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Against a backdrop of stalling life expectancy, the COVID-19 pandemic highlighted the need to tackle inequities in healthcare. Quality improvement has become an increasingly recognised way of tackling complex problems in healthcare. This article presents a step-by-step approach for the use of quality improvement to pursue equity at an NHS provider in England. The Model for Improvement was used to set an aim, develop a theory of change and measures, and test change ideas through plan-do-study-act cycles. A five-step sequence of improvement was used to provide a structured approach to identifying and tackling problems. Projects were designed to use a time series testing strategy in which baseline data were collected, a change was introduced and data continued to be collected over time to assess improvement. The results of three teams that have demonstrated sustained improvements were analysed using statistical process control charts. The teams' achievements included a 27% increase in access to early intervention mental health services for ethnic minority groups; a 92% reduction in racist incidents on inpatient wards; and a reduction in the gap between cervical screening rates for different age groups from 8% to 3%. Quality improvement offers those closest to the delivery of care a way of systematically making improvements in equity. Further opportunities for the field include the use of experimental designs to test combinations of interventions and potential scalability of quality improvement methods across systems with multiple partners. [ABSTRACT FROM AUTHOR]

Background/Aims: Asthma in children and young people represents a substantial burden to the healthcare system, with these patients requiring frequent emergency care and having poorer health outcomes, leading to high system costs and poor patient experiences. This study used quality improvement methodology to achieve the triple aim of improved outcomes, better experience and reduced costs for those aged 0–16 years with asthma in north east London. Methods: A multidisciplinary project team used quality improvement methods to implement and assess two interventions: a community high-risk asthma clinic and educational asthma-friendly school groups, both of which were delivered by a specialist asthma nurse. Population-level outcomes included asthma control test scores, accident and emergency department admissions and costs. Intervention-specific outcomes included number of clinic consultations delivered, did-not-attend rates and participant confidence ratings following the school sessions. Results: Accident and emergency admissions for asthma reduced by 52%, with a 50% reduction in average monthly acute care costs. Asthma control test scores improved significantly, from an average of 18.56 to 22.34 out of a maximum score of 25 (P=0.000) following the interventions. Participants in the asthma-friendly school groups reported increased confidence in both day-to-day and emergency asthma management at the end of their sessions. Conclusions: Having dedicated specialist asthma nurse input in the community and using school-based interventions can help to improve asthma care for children and young people, reducing the burden of frequent accident and emergency department admissions. Using quality improvement methods in pursuit of triple aim outcomes can help teams to work towards a shared goal. [ABSTRACT FROM AUTHOR]

There has been an increase in the adoption of quality improvement methods to tackle complex problems in healthcare. One of the key requisites for sustainable quality improvement is ensuring that organisations have the capacity and capability to make these changes effectively. This article uses a case study methodology to describe the learning from 9 years of developing, delivering and evaluating quality improvement learning programmes at East London NHS Foundation Trust. The key quality improvement learning progammes are evaluated using a Kirkpatrick framework across four levels: reaction, learning, behaviour and outcomes. Five key principles were identified: using a dosing approach; standardising development, delivery and evaluation; developing a community to support learners; making training relevant; and the importance of leadership. However, the authors believe that more research is needed to develop standardised approaches to evaluating quality improvement capability building and to understand why some quality improvement projects are less successful than others. [ABSTRACT FROM AUTHOR]

In 2021, 38 healthcare teams across England and Wales took part in the national enjoying work quality improvement collaborative, which aimed to enhance staff wellbeing and create joy in work. Participating teams were supported to use quality improvement methodology and tools as part of a national learning network. At the end of the programme, 16 teams saw an improvement in at least one outcome measure, while 17 teams saw a sustained deterioration in at least one outcome measure. Aggregate data from all teams demonstrated improvements from baseline in all three outcome measures, with a 51% average improvement in the percentage of people who frequently enjoyed being at work, a 41% average improvement in the percentage of people experiencing no symptoms of burnout and a 42% average improvement in the percentage of people who were extremely likely to recommend their team as a place to work. As the first programme on this topic at a national scale, these findings provide ideas for change that can be adapted or replicated by clinical and non-clinical teams to improve their joy and wellbeing at work, and build their understanding of the barriers they may face and what is needed to overcome them. From the ideas tested and the learning from across the collaborative, a theory of change for enhancing staff wellbeing and joy in work has been created to inform future work in this area. [ABSTRACT FROM AUTHOR]