143 Enhancing the quality improvement culture in a large multi-site palliative care team

<h3>Background</h3> Quality improvement (QI) activity is core within palliative care. However, embedding a culture of sustainable and effective improvement work remains challenging. Poor quality programmes often entail non-evidence based methodologies, lack sustainability, and are frequently abandoned. This project aims to enhance the effectiveness of the improvement activity within a large multi-site tertiary centre Specialist Palliative Care Team (SPCT), embedding forward thinking, relevant, and sustainable improvement work. <h3>Methods</h3> Driven by a trained improvement champion, the key stakeholders helped create a vision for the SPCT’s improvement activity linked to the Trust strategic goals. Using the Model for Improvement¹ and different improvement tools (e.g. fishbone and drivers diagrams) we developed a broad aim with five specific main drivers (increase awareness, engagement and integrated working, build capacity, support delivery), and a measurement plan. Over 18 months, ideas were tested through Plan-Do-Study-Act cycles (e.g. governance meeting times and structures, celebration of team successes, and creating a weekly improvement whole team huddle) with a focus on fostering an improvement culture within the team. <h3>Results</h3> Seven QI projects using improvement methodology are underway (an increase from two last year). There is higher engagement and involvement of the wider team in the development of the improvement activity. Staff trained in QI methodology has risen from 29% to 85%, and 81% of staff reported feeling able to undertake a QIP with support/limited support. Satisfaction with clinical governance meetings is high (rated ≥7/10 by 63% staff), and four projects are being presented externally (none last year.) <h3>Conclusion</h3> Linking the project to the strategic goals of the Trust and the service was essential to get buy-in from key stakeholders. The systematic use of improvement methodology helped define clear aims and outcome measures to guarantee that the changes implemented led to a sustained improvement in the quality of the SPCT’s improvement activity. <h3>Reference</h3> Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: a Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.