Reflective Improvement Meetings Method Guide

This guide describes the method used for holding care experience reflective improvement meetings within the Care Experience Improvement Model (CEIM) approach.

Ensuring a positive experience of care, treatment and support is an essential component of delivering good person-centred health or social care services, alongside effectiveness and safety.

Improving care experiences at the care or support delivery level is not simple and requires effective leadership and a person-centred culture and values. It also requires health and social care delivery teams to have a systematic approach to meaningfully collecting, analysing, learning from and acting on feedback to support quality improvement activities.

This resource sets out some of the key factors required for health and social care teams to embed a robust continuous improvement approach by establishing monthly Reflective Improvement Meetings.  This is a structured space where teams, using people’s experiences of care or support, can effectively identify improvement opportunities and act on them.

Reflective Improvement Meetings

A reflective improvement meeting, when used to consider qualitative feedback information, should be a non-judgemental, non-defensive, improvement focused meeting space that supports information sharing, prioritisation and collaboration. This approach to reflecting on feedback supports teams to fully embrace being open and honest about what they hear in feedback and explore how they feel about it. It allows them to be creative and innovative in developing ideas to solve issues that have been raised and in identifying how good practice can be reliably applied across the team.

Reflective improvement meetings should be multi-disciplinary (where possible) so that acting on care or support experience feedback becomes the responsibility of everyone rather than only one or two individuals in a team.

Project management tools to support an improvement meeting can be found at NHS Education for Scotland’s Quality Improvement Zone. 

Setting up a reflective Improvement Team Meeting

Protect time

Teams should plan enough time to hear and discuss feedback. This works best when a monthly meeting is scheduled in advance and everyone in the team knows when and where the reflective improvement meeting will be held.

It is possible to incorporate this reflective time in pre-existing meetings, although if doing this it is essential that time in the meeting is allocated routinely to allow focused discussion of the narratives and to make decisions about next steps.

In many cases it has been shown that incorporating this discussion on feedback into an already established meeting is less successful than creating a new space for this. This is because often the reflection on feedback isn’t prioritised and can become diluted or overshadowed by the already established focus or purpose of the group. Although if this is the only option, it is advisable to schedule discussions around feedback early in the meeting rather than simply tacking it on at the end when participants are tired and already thinking about moving on to start work or going to their next meeting. 

Build a safe space

Creating the conditions for reflection on the quality of care or support being delivered by a team can require some thought and preparation in advance to generate psychological safety within the meeting space.  Predominantly this requires 4 ground rules to be consistently applied to all discussions, and these are:

• Be kind
• listen to understand,
• avoid judgement or defence, and
• maintain an improvement and action focus.

Although care experience feedback can often be positive, when it isn't it is important that the team is supported with their emotions around this and encouraged not to jump to defending or explaining why something might have happened in a particular way.  Rather, to reflect on understanding why people might have felt the way they did (as shown in their feedback). This can help to remove some of the tendency to blame and can keep the team focused instead on what might be done differently.

Agree on a meeting structure

There is no single meeting structure recommended for a reflective improvement meeting. The structure should be designed around what works best for the team and the approaches they can most easily engage with routinely.  There are however some key elements that should always be incorporated to ensure effective reflection on experience feedback is at its centre, these include:

• time for everyone to read the feedback narratives or for them to be read out to the team,
• reflective discussion on what the team have learned from the narratives (individually and/or from small group review),
• group consideration of the improvement opportunities and prioritisation of improvement ideas, and
• allocation within the team of improvement ideas for small scale testing

Reflective improvement meetings should be held on a routine monthly cycle that follows the collection of narrative feedback from people receiving care or support, their families or carers.

Clarify roles

All those involved in a reflective improvement meeting should be assigned a role. It is important that everyone is clear about their role before a meeting commences. Individuals may also take on different or multiple roles at each meeting depending on what is required or their skills.

It is important to ensure that a senior leader is involved in the reflective improvement meeting who can quickly give permission for improvement activities, such as testing, and who can unblock obstacles or access more senior support when required for change.

It can also be helpful to involve others who can support the reflection, idea generation or in planning and making improvements, such as subject matter experts in the area you are aiming to improve or support staff such as quality improvement or a person-centred care advisors.

Reflective Improvement meeting team roles:

Core tasks within a simple reflective improvement meeting structure

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