Q Exchange

Patients are equal partners in Quality Improvement

Upskilling public and patients to fully and actively engage in quality improvement projects

Read comments 90

Winning idea
2018

Meet the team: Quality Improvement Equality

Also:

The SWAHSN QI Launchpad Faculty
The SWAHSN
Laura Hitt
Rob Bethune
Peter Hillman
Bernadette George
Jonathon Gray
Michael Walburn
Jo Pendray

Our idea

Health and social care staff within the South West region including Q members are aware of insufficient public and patient involvement in co-production and co-design of quality improvement projects, we know that having good patient and public involvement leads to increased patient safety and better patient satisfaction.

There is a common desire to ensure that health and social care quality improvement is undertaken in a co-produced and co-designed approach, however the language and methodology of quality improvement is one that requires significant insight and capacity building through appropriately led Quality Improvement (QI) training.

Locally, of the 400 people undertaking QI training delivered by the South West Academic Health Science Network (SW AHSN), only two patients have received this training.

This project will upskill members of the public with experience of being patients to fully and actively engage with the planning of new QI projects and support the delivery of in progress quality improvement projects.

Our Proposal

Engaging circa 40 public and patients from across the South West with various backgrounds to come together and complete the same Quality Improvement Methodology training package (QI Launchpad) currently offered by SW AHSN to health and social care staff. Upon successful completion of training, public and patients will join an online based panel of experts for 12 + months.

Members of the South West Q community planning or running a QI project can present their proposal to the panel for comment and advice on how to make the projects more patient centred and to give a public and patient voice to the project planning.

Presenting Q members can ask for direct involvement of a panel member within a project, should the panel agree that it would be of benefit, panel members would submit a short application so that the project lead could select the right panel member to support the project team. Panel members will be recompensed by the receiving organisation based on NHS England Patient and Public Voice policy.

The QI trained panel, will enable patients to fully and actively engage in QI projects both understanding the methodology and having positive impact on the outcomes that are in essence aimed at being patient centred.

Benefits we hope to achieve

Patients and Public – By upskilling their knowledgebase on QI, we will offer patients and public the opportunity to guide projects towards a patient centred approach. The online panel approach will facilitate easy panel member contribution allowing them to make an impact on projects beyond their local area.

QI projects – the ability to utilise this pool of patient and public QI specialists that would otherwise be unavailable. Using a co-production and co-design approach with patients and public will ensure projects are patient centred.

System – the panel will be available to provide early stage input on system level change ideas, putting their QI training into practice.

Q community benefits

The South West project would be a pilot, following successful introduction we would work in conjunction with other Q communities to roll the programme out across England, resulting in an active public and patient panel within each Academic Health Science Network region.

By joining the panel, participants will be encouraged and supported to register as Q members, hopefully increasing the South West Q community membership by 40 and leading to broader QI representation. All of the panel members will be paired up with willing Q community members for mentoring and support.

Putting this all together we believe that this will deliver Quality Improvement Equality (#QI Equality)

******Changes made to this Project as a result of feedback from Q members and other supporters******

Good news about support for the project, having looked at the project in depth and understanding that the cost for such a delivery programme are more than the available funding the South West Academic Health Science Network have agreed to Match fund this project through both additional financial capacity and help in kind by providing faculty and administration support. This means that we can delivery all of the intended project aims in a quality improvement way that properly supports the people that will get involved.

Following Feedback and Shortlisting

Our project has come such a long way since being shortlisted, firstly with the help of the SW AHSN we have put in place the initial training program and organised the full faculty who will be delivering our Quality Improvement Training programme. We have had a wonderful response from health and social care teams as well as the public. We have recruited our first 25 patients and are looking for another 15 to join them in becoming QuIPPs members.

The Q Community are brilliant and helped us develop the idea and make changes that have really benefited the programme. We hope everyone will continue to support this project and vote for us.

How you can contribute

Identify patients willing to participate in QI training and panel, within the South West
Experience of other Q communities responding to challenges of patient involvement in QI projects
Tools required for an online based panel to succeed
Appetite across other Q communities to implement a similar project
Q members to support delivery of the programme
I would like to see some external validation of the project so if you would like to help us evaluate our successes please get in touch and offer your support.

Further information

QuIPPs Combined Paperwork (PDF, 2MB)

Reviewer feedback

This is a great project because…

Supporting and equipping more service users and members of the public to be actively involved in leading QI is a key priority. This project has attracted a lot of support from organisations and Q members alike, and the project team have engaged really proactively with Q Exchange and other bidders.

By the time of the event we encourage the project team to think more about…

How they will keep the connections with supporters and people doing similar work elsewhere through Q, to maximise the potential for scale. What insights and evidence will you build through the process that would help others learn from the work?

Comments

continuous quality improvement 23 Jul 2019

thanks for the information and advice

Kainexus
Jonathan Broad 18 Feb 2019

https://youtu.be/QMO1gVrXW1E

Link to our latest video for the project
Jonathan Broad 18 Feb 2019

Hi to all of our supporters and I am sorry we have not been putting much information on this page, please do keep an eye on our project website www.swahsn.com/quipps for all of the latest information including a blog from Laura Hitt and a link to a video of some of participants and their views about the training they have received so far.

I look forward to updating everyone soon with more information and hopefully some reports from people who have been to quipps panels.
Jonathan Broad 28 Sep 2018

Many thanks to everybody that supported or voted for our project at the Q Exchange, we are extremely privileged to be selected and moving forward with our project, in way of an update I wanted to let you all know that we have been successful in recruiting 50 patients to join our programme and will begin the training process in November. I thank you all again for your continued support and hope we can all work together to make the most of the opportunity the Q Community has given us.
Dimitrios Tsiakiris 28 Sep 2018

Very well done to the whole team, it is a very interesting project with a great potential of identifying new mediators. Congratulations!
1. Jonathan Broad 28 Sep 2018
  
  Many thanks Dimitrois, We have continued with our planning and I am happy that will be starting training with a cohort of 50 patients on 10 November. If you'd like to know more please go to our web page www.swahsn.com/quipps and keep up to date with this project.
Matthew Mezey 24 Aug 2018

Want to learn more about what Coproduction is - and isn't? Want help and advice with your own improvement project's co-production challenges?

Do join next month's zoom video call with Q's Coproduction SIG and Coproduction expert Carol Munt.

To register go here: https://q.health.org.uk/event/what-is-coproduction-and-how-can-you-make-it-work-for-your-improvement-project-with-carol-munt-zoom-call-14-sept-12-30pm/

Bring your challenges!
Deon Louw 30 Jul 2018

Jono, this should clearly be a part of every QI project now and in the future. Our regional project on mental health care for ED frequent attenders also had the honour of being shortlisted and although, like you, we're hoping Q members will vote for us I honestly hope you achieve success. Our project is based in the Thames Valley region so may not benefit directly from your South West region outcomes, but the learning from your project will benefit us going forward. Mental health patient partners have been under-represented in the acute and emergency care environment and I'm looking forward to seeing how we can learn from you.
1. Jonathan Broad 23 Aug 2018
  
  Hi Deon
  
  So grateful for your encouragement, I am sorry that I have not replied before now however the one issue with having patients like me as leaders is sometimes we are unwell, I've just had 3 weeks in hospital and was not able to update and reply to you. You are completely correct and I am grateful to the Q community and the SWAHSN for taking up the project so positively, I really hope we will get the funding and see this new way of engaging with patients and families as well as the wider public really take off. If you would like to be involved please keep in touch as I want as much help from Q members as possible. Many thanks, Jono
Jonathan Broad 20 Jul 2018

So it is an absolute honour to be shortlisted for the Q Exchange. Over the coming weeks you'll see how far we have come and developed this project and I hope you will continue to support us through the final stages and vote for us at the national Q community event.
Jonathan Broad 20 Jun 2018

As we come to the last few hours for people to comment on the Q Exchange I'd like to thank you you all for your support and help to get this project ready for the next stage. I hope we will be successful and therefore I look forward to posting more information after 16th July.

Many thanks, Jono Broad and the team.
Hein le Roux 19 Jun 2018

Yes, I would be keen to learn from your work and see how we could apply it to primary care, particularly patient participation groups. Great idea, best of luck.
1. Jonathan Broad 19 Jun 2018
  
  Dear Hein
  
  Thank you for looking at the project and for your comments, I am fortunate to have a couple of GP partners working on this with me from Somerset, we would love to spread this to all areas of the NHS and Social Care and we would be very happy to work together in any way we can. Keep in touch with me and the project and we will see how we can move forward with working closer.
  
  Jono
Elizabeth Beech 13 Jun 2018

Jono this is such an essential proposal as patient participation seems so hard to make happen. So test this out and if it works the rest can follow!
1. Jonathan Broad 14 Jun 2018
  
  Dear Elizabeth
  
  Thankyou very much for your support, you are right that engagement is essential and I hope this will be just one of the tools and methods available to Quality Improvement teams. We are currently seeking support to assess the project and give the evidence of its value. If our projections are correct and we get a good cohort we will look to spread after the first year of working. I look forward to keeping everyone updated on the project as time goes on should we be successful in our bid.
  
  Many thanks again Jono
Liz Shaw 13 Jun 2018

Jono - this sounds like a fantastic idea, as the opportunity to be able to hear that 'patient voice' when working on new initiatives will be so powerful.
1. Jonathan Broad 13 Jun 2018
  
  Liz,
  
  Thank you for your comment I really hope this will be the case so please keep an eye on this project and let us know how we can improve as we go, all input always welcome.
  
  Jono
Claire Higdon 13 Jun 2018

Dear Jono and the team

As a seasoned change agent, I fully recognise that the key to success is working with people who are going to be most impacted or benefit from the change whether it be innovation or quality improvement. Often the lens is limited to the staff component and the patient and wider public ignored or left until too late. This concept of providing training so that we create a pool of experts is tremendously exciting, I can see that they will bring unique improvement ideas to the table! well done and really hope you're successful.
1. Jonathan Broad 13 Jun 2018
  
  Dear Claire
  
  Thank you for your positive comments, I totoally agree this could lead to a significant change in the way we do engagement and hopefully it will result in earlier input from our key stakeholders, the patients and the public. Like you I hope we are successful and that we will get the support of the Q community if we get through to the next round and the final decision. Many thanks. Jono
Louise Hall 13 Jun 2018

How refreshing. I think this could transform the way we 'involve' patients and the public in the design, development and implementation of new or improved processes, pathways or products.

It will be invaluable to have access to patients and members of the public who are trained in QI. I suspect this will also encourage more project leads to invite partners into their projects resulting in more person centred activity that can only be beneficial to future improvement projects in the South West.

I look forward to hearing more about the project and will happily help out with any evaluation scoping required.
1. Jonathan Broad 13 Jun 2018
  
  Dear Louise
  
  I am so glad you like this project and like you I am hopeful that project leads will see the benefit of having that voice into the QI journey of every project. If you or any other lead would like to bring a project to the panels please just let me know and I will keep you informed on the success or otherwise of this project.
  
  Many thanks, Jono
Thomas John Rose 12 Jun 2018

Jonathan, Can you provide some brief details of the training course content please? Maybe just module headings. Regards Tom
1. Jonathan Broad 13 Jun 2018
  
  Hi Thomas
  
  I hope your project is also going well, of course I will email you the basic plans that I have for the training programme. If you are interested and we are successful I am sure you could come and visit usr during the delivery phase and see more of this project.
  
  Many thanks, Jono
Sally Hedge 12 Jun 2018

Dear Jono, what a great, inclusive initiative. Huge potential for positive spread on many, many levels. Do you see any any challenges around recruiting and retaining the patients for this project? Congratulations on putting forward such a great idea.
1. Jonathan Broad 13 Jun 2018
  
  Hi Sally
  
  Thank you for your comments, you are correct that recruitment and retention are the biggest issues for success, we have a firm plan for recruitment across the southwest with the help of our partner organisations and PPI leads as well as links with healthwatch and 3rd sector so we are hopeful that the first cohort will be over precribed. This is of course where Q members can also help by starting to identify patients and public who they already work with and think that would be interested in this project. If yo know of anybody please point them in my direction.
Laura Hitt 12 Jun 2018

Hi Jono. I think this sounds like a great project and well overdue for health and care. I think it is really important for patient and public to be empowered both in their own care, and the ability to support and improve others' care and the system. Hopefully once developed, it will have the potential to become a step in every quality improvement project, rather than a separate entity. I am happy to help and support this where possible. Laura
1. Jonathan Broad 13 Jun 2018
  
  Hi Laura
  
  Thank you for your comments, I am hopeful that this way of engagement will be very successful, we have asked patients to give us their feedback and so far this has been really positive. Lets hope we can prove the concept and method and that others will be able to have access to a well trained team of patient and public QI experts.
  
  Many thanks, Jono
Jonathan Broad 8 Jun 2018

Dear Jo

It is great to have your support and I look forward to working together to make this happen.
Jo Pendray 8 Jun 2018

Dear Jono,

I thoroughly support this initiative - by further developing the skills and knowledge of patients, we bring an opportunity for engagement and integration of patients into quality improvement efforts which is truly inspiring.

Best wishes, Jo
Clare Ashby 6 Jun 2018

Hi - this project sounds great and very similar to our project at Yorkshire Ambulance Service

https://q.health.org.uk/idea/embedding-coproduction-to-ensure-service-user-involvement-in-quality-improvement/

I know some of you have been on to comment on ours to this end, so thanks!

Patient and service user involvement in quality improvement ideas and projects is critical in my opinion, as they bring their own unique ideas and areas for development - the things that matter to them! We intend to train our Critical Friends in QI methods to support them to develop and progress their ideas for improvement. I am positive that we can work together to share our learning as we progress through this process, so in the spirit of the Q community let's keep in touch.

I have supported your project - it would be great if you could click the support button on our project too :-)

Clare
1. Jonathan Broad 8 Jun 2018
  
  Dear Clare
  
  Thank you for commenting on our bid, you are completely correct that our projects aims are the same and that we intend to do this through similiar routes. It would be great to collaborate and I am happy to discuss how we can work together.
Wil 30 May 2018

Jono, I'm so proud of the fantastic work you and the team have put in to get this proposal to this point. I think adding to Rob Bethune's point re ABCD, I think at the heart of this proposal is the recognition that patients and public members have valuable and significant skills and strengths that are not always recognised or called upon, and that with a little bit of support can make a vital contribution to how we deliver health and social care now, and into the future. Look forward to this developing and delivering this proposal with you.
1. Jonathan Broad 31 May 2018
  
  Hi Will
  
  I could not of said it better myself, I am really excited by this project and looking forward to inviting people to get involved, the outcome should be great. Thanks for your support and looking forward to having you on the team.
Rob Bethune 29 May 2018

Hi Jono,

This looks great. What I am particularity interested in will be if these public and patient champions would be able to support Asset Based Community Development across communities and healthcare systems.

Rob
1. Jonathan Broad 31 May 2018
  
  Hi Rob
  
  Thank you for your comment and support, Ia m really glad that you will be joining the faculty if we get support. As to the ABCD of this project I am truely hopefully that this entire project will support its members to understand and impliment ABCD. The one area I know I am struggling with is the assesment and reporting of outcomes and successes of the QuIPPs group. If you have any ideas for this I would be grateful.
Jonathon Gray 24 May 2018

Dear Jono, thank you for putting together and leading this excellent project/ bid. You know you have my full personal support, and that of colleagues across the SW AHSN. Like you and many of the commentators on your bid, I see the patient voice as crucial and the most important voice in the improvement journey. Looking forward to learning from you and with you. Jonathon
1. Jonathan Broad 25 May 2018
  
  Dear Jonathon
  
  Thank you for taking the time to make a comment, I appreciate your support and the help you have given in order to make the most of this opportunity, I also look forward to working closely together on this and proving the value of quality engagement with those who use the services across health and social care.
Jonathan Broad 21 May 2018

Today is the last day for people to uplaod their ideas on the site, If you have anything further that will help us to make this project something extra special please do make sure that you comment and click the blue button to show your support. Thank you all so much for your comments and support so far and when you see the final bid I hope you will see that we have responded and incorporated the great ideas and comments you have given us. We also have listened to the important challanges that have been given and we hope that we are successful in getting to the next stage and seeing you all in Birmingham at the national event. Good luck to all the projects and I congratulate you all on your fabulous work so far.
Robin Davis 21 May 2018

I think this is a great idea and I am also supporting a complementary project which rather than creating a panel of patients aims to "embed" patients / carers and Service users in the heart of QI projects. https://q.health.org.uk/idea/putting-patients-and-families-in-the-driving-seat-of-quality-improvement/ I think there will be lots of benefits of linking and sharing the learning.

So pleased this project is getting lots of comments and support. Patient involvement really help shifts the dynamics and success of Qi projects
1. Jonathan Broad 21 May 2018
  
  Robin
  
  Thank you for your support and I hope that we can work together as I believe that our projects are complimentary to each other, we have in our bid documents taken into acount your comments and I hope you will see and even closer affilation of our ideas. Our intention was alway to ensure that patients are at the centre of QI work and our 2nd aim is that panel members will go on to become central figures in Projects that present to the panels. I wish you all the best and please do stay in touch.
Anne Crawford-Docherty 13 May 2018

I forgot to add, I am now looking at developing a QI course for our Experts by Experience through our Recovery College, as part of a suite of courses relating to the roles that EbEs are asked to take on in organisations
1. Jonathan Broad 14 May 2018
  
  Hi Anne
  
  Thank you for the input and comments, I would love to know more about your work and what went really well and what the pit falls I should avoid are. Thanks again and I look forward to hearing more.
  
  Jono
Anne Crawford-Docherty 13 May 2018

Many years ago I was involved in training mental health experts by experience in qualitative service evaluation methodologies (design, data collection, data analysis, write-up, presentations and posters). The team went on to evaluate our outpatient departments as well as to write up and present the project at conferences. The quality of the evaluations was enhanced dramatically by experts by experience co-designing the evaluation tools, conducting the interviews etc. This project could make such a difference to the future service users as well as those experts by experience who develop these QI skills. Many of ours went on to further develop their research skills through the regional R and D networks
Oliver Watson 11 May 2018

Hello - looks like a great idea and plan. I was wondering if you were thinking of the training as supporting patients to lead QI projects, as well as contribute?
1. Jonathan Broad 14 May 2018
  
  Hi Oliver
  
  Thank you for commenting, the initial idea is to help patients be fully engaged in QI projects and eventually be apart of the QI teams to support QI projects, however I would eventually like to hope that these people will be able to go on to lead projects with the appropriate support.
Julia 10 May 2018

I'd say patient voice is vital. 'Not top down nor bottom up but inside out'

https://www.kingsfund.org.uk/publications/transformational-change-health-care
1. Jonathan Broad 14 May 2018
  
  Hi Julia
  
  I thank you for the link and of course completely agree with you about patients being at the centre of projects.
Robin Davis 10 May 2018

Great idea and as others have already commented getting the patient voice fully heard in QI projects is vital to success. A couple of thoughts: there could be a risk that projects are presented to the panel once the aims are agreed and it might be helpful to have patient involvement in determining what the QI aims should be. The second thought, is probably outside the scope of this proposal, is the challenge of how we support, encourage and enable staff to work in a meaningful way with patients. I have encountered some reluctance to involve patients in QI projects possibly due to fear of how to do it well. I think we should be aiming to have patients involved in all organisations QI training and QI projects. I support this proposal. The learning from this project will help inform and develop QI across the NHS and give insight into how we can support both healthcare teams and patient to meaningful contribute to QI together.
1. Jonathan Broad 14 May 2018
  
  Hi Robin
  
  Thanks for your comments. You are right there has previously been a reluctance to have patients and public at this level of engagement however I think this project is going to help by properly training the patients to be involved through the QI methodology and putting both on an equal footing. I have been encouraged by the positive stance to this project and therefore an hopeful that we will see this become a norm in future QI projects.
Hildegard Dumper 10 May 2018

Hi Jono, Really like this idea - I am passionate about putting in practice the 5 Year Forward View ambition of the NHS as a social movement and skilling-up members of the public to understand how the NHS works and how they can engage with it is essential to the success of this. I would echo what others have said around diversity and inclusion and sustainability. How to make sure we reach all people - including those working/ those on low incomes, and then supporting them once they have done their training to recognise the different roles they can play. Some kind of remuneration would be important to consider.
1. Jonathan Broad 10 May 2018
  
  Dear Hildegard
  
  Tahnk you for your suportive comments, I completety agree with the coments and I've said to others the team have the intention of ensuring a good mix of people from all backgrounds and wlaks of life however we don't underestimate the challange in doing this well. You make reference to remuneration and what we have done is to ensure that we have expenses completely covered by the project and in the second phase if QI project teams ask for the support of a member of the panel to work on projects on an ongoing basis then they will have to sign upto NHS England Patient and Public Voice policy that includes the remuneration of volunteers which we will ensure is agreed. We intend panel members to be treated as a full part of the QI team and this means properly supporting them to carry out their roles. The reason we will only pay expenses for the panel meetings and training is the belief that this is a quid pro quo for the cost of training and support to be involved and the as of panel members will only be 4 hours (2 hours preperation reading and 2 hours online meeting) a month for 18 - 24 months all of which will be from home by WebEx and so there is no physical cost to being a member of the panel. All travel and accomadation cost will be covered for all the training days and the intended Annual get together of members to celebrate the work of the project as it grows.
  
  CAn I ask one more think from you and that is if you would like to show your support please do click on the support botton at the top right hand side of page.
  
  Many thanks, Jono
Sarah Neill 8 May 2018

Hi Jono

Many thanks for the reply. I know how difficult this is and it is probably never possible to mirror the population perfectly. Locally the University of Northampton runs a Service Users forum and a Community Engagement in Research forum - both tend to recruit those with long term health problems and/or those who have retired. This makes representing younger service users and those with acute illness problematic. I have run a parent panel of parents with young children for the last 9 years and we find we have to constantly re-recruit as life is busy and constantly changing with young children affecting their ability to participate. We also have to recruit through non-health community settings such as Children's Centres.

Good luck!

Sarah
1. Jonathan Broad 14 May 2018
  
  Thanks Sarah, I look forward to taking this forward and welcome every input possible.
Sarah Neill 8 May 2018

Hi Jono and team.

Always good to read proposals which embed patient and public involvement in improvement projects. We can't hope to get things right if we don't involve those for whom services are intended. I wondered how you would ensure that participants represent the diversity of the population and specifically how you planned to engage vulnerable groups such as children, young people and their families?

Wishing you every success

Sarah
1. Jonathan Broad 8 May 2018
  
  Hello Sarah
  
  Thank you for your comments and you are right that no one can truly answer the major health care questions without involving the patient. Your point regarding diversity is a good one and I've tried to answer it as honestly as possible, the trusth is that when looking for limited numbers for a project it is difficult to get a truely mirrored group of people to that living either locally or nationally however when we recruit we will be mindful of the need to be diverse and open to everyone to apply, my hope is that the group that we end up working with will be both diverse in itself but will also through its members life stories have gained the skills, knowledge and backgroud to deliver a truely diverse team of QI expert patients
Laurence Whybrow-Gardiner FRSA 30 Apr 2018

Dear Jono,

i have also been thinking about your proposal some more. What has prompted me to comment on your project has arisen from recent event which have been in the news. The very sad passing of a 23month old little boy with a terminal neurological condition mobilised huge number of people who very suddenly got involved in a campaign. There was much about their involvement which was confrontational and controversial. They called themselves Alfie’s Army.

What occured to me is that on every occasion that a patient or their family are unhappy with decisions taken about their care and on every occasion when individuals are sufficiently motivated and mobilised to pursue a complaint; there is an opportunity to learn about engaging and involving people in their care and in improving the quality of their care. At the end of every inquiry into a failure of care is an exhortation for the NHS organisation to harvest the lessons learned. The fact that some care failures are repeated so frequently indicates that all too often this lessons need to be learned again.

One of the reasons why I am a passionate supporter of your proposed project is because it offers an opportunity to break that cycle and for lessons to be learned. I think that all the individuals who are pursuing an NHS complaint are a resource to the NHS which currently gets wasted. It is the intention of Parliament that citizens can access free and independent advocacy and advice when something goes wrong and when they want to pursue a complaint. Each PALS operation and each NHS Compaints Advocacy operation must keep records and will have some data.

An anonymised analysis of the incidents which are complained of provides themes and patterns which a PPIE and a Patient led QI project can get their teeth into. It is not easy to engage with NHS organisations around individual incidents and I don’t think a QI project should be doing that. However, some NHS organisations should have their own Organisation Development unit or their own Patient Safety unit which would be good partners for your project. In this way, and by these means, your proposed project can engage with an internal customer for the output of your project; people who value and support what you intend to do. Every organisation could benefit from allies who have become critical friends.

In my local acute trust I have found a customer for what I do. She is the Matron of several units and she works across the trust at a senior level. As a result of her engagement with me I now have a special kind of relationship. I have been provided with an unremunerated contract. My contract is as an Honorary Lay Observer. I have been provided with a photo ID badge with a magnet strip. My contract terms of reference has been defined as ‘improving the patient experience’ and I am able to swipe onto wards to talk to patients, families and staff. I had to sign a confidentiality agreement.

I am a regular presence on the wards where I am accepted by staff and I am frequently introduced to patients who want to have somebody to talk to. My role does not get involved or interfere in clinical care in any way. I’m not a mediator or a problem solver although often problems do get resolved in a much easier way if patients have a listening partner and if staff have a sounding board. Simply listening is a very powerful intervention. In my role I’d get to co-chair a PPIE group and we harvest our lessons learned.

Best wishes from Larry
1. Jonathan Broad 10 May 2018
  
  Hi Larry
  
  Thank you for your comments and thoughts and ongoing support of the idea, I look forward to meeting in September.
Joanne Watson 29 Apr 2018

Hi Jono

Like all the other great people before me making comments, I really like your idea. I have been thinking about the SWAHSN Patient Safety Launchpad as part of the review process and how the course can set people up to succeed to varying degrees. Here, what are the risks of failure on a personal level? Whilst at risk of sounding overly maternal and there is a lot to learn from this F word, this whacky idea (that's a complement) may need stronger guidance about where to start in the complicated health care system. I have been teaching on several collaboratives in the last year and the most successful ones have had a theme to them- the people involved were all working in the same area e.g. end of life care or diabetes inpatient care. This commonality brought people together and enabled more insights into other people's work. A theme for service users to approach in different ways with QI skills is what I am thinking about.
1. Jonathan Broad 4 May 2018
  
  Dear Jo
  
  Thank you for your kind comments and your continued support on this project with your guidance and suggestions to keep me grounded I know we will have a brilliant project. Also thank you for agreeing to be a member of the faculty for this I as always look forward to having great fun working together.
Jonathan Broad 24 Apr 2018

Hi Emma

Thank you very much for the feedback, all of the comments are really valued. I would like to pick up the comment about trusts buying in to this idea. I am very happy for you to help with this from the CCG point of view and am happy that this is being strongly supported by the SW AHSN who will also help to get the panel embedded in the south west. Also I have to make it clear that the nme of QIEquality is used to show that patients are not currently a part of the team for QI and that our supposition is that projects would do better with the patient voice at the center of the QI discussion, therefore we are seeking to bring equality of patient voice and better QI skills to Patients, we will open the training and panel to anyone who wishes to apply but we are targeting skilled people who can commit to the project. We will sek people with passion and train them with the skills.

Warmest Regards, Jono

Thanks Jono
Emma Greenslade 23 Apr 2018

Hi Jono
This looks great - just a few comments from Sam Holden and I and we completely appreciate that this is the outline proposal so our comments may be helpful in future stages...
Best wishes,

Emma

Is there a way of helping to encourage / ensure that
provider organisations buy into this?

NHS Organisations working in partnership – nhs
organisation mentorship of this cohort and other QI trained personnel?

Co-ordination and targeting of QI resource to
Devon-wide projects (process for?

Can diversity of applicants be encouraged through e.g.

Courses put on during evenings and weekends;

Virtual spaces set up;

English as a second language supported;

Re-imbursement of travel costs;

Diverse geography for training considered.

#QI Equality – query ref the equality aspect of this
(as per the points above) or is to deliver enhanced quality improvement
projects etc?

Through the application process, consideration of how
to recognise and address personal agendas and interests in applicants
(balanced view) as well as to recognise those applicants who may have been
on similar training;

Consideration of how existing lay members within
organisations could be utilised – as well as how this cohort of trainees
are utilised in conjunction with existing QI trainees and e.g. lay reps
around the patch.

Consideration re reference panel set-up / independent
panel – could / should this be particular to specific projects (could this
tie in with organisation’s existing public and patient participation
groups / networks)?

Will there be a methodology for evaluating success?
Julia Tugwell 22 Apr 2018

Where do I apply for this?
1. Jonathan Broad 24 Apr 2018
  
  Hi Julia
  
  I am sorry I missed getting back to you. I'm grateful for the question but I was slightly confused by it. I wasn't sure if you were asking directly about the project proposal or about Q Exchange as a finding stream.
  
  The proposal will go into the bid format for Q Exchange and we go pie or project will be successful. If this is the case we will be advertising for patients from the south West initially to start training in September. If you look me up on Q members list and send me a message with your details I'll keep you informed.
  
  Cheers Jono
2. Julia Tugwell 24 Apr 2018
  
  Hmmmm. Patients are equal partners yet our questions get ignored.
Laurence Whybrow-Gardiner FRSA 17 Apr 2018

I am very keen to see this project proposal pursued and I believe that the issues to be addressed in this effort have the potential to transform the understanding, trust and confidence that patients have in their own ability to drive quality improvement and health care innovation. I am delighted to pledge my support this bid for funding.
1. Jonathan Broad 20 Apr 2018
  
  Hi Laurence
  
  Thank you very much for you kind offer of support and I am grateful for your comments. I had the chance to look at your project today and I hope you will do well with it as you work it up, I see that Helen has given some great feedback and she is very positive about the principle of your idea.
  
  Cheers, Jono
2. Matthew Mezey 17 Apr 2018
  
  Hi Larry - and everyone! - hit the blue 'Support this idea' button at the top of your page to show your support :-)
  
  Matthew
Ana Juett 16 Apr 2018

Hi Jono I think it is crucial that the patient voice is part of this networking. This is an excellent idea and will be of value to all. Happy to support and link in. I do think it is right to keep it fluid enough at this point to ensure that a wide variety of voices are able to join and to be supported to be heard. You might want to contact Bella Starling who did some work on an international project a few years back which may be relevant.
1. Jonathan Broad 20 Apr 2018
  
  Hi Ana
  
  Great to hear from you and thank you for your comments and offer of support which I would very much value. When we get further down the line I will come back to you. You mention a collegue in your comment is it possible for you to send me her email details please.
  
  Cheers, Jono
Jo Murray 16 Apr 2018

HI Jono (and SW AHSN colleagues)

Great project and well done on your video bid. A couple of points to consider:

Use of Liberating Structures within co-production/co-design and the QI training. (http://www.liberatingstructures.com/) Liberating Structures introduce tiny shifts in the way we meet, plan, decide and relate to one another. They put the innovative power once reserved for experts only in hands of everyone. We're planning to use some these in our Sepsis event next month (https://q.health.org.uk/event/sepsis-a-regional-patient-centred-learning-event/) and there are other ideas in the Q community SIG "Liberating Structures in healthcare".

Have you thought about how to include "harder to reach" groups of patients such as those with Learning Disabilities and how they might be included in such a project? Just to add a little bit more challenge!

I can link you up with our PPIEE lead who may be able to help with ideas around evaluation and working with Learning Disabilities. Message me if useful and I will put you in touch.

Many thanks

Jo
1. Jonathan Broad 20 Apr 2018
  
  Dear Jo,
  
  Thank you so much for your comments and of course your challenge,one thing I have always intended to be is honest and as to your challange regarding those with Learning Disablities I have not considered deliberatly accessing or denying access to any group, should someone come forward who is able to access and utilise the training and engage with the panel process I don't care what background or area of the patient population they come from. The only criteria for being involved will be the ability to undertake the training and be available for the 12 month process of being an online panel member. If I can give help to anyone to support them in this aim then I will do my best to support anyone with the desire and vision to get involved. As to liberating stucture, I agree that this is the best way to go forward and that members will be involved in the design and process of how we structure things, I have a set of pre design concepts but they will all be up for discussion once the members have been selected. Many thanks for your offer of support and should we get applications from the learning disabled community I will come back to you for help and support.
  
  Cheers. Jono
Paul McArdle 15 Apr 2018

Hi Jono. It was good to catch up earlier this week and hear about this project. It sounds great. As we also discussed, there may be some synergy here as we are considering submitting a bid to the Q exchange to investigate how we strengthen how we hear the voice of the people who use our services. Our experience so far is very limited, but what little we have done has been revelatory often turning what we thought were great ideas, upside down once we see clearly the perspective of the user.

Were you able to develop such partners with QI skills I am sure this would be a significant resource we could benefit from and could help guide and strengthen how we design and deliver our services.

In return our project might provide a test bed for those individuals going through your proposed training programme to gain practical experience of shaping QI work in the realm of the co-design and development of services.

Happy to discuss further

Kind regards Paul
1. Jonathan Broad 20 Apr 2018
  
  Dear Paul
  
  Thank you for the positive comments, I think that this would indeed be a brilliant partnership and would very much welcome working together, should we get approval I would love my proposed panel members to work with your trust to help get patient QI team members involved in your QI projects. Good luck with drafting and putting your idea online and when it is put up I will of course comment and offer any support I can offer you in return.
Anna Burhouse 14 Apr 2018

Dear Jono,

it's lovely to see you articulate a dream I know you've had for a long time. Congratulations on a great pitch. It's convincing and shows your passion for co-production and QI.

If it would help you to have some concrete case examples of the benefits of this approach, then I'd happily speak to some young people that have been using QI to help co-produce and co-deliver mental health support for other young people to see if they would be willing to provide some examples of how this can work in practice. We are meeting up next in early May. Just message me if this would be helpful.
1. Jonathan Broad 15 Apr 2018
  
  Dear Anna
  
  Thank you very much for your comments and kind offer of help. I would of course be delighted to hear from people who are using this or similar types of engagement in QI and for that feedback to help make this bid the best it can be, I look forward ot hearing you again and I will email you to ensure we hear from your team. Warmest Regards, Jono
Matthew Mezey 12 Apr 2018

My personal view: I love this idea, and the ideas to help it spread more widely later too.

Some comments, possible tweaks etc:

-       As well as passing on the QI expertise, can you also be very open to evolving the training in ways that make it really resonate with patients, make them want to do the training?
(NB It’s a separate bigger issue, but really growing and developing QI practitioners may need a ‘Learning Partnerships’ approach, beyond the more common didactic transfer of technical knowledge. More on this here: http://journals.sagepub.com/doi/pdf/10.1002/abc.21202 - it’s from the HE sector, but the lessons transfer to QI. On a recent ‘Closing the Gap’ Q SIG Zoom call, we heard that Helen Bevan’s ‘NHS Horizons’ team are looking to reimagine Personal Development Plans (PDPs), perhaps along these lines).

-       And do we need to limit the QI projects that benefit from using the panel to just Q members’ projects? Why not invite non-Q (or not-yet-Q!) patients, public too? I like the idea of getting Q further and further out of its bubble, and into everyone’s life.

-       It might be well worth talking with Q member Joy Furnival, and Q team member Chris Collison, about ways to measure QI capability shifts in the particpants in the training – ie before and after the course. (She has a journal article coming out on this imminently).
It would be great to progress the thinking on this crucial topic of understanding ‘QI capability’. The sector as a whole would thank you imho.

-       Related to above, it might be valuable to the sector to create a self-assessment maturity model for patient and public involvement in QI projects. (If this doesn't already exist).
This tool could be really valuable for SW, and the whole QI sector could use it too.
This could be a fabulous little project for interested Q members to collaborate on – with a great tangible, shareable output.
Mark Duman/Monmouth Partners have something along these lines already – in both individual-focused, and org-focused versions. (But I guess it would be somewhat proprietary).
Again, something to speak with Chris Collison about.
The PPI team at the drugs regulator MHRA had an interest in creating such a PPI self-assessment maturity model at one point too. Maybe they'd help...?

-       Also well worth inviting members of Q’s Co-production SIG to add their feedback on your project. The group is here: https://q.health.org.uk/community/groups/co-production/
1. Jonathan Broad 13 Apr 2018
  
  Dear Matthew
  
  Thank you very much for some very clear and helpful suggestions, I will contact the Q community special interest group you highlight and seek there support with this. We will after considering comments be ensuring that the training is both fully functional in delivering QI methodology but also reflects the experience brought to the table by patients.
  
  You are also very right to point out about evaluation of the project and the achievements and with this in mind I have added this to the areas we need help with the project asking for external scrutiny and evaluation. Thanks again and I look forward to hearing more comments if you have them.
  
  Jono Broad
Thomas John Rose 12 Apr 2018

Our Q Exchange project idea 'Community Support' will be undertaking some co-production/co-design. We would be very keen to share our experiences of this with your project if this would help.
1. Jonathan Broad 12 Apr 2018
  
  Dear Thomas
  
  Thank you for your comment and I wish you all the best with your community support bid, I would be delighted to hear more from you as you develop your bid and especially around the co-production and co-design elements.
  
  best wishes Jono
Stuart Monk 12 Apr 2018

Hi Jono

This is a really exciting proposal - we all know the importance of QI and the role patients can play in accelerating positive change in healthcare delivery.

There are a lot of people living in the South West who have had/are having great careers in other industries that could bring their own continuous improvement expertise and tools to your initiative. Think about how you get these people engaged as members of the public/patients, as it as a real opportunity to bring in some fresh thinking to help us all!

I strongly support this proposal, good luck!

Stuart
1. Jonathan Broad 12 Apr 2018
  
  Hi Stuart
  
  Thank you very much for your comments and I totally accept your point that we need to find people from many walks of life with experiences and backgrounds that will help them in this process. We will be asking prospective members to send in a pen portrait and give reasons as to why they would benefit from joining this projecct. I am hopeful that with the support of Q members who can point people in our direction when the project goes live that we will have new and enthusiastic patients and public getting involved. Please do keep an eye on the bid as it progresses and you should see your ideas incorporated into the bid.
  
  Many thanks Jono
Darryn Allcorn 11 Apr 2018

I am really excited to see this well thought out proposal, in my experience service user involvement is key in any improvement work so putting the patient service user at the heart of any project should be the norm. However, this is always one of the most challenging and complex areas to get right and as such i feel many opportunities are missed, as teams often avoid this complex element and this perspective is often missed and the true voice of the patient not heard. Having skilled public and patient practitioners, i see is a positive way in shifting mind sets and growing confidence through use of skilled individuals in projects and having this resource available would be welcomed.

I wish you well
1. Jonathan Broad 12 Apr 2018
  
  Dear Darren
  
  Thank you very much for your comments and I totally agree that we all need to do more to develop our engagement, I hope that this bid will be successful and that wee will soon be able to offer the high level patient and public input to quality improvement we all wish to see. I thank you for taking the time to look at the bis as I know senior executives are extremely busy and it is great to have your support.
Suzanne Wood 11 Apr 2018

Dear Jono

That sounds great and clear that a lot of thought has gone into this from you and the whole team. Really excited to see how this proposal develops and happy to comment further or to chat about any questions or ideas - just let me know.

Suzanne
Suzanne Wood 11 Apr 2018

Dear Jono

Suzanne here from the Health Foundation. Thanks for sharing this really interesting proposal. A few initial thoughts from me -

Do you think the training will need to be adapted at all - ie are there some bespoke elements particularly relevant to patient leasers in QI or do you think it is important and sufficient that everyone has identical training?

Without trying to pin it down to much (flexibility is important), I wondered if it might be possible to say a bit more about the different ways (and different stages) that the panel might be used. At the moment it reads like it starts at the stage someone has an idea for a project which is great but I think there might be some value in considering a spectrum that starts even earlier. For example:

- diagnosing the problem/issue that needs to be solved/testing assumptions

- scoping, planning and design of the improvement project

- Shaping measurement and evaluation (and helping measure outcomes and impact)

- A panel member being recruited to work as part of the team

- dissemination and communication of learning/supporting spread

Can you say a bit more about how you will make sure the panel is well used by South West Q Community members? It will be particularly important that people get the chance to use their new found knowledge and skills fairly quickly after they complete the training so you will need sufficient requests for this to happen. Perhaps some of the budget for this project could be focused on engaging Q members in your area in understanding the value the panel and getting to know who the panel members are? Do you think the pool of local Q members will be enough or could you consider widening out the group who can access the panel? Of course the flip side is that you don't want the panel to be overwhelmed and not have capacity so it will be an art to find the right balance - I am sure you will do it :)

I wasn't quite clear on how it would work if a Q member or team wanted a panel member to work directly on a project? Would panel members volunteer and there would be a selection process if more than one volunteer?

I hope these comments make sense and are helpful. Happy to chat further and look forward to seeing what other people think and seeing this proposal develop over the next few weeks.

Good luck!

Suzanne
1. Jonathan Broad 11 Apr 2018
  
  Dear Suzanne
  
  First of all thank you so much for looking at this proposal, you are very right in that in this first instance we did not want to tie ourselves down to much and allow wonderful colleagues like yourself to really come up with brilliant ideas and I really glad to say you have not disappointed us so far. The team here have discussed all of your points in our planning either at depth or in light touch sense and it is clear you fully understand the principles behind our bid and how we can strengthen it moving forward. First and main point you raise I would like to answer here though and that is because the answer is in our title, we want to deliver the exact same training using the same design as we would for staff because we want to equality, we may use different example to demonstrate some ideas but we will in essence be delivering the same training using the same language and methodology so that all involved are fully prepared to engage and access any quality improvement project. You are also correct that the panel will be used in many different ways but initially to help guide the planning of new QI projects and to help support ongoing projects.
  
  Again thank you so much for your feedback and I hope you will see all of your points answered as we move forward together.
  
  Jono Broad
Corinne Thomas 11 Apr 2018

Dear Jono

This is a great proposal. In my long experience of working in QI and patient safety, true patient and public involvement is one of the most difficult things to get right. We had some limited success within the South West Zero Suicide Collaborative and this is where I learnt the true value of involving patients and people with lived experience every step of the way. I wish you every success and look forward to learning from you as part of the Patient Safety Kernow Quality Improvement Collaborative.
1. Jonathan Broad 11 Apr 2018
  
  Dear Corinne, Thank you for your support and positive comments. Should this be a succesful bid I know we will learn from the work of the Cornwall Patient Safety Collaborative and I hope this project will also support our work together.
Helen Davies-cox 11 Apr 2018

Quality and value are only ever viewed through the lens of the 'customer', therefore engaging the 'customer', (for us this would be patients and service users) in quality improvement projects, from the outset is a very powerful and efficient way of ensuring that developments in the delivery of health and care services are fit for purpose and are of value to those we aim to serve.

I strongly support this exciting idea.
1. Jonathan Broad 11 Apr 2018
  
  Dear Helen, Thank you for your kind support, should we be succesful I would welcome your help in finding patients who could join this exciting project.