Improvement team person-centred vision 

Taking time out to create an improvement team vision statement that helps to describe the quality of person-centred care or support that the team want for people who interact with their service can be helpful for a new Reflective Improvement Group.

This activity can be used as a way of involving the whole group in shaping the future of person-centred care or support in their service. This can also help to keep the group focused, support ownership and commitment to the success of the group, and frame group discussions to ensure that people who use the service are at the center of all decisions and changes.

An improvement team vision statement is also a way to explain clearly to others what the team's quality and improvement aspirations are and helps the team to remain focused on what’s important. 

The difference between a mission statement and a vision statement is that a mission statement is about what you do now (your approach and objectives) whereas a vision statement is firmly based on the desired future.  There are many approaches to developing a vision statement, one example is shown below.

Vision statement framework:

An example improvement team vision statement:

Team reflection

Using reflection to capture new knowledge or feelings about hearing care experience feedback (positive or negative) can help a team to continuously learn and improve. Building reflection into an improvement meeting is a big part of being an effective improvement team, as it gives those involved the ability to learn and adapt quickly.

Doing this can be challenging because when work is busy it can be difficult to find and justify the time to reflect on what feedback means for the quality of care and support delivered by the team, but it is important to find time and ways to put what is learned from feedback into action.

Important questions to help teams reflect on experience feedback include:

• What do you notice?
• What are you curious or wonder about?
• How does this make you feel?
• What improvement opportunities does this present?
• What improvement ideas could you try? 

It can also be helpful to use tools such as those used in Values Based Reflective Practice to support team reflection on narrative feedback. The ‘three levels of seeing’ tool works well when used immediately following the team hearing or reading feedback and then the NAVVY tool helps to create a space between the ‘issue’ and any proposed ‘solution so that teams don't jump to solutions.

Prioritising improvement ideas

The improvement team will be able to identify and prioritise opportunities for improvement highlighted through their reflection on the feedback.  This may also be assisted by generating criteria or questions that help to prioritise what the team should work on first. For example, the team may ask questions like:

• Is this improvement idea a quick win (easy to test with high impact potential)?
• Is it more complex but would have a positive impact for service users and/or staff?
• Is it of high importance to service users, patients, families or carers?
• Will it support staff in their work to deliver person-centred care?

A prioritisation matrix can also be a useful visual tool to help the team to decide which improvement ideas to test first and how to focus their activity and energy.  It works best when carried out collaboratively within the reflective improvement team. It can help to build broad buy-in and communicate why the team have chosen to test certain ideas before others.  A simple form of this is the 2x2 matrix. 

Using quality improvement (QI) approaches

It is recognised that not everyone working in health and social care has experience of using quality improvement (QI) methods. Where this is the case for those involved in a care experience reflective improvement meeting, it is important to seek support from others in the team or from the wider organisation, such as qualified Improvement Advisors, to help robustly plan and take forward testing and implementation of change ideas.

The team can also develop their knowledge and pragmatic skills in using quality improvement approaches by utilising the online resources and personal development tools available at NHS Education for Scotland’s Quality Improvement Zone in ‘TURAS | Learn’.

The quality improvement journey

The Quality Improvement Journey shown in figure 5 illustrates the stages of an improvement initiative or project.  

The Care Experience Improvement Model recommends using this approach to help develop a quality improvement infrastructure for the Reflective Improvement Meeting. It can help team members visualise how their work on gathering feedback can support them to ‘understand the current systems’ from the perspectives of people who receive care or support, their families or carers. This assists in moving care experience feedback into improvement action by using the last four stages of the model shown in figure 5 to guide the activities of the improvement team. Find out more about the quality improvement journey at the Quality Improvement Zone.

The QI Journey

Feedback trends

Once the Care Experience Improvement Model is embedded into team practice and Reflective Improvement Meetings are established on a monthly cycle, the team may start to see trends in the data gathered from feedback over time.  This can also at times result in less positive feedback re-emerging about changes the team thought were ‘quick wins’ early on. Seeing this in the data should be viewed as a positive aspect of the process now established, as it helps to provide assurance when changes are making a difference and enables the team pick up on any changes that may need to be reviewed by the team again.

Bringing these issues back to the reflective improvement team can be hard but it is important to focus on continuous improvement and maintaining the non-judgemental, non-defensive maxim of the improvement team. 

Collaborative improvement partnerships

Once the Reflective Improvement Meeting is established the team should consider inviting people who use the service or those that support or advocate for these individuals to participate as improvement partners. The value of involving people who have a service user perspective in the improvement team can be immense as they can offer unique insights into what really matters and they can help focus the team’s attention on improvement ideas that are most meaningful for the people they care for or support.

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