Access QI Collaborative Learning Session 5: Measurement and PDSA

In August 2023, the Access QI collaborative delivered its fifth learning session providing teams with the opportunity to:

• reflect on their own progress and learning
• continue to make valuable connections with other team members, and
• learn more about key quality improvement tools to support their ongoing quality improvement activity.

Sharing learning 

NHS Forth Valley (Gynaecology)

NHS Forth Valley’s team opened the session sharing insights and learning from their improvement project. The team is working to reduce time to cancer diagnosis and treatment waiting times by streamlining their postmenopausal bleeding (PMB) referrals. They aim to achieve this by:

• streamlining and separating out both their PMB and PMB with Hormone Replacement Therapy (HRT) referrals, and
• trialling a one-stop ‘see and treat’ clinic model.
  
  

So far, the team has developed a process map and collected key data on their current operating model. The detail gathered from these exercises has enabled them to begin developing and testing their change ideas. Having separated out their PMB and PMB/HRT referrals since January 2023, they now have a PMB wait of two weeks and a PMB/HRT wait of four to six weeks. They have also designed and begun testing a potential ‘see and treat’ PMB clinic model. The first trial took place in August 2023 with a further four trial clinics scheduled. The team will continue to monitor the results from these testing cycles including their qualitative and quantitative data collection.

The team has also learned from their activities. Regular team meetings, process mapping and data collection have all supported them to develop their change ideas. They also believe their collective positivity and team work has sustained their progress. Their most significant challenge has been around outpatient hysteroscopy (OPH) coding.

The team plan to continue testing and reviewing their changes and are keen to gain further patient feedback on their new model. They aim to do this by seeking patient representation at their regular planning meetings.

NHS Greater Glasgow & Clyde (Paediatric ENT)

Next to share their experience was NHS Greater Glasgow & Clyde’s Paediatric Ear, Nose and Throat (ENT) team. Their process mapping and data collection activity has led them to focus in on their theatre waiting times. Theatre access is a limited resource within their service so the team considered ways to reduce theatre time and free up more capacity. They considered whether it would be possible to avoid general anaesthetic for any of their procedures. A peer-reviewed literature search identified that automated brainstem responses (ABR) can be performed with melatonin in children aged between one and six years old without the need for sedation. They were also aware of their local radiology department’s success in the use of melatonin with patients over the past 10 years.

Preparation for their test involved:

•  identifying a suitable testing location
•  purchasing relevant ABR equipment
•  acquiring pharmacy agreement on melatonin dosing and preparation, and
•  gaining clinical governance approvals.
  
  

The team has now conducted its first testing cycle with eight patients over a four week period. This cycle has produced promising results and learning to inform their next round of tests scheduled for later this year.

Benchmarking for success
The teams were then introduced to the first of two learning topics: benchmarking for improvement.  Used across many industries and sectors since the late 1970s, benchmarking is a structured approach to quality measurement and service improvement.

Benchmarking helps to:

• Identify strengths and weaknesses within services.
• Identify the level of performance possible by looking at the performance of others.
• Promote changes and improvement in quality, productivity and efficiency.
• Help to better meet the needs of patients, families and carers.

Learn more about the background, purpose and processes involved in benchmarking by accessing our presentation materials here.

Teams were then invited to engage in a session of virtual networking where they reflected on their experiences of benchmarking within their own quality improvement projects.

Data for Improvement

The second topic addressed was about data for improvement. This session offered a review of the purpose and value of both qualitative and quantitative measures. The presentation can be accessed here.

This article also provides a useful overview of data for improvement within complex healthcare systems which can be read here.

Next steps
The final Access QI collaborative learning session will take place in November 2023 and will focus on sustaining and sharing improvements. This will support teams to move closer to full implementation of their respective change ideas in preparation for the end of programme event taking place in February 2024.