Quality improvement can be defined as an evidence-based, systematic approach to continuously improving care and achieving better outcomes for patients. A report was published by The Kings Fund in 2016, ‘Improving Quality in the English NHS’ (Ham, Berwick & Dixon, 2016). It argued that without a sustained and comprehensive commitment to quality improvement, the NHS cannot meet the health care needs of the population it serves.
At East Lancashire Hospitals NHS Trust (ELHT), the inpatient speech and language therapy team had been recording issues and incidents across the hospital relating to patients who presented with dysphagia. Common themes for these issues were:
- Patients being discharged without SLT recommendations, information, or thickener
- Non-compliance with SLT recommendations on the ward
- Late or no referral made to SLT
- Poor communication between staff on wards
- Non-compliance with the ward swallow screen protocol
- Poorly maintained oral hygiene
In an attempt to improve patient safety, Nicola Fleming, speech and language therapist, has been working collaboratively with the Quality Improvement team to lead a project that aims for a 25% reduction in the number of incidents relating to SLT per month by December 2019.
The project follows a ‘Plan, Do, Study, Act’ model for improvement, looking at what it is we’re trying to accomplish, how we’ll know that a change is an improvement, and what changes we can make that will result in improvement?
The common themes relating to issues and incidents reported on for patients with dysphagia were used as primary drivers for change, and a number of ideas arose on ways to reduce the number of incidents, subsequently improving quality. Some of these ideas are currently being implemented across the trust, such as:
- A survey given to nursing staff and healthcare assistants looking into knowledge and confidence in dealing with patients with dysphagia, to guide the projects further secondary drivers (areas that have a need for change).
- Initial discussions around developing an e-learning awareness course for dysphagia available to all ELHT staff.
- Further training given to ward staff as capacity allows and where the need it identified.
- An update of the trust’s internal internet page for speech and language therapy.
- Editing and re-wording of the ward swallow screen protocol to make it easier to follow.
- Speech and language therapists writing directly on to the patient’s prescription charts so that the requirement for thickener is directly transferred on to the patient’s list of take-out medications (on their transfer of care/discharge letter).
- SLT’s having editing rights on their patient’s transfer of care/discharge letters – to directly record the patient’s SLT recommendations prior to a patient being discharged from hospital.
Regular meetings take place with the quality improvement team in order to evaluate the strategy and project implementation.
Following the Berwick review into patient safety after the Mid-Staffordshire scandal, a number of collaborative improvement networks called Academic Health Science Networks (AHSN’s) were created. The aim of AHSN’s was to support NHS organisations in improving patient safety through a variety of projects; some of which had excellent outcomes such as a falls collaborative that delivered a 60% reduction in falls. The AHSN’s have been recommissioned to run patient safety collaborations for a further three years, and NHS Improvement has recently completed its consultation on a national patient safety strategy, perhaps signalling a renewed commitment to quality improvement.
What quality improvement projects might improve care and result in better outcomes in your workplace?