East London NHS Foundation Trust's systematic approach to quality

East London NHS Foundation Trust (ELFT) takes a systematic approach to quality that supports staff and service users to identify and address quality issues. This has been enabled by several factors: 

• A board that is focused on improvement 
• Development of an organisation-wide QI system 
• QI department structure and function 
• Development and roll-out of improvement capability training 
• Meaningful engagement of people in QI 
• Use of data for learning and improvement. 

Building on these foundations, ELFT is developing an integrated Quality Management System. A range of activities and methods are used as appropriate under the four components of quality management. These include, for example, use of the annual planning and commissioning process (for quality planning); use of visual management boards and regular huddles (for quality control); and use of audit, inspection and accreditation (for quality assurance). 

Duncan Gilbert, Associate Director for Quality Management, described an important part of their approach as recognising the dynamic nature of the management system – ​“it’s not a constant” – balancing attention and activities across the four components at any one time. 

ELFT emphasises the need for work under the four components to be interconnected, and conducted sequentially, not in isolation. For example, once improvement efforts have achieved new levels of performance, the system moves back into quality control to maintain the new level of performance. 

ELFT has tried to be more intentional about its work on Quality Planning and Quality Control, and to enhance understanding about how the different components connect to each other at the service level. Duncan has some specific objectives as part of the continued development of the management system, focusing on: 

• Socialisation – including working with colleagues to articulate what the management system looks like, how it benefits teams, and what it is for. This includes developing website content and resources, and a new internal online platform for action tracking (and sharing) progress on quality activities. 
• Strengthening – working with clinical directorates to assess and strengthen Quality Control activities, enhance their team’s Quality Assurance offer, and provide greater support to the non-clinical and corporate functions on their quality journey. Further work is being provided to help teams with their planning and strategy work, including how teams conduct stakeholder engagement. 

The impact of their improvement journey has been evident in gains across many areas of organisational performance, from reductions in instances of physical violence to increased levels of staff satisfaction. Although it is too early to assess the impact of their work to bring together the components of their management system, Duncan could imagine how they could, for example, understand how effective their work on Quality Control had been in due course: 

A key part of their work has involved meaningful engagement of people in quality activities. One example is the development of a service user-led accreditation programme, which forms an integral part of its Quality Assurance work. The programme invites teams to undergo a self-assessment process against 24 standards that are most important to service users. Around 70 services have gone through this process, with service users being involved in assessor teams and accreditation panels. 

The existing culture of continuous improvement, and the senior leadership support and advocacy it has received since 2010, has provided fertile ground for this work. ELFT has existing and well-established Quality Improvement and Quality Assurance teams, which remain vital to its work. Duncan has been supported by, and has worked in concert with, key colleagues at a similar level – such as the Associate Director for Performance and Planning. 

There was a risk involved in calling their work the development of a Quality Management System, ​“as it would imply it was a whole new thing”. Instead, conversations have been framed around ​‘here’s a conceptualisation of what you’re already doing, and here are some ideas about how you can do even better.’ They find that, as a term, Quality Control (understanding quality and performance in real time) can be quite alienating when they are talking to colleagues, but in reality they are often already doing activities within it. 

• ELFT’s management system represents an evolution of its long-term, organisational commitment to improvement, led by the board and senior leadership team. 
• Strengths in quality improvement and quality assurance provided the foundation for their management system, with work taking place with clinical directorates to develop their quality planning and quality control approaches. 
• They have socialised the approach with staff based around work already taking place across the organisation, and how that can be further improved, to avoid it being seen as a new system to be implemented.