Discussion

As well as improving the delivery of the care bundle for AMI and stroke we now have a better understanding of what matters to patients and the factors which improve patients’ experiences and outcomes We have also succeeded in building teams in most trusts with greater skills and knowledge of QI which they have then effectively applied to improving care for AMI and stroke, and extended this to improve care for patients with other conditions.

Mechanisms of support

Support systems such as teleconferencing, face to face meetings and Huddle, were developed to help those participating to overcome or share difficulties experienced. These systems also allowed trusts to share ideas at a national level by providing a nationwide communication network at the frontline of patient care. A QI Network was developed by the core project team to facilitate the coordination of the project. The collaborative approach has enabled staff to become involved from the beginning of the project and has encouraged them to take ownership of the need for change and to lead the changes taking place. The approach has also facilitated the dissemination of QI methods nationally and the new skills and knowledge acquired by QI Fellows has been cascaded to peers, supporting the day to day application of QI by clinicians on the frontline.

Challenges

The greatest challenge the project faced was to achieve and sustain engagement from participating trusts We therefore believe that it is an accomplishment to have only lost participation from one trust during the two years. Trusts implemented the project at different stages and we found it essential that learning and experience acquired by early implementers was utilised to support late adopters.

Other difficulties were also encountered including

  • Time pressures
  • Conflicting demands
  • Connectivity between different staff groups

Quote

"With the workshops taking up so much time (in organising, recruiting, travelling etc.), the 7 5 hours inevitably limited the amount of workshops I could hold. The risk was having loads of workshops but no time to act on any of the findings.” (QI Fellow, Trust 1)

Sustainability

To embed the sustainable improvement that we have successfully achieved through ASCQI we have found there is still a need for:

  • Greater connectivity between executive teams and the work taking place at the front line
  • Greater support from senior management teams to remove barriers impeding improvement
  • More joined up thinking and action involving executive, management, educators and front line staff to translate learning from the project to improved systems of care.

There is also a need to overcome resistance to change. Those wishing to replicate our work will need to consider where their organisation stands in respect to proposed change and develop strategies accordingly.

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Our e-learning programme is designed as an introduction for health and social care professionals interested to learn more about the science and practice of quality improvement (QI).