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Empowering staff and service users to lead quality improvement initiatives

To develop staff and service users in a peer support network with knowledge and skills in improvement methodology. Enabling the delivery of high quality healthcare services using a coproduction approach.

Read comments 14
  • Idea
  • 2018

Meet the team: Make A Change Heroes Network


  • Sonia Nosheen, Transformation Manager, Pictorial Artist
  • Dan Wadsworth, Access Manager, Co-Director 15s-30m
  • Dr Rachel Piling, Consultant Ophthalmologist, Co-Director 15s-30m
  • Andrea Gillespie, Nursing and Midwifery Quality Lead
  • Susan Franklin, Associate Chief Nurse for Quality

How we came about our idea?

 The change agent peer support network, “Make a Change Heroes” was recently created at Bradford Teaching NHS Trust following a conscious effort to bring clinical and non-clinical staff together with a keen interest in driving patient-centred improvement and peer collaboration.

 The MAC Heroes network celebrates diversity, talents and expertise staff bring to the platform. It embraces the premise that staff are experts in their area and have the best understanding of what needs to be improved or opportunities

We asked our staff members to tell us what they wanted to get out of the network and how we could make membership meaningful and worthwhile. Key opportunities for improvements were:

 ·         To be confident in discussing improvements with our service users

·         Save time by getting the initiatives right by seeking guidance from services users and connect to the community to prevent “reinventing the wheel”

·         Develop improvement skills in staff who could develop these skills with service users/ community

·         Create a systematic approach to enabling service user involvement in quality improvement across design, delivery and development of services  

·         Reduce fragmentation by involving other services (commissioners, primary care, social care. Etc) in creating improvements for our community

·         Develop innovative ways to promote recognition and celebration of improvements


Our idea

We want to use these opportunities identified by staff to create key positive outcomes from MAC Heroes network which will focus on:


  • Building staff knowledge to develop/lead quality improvement initiatives – provide training using fun, motivational and inspiring approaches and opportunities to collaborate and share learning.
  • Create sustainability of the peer support network to release people’s potential and self-fulfilment relating to quality improvement. 
  • Developing links with colleagues across community services which will also provide opportunities to work with community patient support groups to develop MAC Heroes
  • Exploring the appetite for service user input: such as involvement, leadership in coproduction, supporting the identification and execution of improvement ideas
  • Developing service user knowledge in quality improvement methodology
  • Sharing the learning widely with the Q community to support similar initiatives


We will be adapting our approach to education/training using the seven steps to design learning partnerships approach evidenced in Taylor & Magolda, 2015. We are keen to ensure members feel that we are working in partnership with them to promote their growth as change agents by challenging their status quo position, developing their confidence to lead improvement (using personal authority, not reliant on positional authority) and opportunities to work collaboratively.


It can be a scary prospect for service users to work with staff that use complex terminology or improvement “speak” and this can make some service users feel isolated, nervous or disengaged. Service users will engage at different levels depending on their interests, experience/ personal stories, skill set and desire to participate. As part of the service user recruitment process, we will be open to having these conversations as we explore this idea further. We will also be factoring this in to how we articulate the network support offer to all participants.


How will we know we have made a difference? 

We have created a driver diagram that articulates our strategy and measures to demonstrate impact and learning. This reflects the network deliverables listed above. We will also have data to understand if MAC Heroes feel as though they are energised and empowered to be part of or lead on quality improvements


Who will be involved?

 The MAC Hero faculty consists of:

·         Quality improvement science experts

·         Expertise and insight in staff and service user engagement.

·         Endorsement of the deputy medical director with an interest in service user engagement and quality

·         Artistic manager who campaigns for universal communication to engage with our communities

·         Social movement expertise


 Next steps towards delivery


·         Identify executive and patient expert/user sponsorship

·         Agree and develop MAC Heroes package and levels of opportunities within it

·         Up skill staff MAC Heroes to support delivery of service user MAC Hero training

·         Scope out interest and recruit service users via existing patient/service user involvement groups

·         Provide peer support to service users to become energised and empowered in improvements

·         As part of our long-term goals, we want to take this model to our community partners e.g. CCGs, Council and neighbouring acute trusts, to develop MAC Heroes across the community.  



Batalden M, et al. Maren Batalden, M., Batalden, P., Margolis, P., Seid, M., Armstrong, G., Opipari-Arrigan, L., Hartung, H. (2016) BMJ Quality Safety. 25:509–517.

Filipe,A., Renedo, A. and Marston, C. (2017) The co-production of what? knowledge,values, and social relations in health care. PLOS Biology.15(5)

Taylor, K.B and Magolda, M.B.B (2015) Building Educators’ Capacities to Meet Twenty-First Century Demands. Available from: [] Accessed on: 3 May 2017


How you can contribute

  • If this work is within your gift, please share any evidence base and insights you might have around:
  • how you have recruited service users to be involved in quality / service improvement initiatives
  • how you have set up similar change agent networks and how you have sustained momentum
  • If interested in our idea please make contact to collaborate with its development and promotion for benefit of the wider Q community and beyond


  1. HI Helen

    Many thanks for the links signposted. Any help we can get as well learning to be gleaned from others that have done this already is much appreciated. I  hope that you can support our idea as well as inform any colleagues with an interest to contribute their views.


  2. Hi all.


    weve done quite a lot of work around this in Sheffield. The Microsystems Coaching Academy which is a Qi methodology based on the Dartmouth Institure, is now activity encouraging this in all QI projects. At SHSC this is now our aim as it is at ELFT are at the forefront of innovations in QI and service user involvement. We have 1 employed QICoach with service user experience and another being trained. Changes the tone completely at QI meetings, with much more attention pains to quality as defined by the patient rather than just by the professional.

  3. Difficult problem to crack, how do you get frontline staff enthused about improvement? Great to see so much enthusiasm in an acute Trust.

    1. Thanks Mel for your comments . We are finding that there are staff that do have an appetite to constantly improve. We also know we need to advertise this initiative using better communication approaches to get to staff that are 'hard to reach' and 'leading from the edge'. Staff are constantly challenged by their perception  that they have no power to make or influence change. The significant pressures on the shop floor is a major contributory factor but also supportive leadership that appreciates the need for improvement at all levels could be better. We don't expect all staff to participate in this because they need to have the right mindset and also appreciation of the benefits for continuous improvement. We were overwhelmed by the response we had to this idea and will be working hard to keep the enthusiasm and momentum going. This is going to be the challenge. We are keen to build on learning gained from other organisations / agencies where this sort of initiative has worked. So any signposting or suggestions or models of learning to trial will be much appreciated.

  4. This project has much in common with our proposal and that of YAS (Clare Ashby). I agree with Clare that our geography would make this a great learning opportunity and would be ideal for collaboration.


    1. Hi Shelley

      Really grateful for your comments. I do agree we need to collaborate on this. We will be holding our next network meeting where we hope to discuss this with our Make A Change Heroes (MAC Heroes). Our initial co design launch session highlighted the importance and the obvious gap around poor service user and also community and partner engagement in developing and delivering quality improvement initiatives in our Trust especially where it would benefit better streamlined services

  5. I fully support this project. It has some similar elements to our Yorkshire Ambulance project below

    Please take a look and see if we can collaborate in any way - seems like it might be a win-win given our close locations to each other. We are happy to share our journey so far including how we have recruited our service users to our Critical Friends Network and share any further learning from the coproduction we will be undertaking with our service users in the near future - we believe by using coproduction methods we will build a network that sustains, develops and grows itself.

    You may also like to look at joining the coproduction SIG that the Q Community host -


    1. Thank you Clare for your comments and your support. I've already signed up to the coproduction SIG as well as the liberating structures SIG as I do feel there is so much to learn but also reflect on to ensure we can keep our staff and service users interested in this worthy cause. It would be really useful to catch up to share your experience of setting up your critical friends network  and also exploring how we can work more closely and collaboratively. Good luck with your idea as well


    2. This project has much in common with our proposal and that of YAS (Clare Ashby). I agree with Clare that our geography would make this a great learning opportunity and would be ideal for collaboration.


  6. Guest

    This sounds like an excellant way to support individuals and teams to make change happen in their environment. It takes like minded people with a keen interest in making improvement, however small, along the improvement journey. Alongside this is an approach of creating a community outside of the hospital environment, a barrier that is shared by lots of organisations. Surely this can only be a good thing! Good luck

    1. Thank you Erin for your kind words and reflection. It is not going to be an easy feat but the more feedback we get the more chance we can attempt to refine our idea and develop the infrastructure to make it work in practice

  7. Guest

    This sounds like an excellant way to support individuals and teams to make change happen in their environment. It takes like minded people with a keen interest in making improvement, however small, along the improvement journey. Alongside this is an approach of creating a community outside of the hospital environment, a barrier that is shared by lots of organisations. Surely this can only be a good thing! Good luck

  8. Guest

    Sonia Sparkles 4 years, 1 month ago

    Sounds like a fantastic idea to help move towards creating QI Leaders in our service users/community. It will help break down some of the barriers we have in ensuring service users/community feel confident in taking part, knowing what to expect and having actual power to influence the change steps/decisions.

    I really like the idea of the staff providing this peer support and development - what a great way to create meaningful connections and for both parties to learn at the same time.


    Good luck

    1. Thank you Sonia for your comments. Help us cascade the word about our idea through your networks. We need more  feedback to ensure we get this right.

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