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What is the challenge your project is going to address and how does it connect to your chosen theme?

We hear feedback from front line staff (bands 2-5) that they are unable to participate in the courses and initiatives run and supported by the Cumbria Learning and Improvement Collaborative (CLIC). This is due to lack of resource on wards and staff being unable to control their own diaries. As a result of this, those we tend to reach with our continuous improvement work are at leadership level. To sustain continuous improvement, we know that ownership from the staff doing the day-to-day work is essential to success of any improvement project.

The current model of delivery only enhances the ‘top down’ hierarchical approach that we wish to move away from. We are also aware that in doing this, we miss many of our staff with protected characteristics. Government and trust level statistics show that staff who fall under the majority of the nine protected characteristics are over-represented in roles in lower bands compared to the demographics of England as a whole (NHS Workforce, 2018).

What does your project aim to achieve?

Our project aims to give lower-banded staff working on the front line in a hospital setting the skills to undertake effective improvement work.

We will do this by creating a programme that delivers tools for improvement in a small group setting over the course of an hour, where the outcome is a specific piece of improvement. We will then deliver the programme in different settings and gather feedback from participants in terms of how confident they feel about using the tools to identify and implement improvements.

Long term, we will assess how access to and knowledge of improvement tools impacts on efficiency and safety. In Cumbria and elsewhere, there is a focus on transformation work which can make it difficult to encourage continuous improvement, meaning improvement efforts are often not sustained. By holding a teaching session and then leaving staff with the materials, know-how, and continued support we will empower staff to embed their own culture of improvement at ward level.

How will the project be delivered?

The project will be delivered using our current workforce of facilitators and upskilling other staff members into facilitation roles to deliver the one hour sessions. Across the service improvement team, we have specialists in data, engagement, human factors, patient experience, and strategy who currently support wide ranging improvement projects and have experience of delivering and facilitating courses. We have previously delivered many Rapid Process Improvement Workshops in acute and ward settings but find that increasingly, managers are finding it harder to release staff for a full week of improvement work, which has led us to consider new ways to deliver our tools.

Our goal is that by delivering one hour bursts, more staff will be able to participate and learn first hand about improvement with little impact on resource and capacity, and will have the knowledge to be able to become Q members themselves, building a stronger front line Q network.

What and how is your project going to share learning throughout?

We have identified gaps in staff that we are reaching with our improvement work. This project aims to directly address those gaps and strengthen understanding of Continuous Improvement across the wider workforce. We will tailor our sessions to address specific requirements and ensure that every member of a team receives face to face dedicated learning time with our facilitators.

In turn, we will ensure that participants receive the skills they need to share their learning across their own networks as well as up to their team leaders using the same engagement approaches already in place as part of our other improvement programmes.

We have also received feedback from staff that we have previously worked with, who have gone on to apply to be Q members that they feel the individual nature of their Q membership is something that they can take with them wherever they go, and is unique to them and their own improvement journey. We will share this with the teams that we work with.

How you can contribute

  • Front line staff at any level in other areas about how they feel this idea would work in their own teams.
  • Any continuous improvement specialists currently delivering shorter sessions to small groups.
  • Any staff working at bands 2-5 who are Q members, to discover if they identify with any of the themes above.

Plan timeline

28 May 2019 Begin cohort 6, (30/60/90 day follow ups)
25 Jun 2019 Begin cohort 7, (30/60/90 day follow ups)
26 Jul 2019 Begin cohort 9, (30/60/90 day follow ups)
31 Jul 2019 30 day follow up with cohort 1 and begin cohort 2
2 Sep 2019 Finalise plan and identify areas to run first three cycles
24 Sep 2019 Begin cohort 11, (30/60/90 day follow ups)
1 Oct 2019 Implement plans and begin first PDSA cycles - cohort 1
29 Oct 2019 30 & 60 day follow up and begin cohort 3
26 Nov 2019 30, 60 & 90 day follow up of Cohorts 1,2&3
27 Nov 2019 Review feedback from current cohorts, measure uptake
3 Dec 2019 Advertise next round in January. Winter pressures break
7 Jan 2020 Begin Cohort 4 and cohort 2/3 follow ups
4 Feb 2020 Begin cohort 5, (30/60/90 day follow ups)
28 Jul 2020 Begin cohort 8, (30/60/90 day follow ups)
25 Aug 2020 Begin cohort 10, (30/60/90 day follow ups)
29 Sep 2020 Analyse all data to this point and create a case study
29 Sep 2020 Begin cohort 12, (30/60/90 day follow ups)
29 Sep 2020 Build a business plan to continue this work on


  1. Hi Lydia,


    Thanks that great, do you have a specific way of documenting projects so they can be shared? I am looking at potential platforms to share work currently and any advice on what might work well.



  2. What a great way to build and transfer knowledge from the frontline. I see Rachel Houghton has commented too. Have you seen her great work re shared governance?

    Good luck

    best wishes


    1. HI Anna,

      Rachel's project is fantastic isn't it? I'm so glad more and more of us are seeing the potential in beginning QI initiatives direct from the staff on the front line. Her tool looks fantastic.


  3. Brilliant idea to increase exposure to improvement tools. Giving everybody the opportunity to learn more about continuous service improvement, no matter what banding you are, will certainly help implement positive changes.

    1. Thank you for your lovely feedback Kayleigh!

  4. Great idea and will make a significant difference to a key group of staff who are sometimes left behind

    We know from our current work that many of the best improvement ideas come from these very staff and we need to include and empower in every possible way

    If we can pilot this idea with the help of Q then I'm certain we can establish it as a way we do things for the long term

    1. Thank you Stephen,

      I believe it's more important than ever to try to 'fill in any gaps' as it were - making sure we equip all staff at all levels to drive change from their own corner of the health service.

  5. A fantastic idea, it will really help frontline staff who have difficulty in finding time to access training

    1. Thank you Ruth, that's certainly our goal!

  6. Guest

    Rachel Fleming 1 year, 9 months ago

    I really like this idea. Where there are staff in ward areas who have been involved in RPIW can they help to support these staff members?

    Good luck


    1. Hi Rachel,

      Yes we hope that the more staff we get to have face-to-face time with, the more we will build a support network for those who have already participated in an RPIW, and potentially polish their skills too.

  7. Hello All,


    I am fully behind the idea of reaching out to frontline staff and encouraging innovation directly within their areas, their ideas will be very interesting. Have you considered how you will capture their activity? Also will they be assigned to a QI 'mentor'.




    1. Hi Rachel,

      We are fortunate enough that two of our small team of six are experts in measurement and data collection and analysis, and as such we will have full attendance, feedback and measurement plans in place. We have already developed a step by step beginners guide to measurement which we are currently running a PDSA on. We look at our projects from 30, 60 and 90 day intervals after any intervention and offer additional support beyond the training and workshops that we provide, and would aim to continue to use this continuous follow up and support model. We currently find that one of the best ways of collecting feedback and being able to provide more support is simply to be present within front line areas and build strong relationships with staff at all levels there.

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