Skip to content

Q logo

Meet the team


  • Des Gorman
  • Abigail Hopewell
  • Becky Maclean
  • Linda Gaboldini

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

The problems, challenges and inefficiencies of the health service cross system boundaries and therefore the solutions and improvements must do likewise. As the improvement community of an ICS we are made up of the health & social care providers of the region and have been working to share and build our QI capabilities across our ICS. We now need to test and evaluate ways of applying these skills to collaboratively improve system wide ‘wicked’ problems whilst building QI capability and capacity across the system.

End of Life Care extends beyond any one service provider and inadequacies in provision can have a huge impact on patients and their families. As such, it provides an area of opportunity to develop and test our approach, build QI capability and capacity and improve a crucial patient service.

What does your project aim to achieve?

  • Increased QI capability & capacity across the ICS:
    The approach will integrate QI training with application of skills to a ‘wicked problem’ with the aim of improvement and embedding learning, leaving QI skills across the ICS, beyond the term of the project.

Measure: Number and cross section of programme participants & assessment of continued use of skills post project.

  • The evaluation of an improvement approach to ‘wicked’ problems. The QI community of Gloucestershire ICS has the skills to support system wide improvement & wishes to test a structured and coordinated approach that could be evaluated and shared.

Measures: Sharing the evaluation of the approach tested.

  • Accelerated learning relevant to delivering consistently high quality, patient centred End of Life Care.
    The approach is to be tested on a real life ‘wicked’ problem, enabling the learning and improvement across End of Life Care to be accelerated.

Measure: The number of learning outcomes from the PDSA cycles undertaken.

How will the project be delivered?

We have representatives from the ICS with a variety of QI, leadership, patient experience and evaluation skills, from all health care sectors, the council and CCG and are supported by the WEAHSN. We have access to a wide variety of improvement opportunities and the skills to support them. As an ICS we have Clinical Programme Groups with clinical and patient representation and are linking in with the Primary Care Networks. Our first milestone will be to build our clinical and patient/ family representatives so that we may test out approach with End of Life care across the ICS.

It is intended that a part time project coordinator will carry out the testing and evaluation, document the evaluation and create a programme guide, enabling the approach to be shared and replicated. The ongoing application & development of these tools will then be taken up by a QI role to be recruited into the CCG ensuring that the approach developed is sustained and applied across the ICS.

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

The learning from the test and evaluation will be shared with the Q community and the wider Health Service through presentation at conferences, discussion on twitter (#improverswithoutborders) and through the establishment of a project webpage. The WEAHSN is a partner in this proposal, providing a wider platform from which to share the work undertaken as well as the outcomes. Members of the Gloucestershire ICS also attend the locally established but nationally (virtually) attended Delivering Improvement Network, which has been established through the Gloucestershire Safety & Quality Improvement Academy to enable Health & Care organisations to share learnings from their improvement journeys. This will provide an additional sharing platform. In the event of a successful evaluation, the approach will be documented in a programme guide that can be shared across the wider health community.

How you can contribute

  • Experts : Dependant on the tools identified as most suitable for the 'wicked problem' experts will be needed to teach and coach those using them
  • Promoters : The aim is to develop an approach that, following evaluation, can be replicated. Help with 'spreading the word' and sharing will always be needed.
  • Strategist: Identifying connections with other projects and people who should be involved
  • Fixers: Offers of time and expertise to help with website development and project evaluation as well as tools and resources that we may be unfamiliar with.
  • Critical friends: An external view so that we can adapt and test our approach to stand the best chance of developing a successful collaborative approach.
  • Networkers: linking up ideas similar to ours, so that we may learn better & faster
  • Collaborators: Identifying collaborative opportunities that we may not have spotted.

Plan timeline

31 Oct 2019 Build clinical and patient representative team
1 Nov 2019 Identification of projects that received Q exchange funding
30 Nov 2019 Recruit project coordinator
31 Dec 2019 Evaluation & Programme Guide creation
31 Jan 2020 Collect data & patient stories
29 Feb 2020 Commence diagnosis of 'wicked problem'
29 Feb 2020 Plan QI approach
29 Feb 2020 Plan evaluation approach
31 Mar 2020 Identify improvement tools to be used/ expertise required
30 Apr 2020 Commence PDSA cycles and data collection
30 Nov 2020 Regional sharing and celebration event
31 Dec 2020 Evaluation & Programme Guide creation

Project updates

  • 6 Jan 2021

    Improvers Without Borders partnered with the Palliative and End of Life Care collaborative. The collaborative had planned a face-to-face strategy development event in April but it was cancelled in light of the Covid pandemic. When planning to rearrange the event, it was clear that it would have to be virtual and the timing would have to coordinate with ongoing commitments. The delay gave Improvers Without Borders the opportunity to support the End of Life Collaborative to use a Quality Improvement approach to co-design, with system partners, the new End of Life strategy.

    The proposal recognised a pre-existing intention to run three two-hour sessions instead of a full day programme. We co-designed the approach to these days as well as agreeing what preparation work would be needed and what the follow-up work should include.

    The event aimed to reach as many parts of the community as possible, the following was achieved:

    • Engaged ICS and third sector colleagues
    • Representation from commissioners, the hospital, health and social care, the council, the ambulance service, care homes and hospices, patients, third sector, carer’s, bereavement, frailty, and children’s services
    • Average of 70 attendees per session
    • In their feedback participants found:

    the main sessions interesting and informative (96% scoring the event 6/10 or greater)

    the activities engaging (90% scoring 6/10 or greater) and informative (94% scoring 6/10 or greater).

    The session outputs were as follows:

    • Session 1: Reviewed and agreeing high level system maps
    • Session 2: Identifying six work streams as focal points for the new strategy
    • Session 3: Looking in more detail at what problems and solutions might look like in these
      6 areas.

    Follow-up session: Completing driver diagrams for each area, identifying change ideas.

    The resulting 6 work steams (which will go forward to be investigated in working groups) are:

    1. Professionals confident in responding to the changing needs & wishes of people as they reach the end of life and also then communicating well with system colleagues
    2. Understanding of the Individual & their family including their unique presentations and needs, and consideration for personal context e.g. culture, ethnicity or learning disability
    3. Shared knowledge of the full range of services and community assets in the county so that patients can be supported to access the right care at the right time for them
    4. Shared Care Plans to enable timely responses & good documentation of wishes (inc. digital solutions)
    5. Smooth & supported transitions between children’s and adult t Palliative and End of Life Care services
    6. A sustainable funding model to enable high quality EoL care to meet the needs of our local communities  (noting recent challenges of charitable income)

    With five months still to run, the Improvers Without Borders project is now looking to:

    Continue  supporting the EOL team, using a structured improvement programme

    • Capture and evaluate the approach
    • Review/pursue opportunities to deploy the process in other areas that have expressed interest:

    o   Other clinical programme groups, e.g. Dementia

    o   Other ICS programme delivery areas, e.g. integrated locality partnerships/population health management e.g. Tewkesbury ILP

    o   Other programme delivery stages, e.g. design, implementation etc

  • 1 Jun 2020

    Project Update: June 2020

    No doubt, like many other QI projects, progress with the ‘Improvers Without Borders’ project has been affected by the fight against COVID-19. In recent weeks the project has, however, started to gain a little momentum, most significantly with the recruitment of our Project Manager. The project meetings are starting to recommence and discussions with various experts with offers of participation have been received and pursued. Things may have been on hold for a little while affecting our anticipated project timeline, but the enthusiasm for the project has not dwindled as we start to bring our team back together again.


  1. Hi Victoria

    Interested in this work of yours - have some experience of systems mapping of services around falls prevention - started with fire service - and expanded the work to involve community services and social care with patient voice ++. Happy to share and play in if I can.



    1. Hi Nikki

      Thanks for getting in touch - that would be great if you are happy to share. I'll drop you an email and we can go from there.

      Best Regards


  2. Hi, I've just joined the Q Community and this looks like a really interesting piece of work. My background is from outside of Healthcare but I have lots of experience in applying systems thinking to solving complex problems, facilitation of co-creation workshops, and continual improvement. I'd love to contribute to this activity if there is the opportunity to do so.

    Kind Regards,


    1. Hi Mark

      Thanks for getting in touch, we are always looking to expand our team of willing contributors! I'll drop you a line so that we can explore this further.

      Best Regards


  3. Guest

    charles daniels 2 years, 7 months ago

    Well done team,

    A wonderful idea and sorely needed. I am working across Last phase of life/frailty/ palliatiave care/ integrated care/care homes in our complex "systems". Really challenging work to improve both the specific clinical services for patients and carers and the need to understand what is required to support the system.Would love to learn from you and share anything which we have learnt.

    1. Thanks Charles, you hit the nail on the head with your comments about the many facets of end of life (frailty / long term conditions / dementia / care homes / palliative care / cancer / urgent care / primary care etc). As a GP, I see many services working really hard to support patients and their loved ones (on many aspects of care, not just end of life), the challenge is how do we do that in a much more integrated way working together as services with patients and their loved ones. We believe quality improvement is a big part of the answer. Our work will aim to build on the great work already underway in Gloucestershire using end of life care to build our template.  We aim to bring two strands of important work together: 1. General practice is gearing up to work at scale across primary care networks, working much closer with our wider community services in a place based way. 2. We have a very active quality improvement community across all NHS commissioners and providers which is supported by our shadow Gloucestershire Integrated Community System (ICS). Should our project be supported, we will aim to connect up these two spheres of influence to improve patient care using end of life care to build our template.

  4. Hi Vicky - this looks like a really exciting initiative. Very happy and willing to support as critical friend and promoter, plus to share any new materials we gain for our revamped academy that might be of interest. I will also bear in mind for potential networking and collaboration opportunities. Meanwhile, if you think there is something I can help with, please contact me direct.



    1. Thank you Dave, your enthusiasm and quality improvement expertise is always appreciated. Working on improvement across borders is your forte.

    2. Thanks Dave, much appreciated!

  5. Hi

    This sounds an interesting project and similar to mine, just across a larger footprint. I'm looking at how we can use QI in a primary care network to tackle a problem specific to that population. I'd welcome your thoughts.



  6. Guest

    Hein le Roux 2 years, 10 months ago

    With the potential of our ICS to further support a real focus on care, particularly improving outcomes that are important to patients we wish to focus on an area that will allow us to appeal to the hearts and minds of colleagues. End of life care is emotive to all of us and we believe that colleagues across our system will support this worthwhile improvement endeavour allowing us to test and refine learning before applying to other care areas.

  7. Hi team, great to see your ideas here and would happily offer you any support I can. Have you thought of asking Julian Able about his thoughts? His knowledge about EOLC and his experience of improvement is phenomenal.

    warm wishes


    1. Guest

      Hein le Roux 2 years, 10 months ago

      Thanks Anna, that is a great idea. I believe he has retired, do you know his email?

    2. Guest

      Kathryn Hall 2 years, 10 months ago

      Hi Anna,

      Thanks for getting in touch we would love to have your support and ideas, both on how we can best mobilise this really important project around EOLC but also how we can best use the experience as a real test of change to our cooperative QI approach as an ICS. So look forward to catching up soon.

      Best wishes



  8. Hi Victoria,

    This sounds interesting. I was previously involved in some work where we use a QI approach to tackle EOL care across an ICS. The QI method helped us get past the complexity to focus down to practical action fairly quickly. I think it was helpful as EOL care is so complex it can easily become overwhelming when looking at how to improve the system.

    I think that experience is partly why we are now looking at how to support QI based integration through a developmental approach to capacity development. Check out our bid  'quality coach development programme'. There may be some synergies between these ideas?

    1. Guest

      Hein le Roux 2 years, 10 months ago

      Hi Jem, thanks for your support. Gloucestershire ICS is doing well on our integration journey and we want to build on this. Our opportunity is taking a QI approach to galvanise Gloucestershire settings, professions and organisations in how they approach one of our most vulnerable groups of people; those at the end of their lives together with their loved ones. By using QI methodology and involving patients and relatives, we aim to make care as seamless as possible and then spread learning to other clinical areas where care spans the ICS. Like you say, often it is small improvements particularly better communication that can make a real difference to people at their most difficult time.

Leave a comment

If you have a Q account please log in before posting your comment.

Read our comments policy before posting your comment.

This will not be publicly visible

Please note that you won't be able to edit or delete comments once posted.