Examples of quality improvement initiatives in health and care
Whilst each health and care organisation faces unique challenges, sharing learnings and ideas in Quality Improvement and Quality Improvement examples across healthcare settings enables best practice to be spread so that it can benefit many more stakeholders. New ways of working in one environment can often, with some adjustments, be transferable into another environment, or a novel methodology in one setting could inspire ideas for another.
At ImproveWell we believe in the power of spreading and scaling ideas in Quality Improvement; within and across teams, stakeholders, hospitals, organisations, and disciplines. If new ways of working can be adopted that can benefit thousands of health and care workers and their patients, we want to see that happen.
Here we explore some effective Quality Improvement examples in health and care, from teams that are leading the way.
Examples of Quality Improvement initiatives
Royal Cornwall Hospitals NHS Trust
The maternity services at Royal Cornwall Hospitals NHS Trust maternity department saw significant impact from a which subsequently underpinned a three-year programme. The ImproveWell solution enabled staff to submit ideas of improvement and share feedback on their daily experience at work.
In 2017 the Care Quality Commission (CQC) rated maternity services at the Royal Cornwall Hospitals NHS Trust as inadequate. After launching a partnership with ImproveWell in March 2018, a CQC inspection in September 2018 saw the maternity department’s rating move up to “requires improvement.”
In March 2019, an independent SWAHSN study (2019) showed that 75% of staff using ImproveWell felt able to improve their area of work (compared to 53% across the Trust as a whole) and 85% of staff felt empowered to implement ideas for change.
In the 2020 CQC inspection, the department gained a rating of “good.” The CQC report published in February 2020 states, “Staff felt their ideas mattered and they were encouraged to submit improvement ideas to the ‘ImproveWell’ application to improve performance and experience for women and their families.”
This example shows that putting power into the hands of involved staff contributes to overall improvement within the department, leading to better care and services.
NHS Nightingale Hospital London
Another example of novel NHS Quality Improvement is the NHS Nightingale Hospital London (Nightingale), a temporary hospital set up by NHS England for the COVID-19 pandemic.
As highlighted by Collins et al., the Nightingale represented “a rare ‘natural experiment’ for the NHS, from which important and potentially transferable lessons can be learnt and shared. Rapidly creating a safe, sizeable and scalable ICU in a non-clinical environment presented unique challenges that required novel and often emergent solutions. This mandate produced an environment of anticipation, adversity, unfamiliarity and uncertainty, to which creativity and innovation were necessary and natural responses.”
Whilst setting up this 500-bed intensive care unit (ICU) hospital at speed, the management team adopted a learning system approach to ensure they were improving continuously in many areas across the unit. These include quality improvements in clinical care, operational delivery and staff experience and wellbeing.
In order to facilitate this “learning hospital” approach, whereby management decisions rapidly impact patient care, and vice versa, Nightingale employed two key feedback mechanisms:
- The novel Bedside Learning Coordinator role. Inspired by military colleagues, the coordinator learned from patients and staff and made sure their ideas were implemented swiftly. From the bedside, back to the bedside.
- The ImproveWell digital solution to both gather real-time insights at the bedside and also close the feedback loop with staff.
Feedback gathered was then triaged into three areas: what should be fixed (immediate), improved (continuous) and changed (bigger scale).
In the second wave of the pandemic, they captured over 200 change ideas through the ImproveWell solution alone, which ranged from quick fixes to improvement projects around multidisciplinary work to more significant changes around policies and practices.
This example shows how quickly ideas can be collected and evaluated for faster improvement and continuous learning within hospital settings.
Quality Improvement examples in the operating room
Vascular ties are used in surgery to locate and identify vessels, nerves, tendons, or ureters. The number of ties used is recorded before and after operations to ensure none are misplaced or reused. Medical professionals at the Royal Cornwall Hospital NHS Trust devised a simple yet effective quality improvement measure to facilitate this process.
To prevent ties from being lost and near misses occurring in the operating room, a member of staff suggested that ties should be stuck to the whiteboard. This simple suggestion means the ties are visible and in view for counting.
This example highlights the value of empowering staff to suggest improvements and how implementing recommendations quickly and without excessive bureaucracy can be very powerful.
Quality Improvement examples in nursing
Nurses follow schedules to ensure medications are provided on time for patients. However, patients aren’t always aware of these schedules. As a result, they may be temporarily away from their bed when the nurse brings their scheduled medication. This also applies to the regular checks that nurses use to monitor progress.
Through ImproveWell, nursing staff suggested using calling cards, left in the patient’s room with information about the missed visit. These calling cards have a space for the time the nurse visits and instructs the patient to bring the card to the next available staff member, so they don’t miss important medications or checks.
This example demonstrates how simple ideas can be implemented to both save time for nursing staff and prevent critical events, such as missed or forgotten medications.
Quality Improvement examples in critical care
Students in the United States were asked to create a Quality Improvement project for Intensive Care Units (ICUs). Patients in these departments are often in a critical state. If a patient’s health does not improve, they may be placed into palliative or end-of-life care. When family members visit, it can be both an emotional and stressful experience.
To improve the quality of care for patients and their families in the ICU, the creation of a Comfort Care Cart was proposed. This cart would be placed in a central location in the department, so multiple families have access to its amenities. Goods stored in the Comfort Care Cart included coffee, tea, fruit, mints, non-hospital tissues, items to give the patient a shave, reading literature, a Bible, brochures for grief support, and battery-operated candles.
The advantage of this Quality Improvement example is that it can now be implemented in further areas to support quality care, such as in paediatric offices, maternity departments, neonatal care, and more.
Quality Improvement example in neonatal care
In neonatal care, medical professionals must record the time regularly. Each visit, check, documentation, and note entry requires an associated time stamp. If clocks are not synchronised, or inconsistencies are missed, consequences can be fatal.
To prevent timing inconsistencies, neonatal care staff proposed a solution: centrally controlled digital clocks installed in each room. This ensures that recorded times are correct, regardless of where in the building the staff member is. The clocks also display room temperature, another required record for notes.
When mere minutes can mean life or death for patients in neonatal care, this Quality Improvement initiative effectively removes the risk of false time recordings and reduces potential litigation concerns.
Quality Improvement examples for ward improvements
At the conclusion of a healthcare worker’s shift, they have often collected an assortment of items throughout the day in their pockets. These might include medical materials such as plasters, paracetamol and more. In the rush to get home, staff often discard these items, wasting them unintentionally.
Staff members at the Royal Cornwall Hospital NHS Trust were aware of this waste and proposed installing “Amnesty Boxes” in various rooms. Now, staff can leave extra items in these boxes and easily retrieve them. Any items that can still be used are brought back into circulation.
The implementation of the “Amnesty Boxes” as a Quality Improvement initiative is another simple idea that saves the hospital thousands in supplies costs while making the end-of-shift transition easier for staff.
Quality Improvement examples in Mental Health Services
East London NHS Foundation Trust (ELFT) provides mental health, community health, primary care and specialist services to 1.8 million people.
In 2017, ELFT started using a Quality Improvement approach to help achieve the strategic objective of improving staff experience using the Institute for Healthcare Improvement (IHI) Framework for Improving Joy in Work. ELFT’s “Enjoying Work” programme brings together teams to develop their own ideas and apply Quality Improvement to enhance positive emotions at work.
“Enjoying Work” supports teams to assess how people feel on a day-to-day basis and capture ideas. This enables teams to enhance what brings them joy at work, and tackle what gets in the way of having the best possible experience, using the ImproveWell platform.
“We’ve now had over 50 teams take part in this programme and we’ve got stories from all those teams about the richness of coming together as a team, talking about enjoying work and looking at the things that really contribute to us having a great day at work – and the things that get in the way,” says Dr Amar Shah, Chief Quality Officer, East London NHS Foundation Trust.
In 2021, results from the initiative were published in a peer-reviewed article in the British Journal of Healthcare Management.
In the first two cohorts of ELFT’s Enjoying Work programme, 14 of the 21 teams demonstrated sustained improvement in the percentage of staff who felt they had a good day at work. Building on the successes and learnings from ELFT’s Enjoying Work programme, in the summer of 2021 the Royal College of Psychiatrists launched a national Enjoying Work collaborative to achieve improved workforce wellbeing.
This is a great example of scalability in NHS Quality Improvement. Indeed, in September 2021 the Institute for Healthcare Improvement (IHI) launched its latest Joy in Work collaborative and made the ImproveWell solution available to 15 participating organisations across the NHS, US, Canada and Kenya.
Power your Quality Improvement funnel
These examples show how health and care staff have found creative and efficient ways to improve the quality of their services. Many of these health and care providers have been able to gather and spread ideas for Quality Improvement more effectively using ImproveWell.
ImproveWell is an award-winning real-time feedback platform for improvement in health and care. The digital solution makes it simple for organisations to capture continuous, real-time and actionable ideas and insight from the frontline to improve staff experience and the quality of patient care. Using the smartphone app, everyone can suggest ideas for improvement and more, 24/7.
Sign up for a free demo to learn more about how ImproveWell can support your Quality Improvement work.