aim: To improve support for people experiencing frailty through system improvement coaches to help teams join up the care on offer.

Approach: ‘Please, just ask them to work together’ was the feedback from a lady who had 82 medical appointments last year. So our call to action is to improve support for those with frailty by joining up care closer to home.

Frailty is a complex syndrome, present in 53% of people over the age of 65 in Gloucestershire. Having developed a system improvement coaching programme, we are training our second cohort of coaches in September 2024, who will then support neighbourhoods over the following year. This work is informed by our local Improvement Collaborative, and will be further developed through our work as a pilot site for the Health Foundation’s framework for improvement across health and care systems.

Aim: To increase involvement and representation from diverse communities on improvement work in health and social care services through the development of a training programme.

Approach: A recent pilot project in our area identified our community’s desire to be actively involved in shaping health and social care services. This project will focus on developing a team of diverse, community-based peer improvement champions through a training programme.

Using a co-design approach, we will deliver our project in four phases:

Phase 1: Conduct a needs assessment for our steering committee and co-design the programme.
Phase 2: Develop training materials and recruit diverse community members to strengthen our partnerships.
Phase 3: Deliver training sessions and improvement initiatives.
Phase 4: Analyse project findings and establish a sustainable approach to share learning, with peer support for champions.

Aim: To reach front line staff and the public with critical patient safety learning and resource materials.
 
Approach: This project will use a multidisciplinary team, including patient advocates and clinicians, to co-design a multimedia resource pack for health care services and patient advocacy groups. It will enable us to reach people that may not be aware of the PST programme and identify more diverse ways to spread learning and help close the loop on patient safety incidents.

The pack will include leaflets, posters and banners, as well as digital resources of electronic posters, digital presentations and videos. A communications campaign will support the launch and we will evaluate the usefulness of the pack as part of the overall review of our patient safety learning programme.

Aim: To support bereaved children and improve their outcomes with a single session intervention.

Approach: With 90% of children having experienced bereavement of a close relative, friend or pet, this project will provide a single session intervention (SSI) to prevent more complex needs developing. We will support children experiencing bereavement through a collaborative approach that brings together key systems around the child – healthcare, education and the voluntary/community sector. This will include:

• co-facilitating children’s workshops to enhance coping skills and adjustment
• providing timely information, resources and signposting
• providing an opportunity to connect and build trust with ‘warm introductions’ for children and partners
• empowering children to have active roles in their grief journey
• enhancing staff knowledge and competence.

The funding will enable us to employ a co-ordinator to train staff across systems and co-deliver the workshops.

Aim: To develop a comprehensive data overview of the person at the centre of health care, with the aim of evaluating and measuring the value and sustainability of services.

Approach: Fragmented and incomplete data often fails to capture a holistic view of the person at the centre of healthcare processes, their goals, challenges and wishes. This project will establish a bigger picture of the patient by pulling data stored across paper and digital sources into a single system. From our position in the health board’s strategic programme, we will use this single, reliable source of information to make data-driven decisions with the aim of improving access to care and reducing health inequality.

By collating data, evaluating progress and measuring the impact our project has, we aim to embed core principles, such as sustainability, equality and providing value for all, into our standard operating model.

Aim: To support the effective use of the Patient Safety Incident Response Framework, we will develop a learning resource pack of prompt cards to spread knowledge and understanding across the whole of the healthcare system.

Approach: Last year we surveyed all those involved in Patient Safety Incident Response Framework reporting and one of the strongest themes that emerged from the responses was a lack of clarity about ‘what good looks like’ or whether practitioners were ‘worried not doing it correctly.’

To support staff in implementing Patient Safety Incident Response Framework with greater consistency across the system, we will co-create a set of safety prompt cards to support ongoing, real-time learning. We envision the cards having case studies and vanguard responses on them. This will also help to ensure standardisation of learning responses across system and geographical boundaries.

Aim: To test the concept of supporting patients with multiple long-term conditions in a single clinic, bringing together clinical experts from all care sectors to reduce appointments for each condition.

Approach: One in three adults in the UK are living with long-term conditions. Many of these conditions are comorbid. Traditionally, each condition would be managed in isolation and reviewed separately, resulting in patients having avoidable additional appointments.

We will work across multiple specialties in a single clinic, bringing together clinical experts from all care sectors. This will result in fewer appointments for patients and provide local, easy-to-reach access, reducing health inequalities. Following a pilot, we will use a comprehensive ‘lean sigma’ approach to develop clear and measurable project goals and maximise limited resources, learning and improving from each delivery sprint.