Strategic Transformation and redesign model case study: King George Hospital's emergency department 

The trust aimed to improve patient care and staff experience by delivering high-quality care, creating a diverse workplace, restoring core services, making better use of resources, being a proactive contributor in the local community, and understanding inequalities.

Underlying these strategic objectives is Barking, Havering and Redridge Uiversity Trust’s continuous improvement (CI) methodology, spearheaded by the new Strategic Transformation and Redesign model (STaR) which brought together four change teams.

King George Hospital's emergency department (ED) faced challenges in meeting the national target of 76% of patients seen, treated, and discharged within four hours, a 45-minute maximum on-site time for ambulances, and improving staff and patient satisfaction. By partnering with STaR and utilising the CI methodology, ED has achieved a 30% increase in patients seen, treated, and discharged within four hours, a 68% reduction in ambulance handover time, and 100% staff and patient satisfaction. 

In addition, departmental staff from all levels enrolled on the CI training to further build improvement skills to improve and redesign the way that care is provided.

The managing director, an executive board member, led from the front by attending daily huddles and promoting changes at board level, which helped to overcome roadblocks. This clear and visible leadership has highlighted how important it is for everyone to embrace and adapt to change.

Resources: 

PDF: Exhibition stand
Document: King George Hospital (KGH) ED SDEC project summary
Document: KGH RAFT project aims
Document: ECG Machine explainer
Document: Improvement board diagram 
Slides: KGH ED RAFting improvement diagram
Slides: KGH ED London Ambulance Service improvement diagram 
Spreadsheet: Process at a glance
Spreadsheet: RAFT Pilot data
Spreadsheet: CI project document
Spreadsheet: RAFTA data - Review post-rapid handover

The Care Trust Way - Ambition to action 

In 2019, the trust embarked on a mission to revolutionise care at Bradford District Care NHS Foundation Trust.  Not just wanting a quality improvement method – the trust wanted a way of working that encapsulated our values. That's how 'The Care Trust Way' was born – a philosophy of improvement and innovation woven into the very fabric of the organisation.

Inspired by the world's leading quality improvement models, the trust crafted a framework uniquely our own. Their leaders became champions of change, fostering a workplace where every voice could be heard. They empowered staff with the tools not just to improve their day, but to make everyone’s experience better.

The trust's board members, using their 'Go See' framework are on the front lines, seeing the challenges, celebrating the wins. This shared understanding fuels better decisions that reach right down to the patient level.

As a result, they've seen better outcomes, with a more responsive experience for our patients. The staff also feel it – in the pride of owning their improvements and our Care Quality Commission inspections reflect this transformation. The 'Care Trust Way' isn't just a project; it's who they are and the way they do things.

Resources: 

PDF: View the exhibition stand.
Document: The Care Trust Way case study. 

Birth a new era: collaborative strategies for an improvement culture in maternity care

The Ockenden Report prompted a call for accountability and reforms in maternity services. Following a 2022 Care Quality Commission (CQC) inspection, the trust responded by launching a maternity culture and improvement programme. 

The programme aimed to provide outstanding care, ensure Hampshire Hospitals NHS Foundation Trust is a great place to work, making best use of resources, innovate for a sustainable future, with collaborative working to benefit the population.

Their targeted interventions included staff training, behaviour framework development, culture conversations and building psychological safety. The implementation of the programme aimed to enhance openness of the maternity culture, develop leadership and management skills, and foster a mindset for improvement initiatives.  

Over 200 maternity staff completed fundamentals of quality improvement (QI) training (bronze level); this represents 11% of all bronze QI trained staff trust wide. In addition, 26 attained practitioner level (silver) training. Additionally, two QI coaches were trained at gold level, increasing capacity for improvement support within maternity services.

External culture and team-building exercises were run through SimComm, and completion of a perinatal culture leadership programme has encouraged ongoing conversations about workplace culture.

An improved culture and focus on continuous improvement can be seen across all levels of staff, and  HR data indicates a reduction in staff turnover, with increases in recruitment and retention. Independent surveys also showed improved CQC patient survey results.

Robust governance infrastructures ensure clear visibility of all improvement initiatives, facilitating collaboration and progress tracking.

Resources: 

PDF: View the exhibition stand. 
PowerPoint: maternity services case study

Ongoing journey from inadequate 'Back to Good': A team effort through co-production

Following a period of poor leadership and failing quality governance, the trust's Care Quality Commission (CQC) rating declined from 'good' to 'inadequate' in 2020. The deterioration observed is not uncommon within the NHS, especially within mental health services. The King's Fund (2024) highlighted that a range of quality care issues stem from not following proper processes for managing quality and safety. This was clearly a problem at the trust, and providing poor care simply wasn't acceptable.

As such, our focus has been to improve the mental, physical and social wellbeing of the people in Sheffield communities using a holistic approach, which became the trust vision. Meaningful co-production was fundamental, alongside making improvement more visible in areas such as reducing restrictive practice especially for black communities,
reducing falls and supporting waiting lists.

Being placed in special measures pushed us to improve their services fast, and continuously monitor quality through better internal procedures.

The implementation of the 'Back to Good' programme contributed to improvements in areas not meeting required standards. This supported the trust to make significant and sustained improvements resulting in a better CQC rating. They exited the Recovery Support Programme and although there is a long way to go, the process has been noted by NHS England as exemplary. 

View the exhibition stand here. 

Embedding quality and improvement within an ambulance trust

The trust began their quality improvement (QI) journey last year, aiming to deliver high-quality care that is safe, appropriate for patients, financially sustainable, and integrated into the wider operational system.

The service adopted a systematic and structured approach from Lean Six Sigma methodology, enabling a deep dive into problems identified as part of a wider quality management system. Unlike other NHS trusts, ambulance trusts have not engaged with QI as successfully. To embed QI in the organisation, we had to create a psychologically safe culture that supports people to have a sense of control and influence over the improvements they can deliver. 

To achieve this, the trust is delivering three key enablers:

• development of QI capability,
• leadership and social connectedness, and
• effective use of data and digital tools.

Two organisational-wide QI projects were identified last year, focusing on keeping patients safe in the stack (KPSITS) and recruiting emergency medical advisors (EMAs) and health advisors (HAs). Both projects have demonstrated significant improvements for patients and people, achieved through board-to-floor support and collaboration with engaged individuals who provide valuable insights to support problem resolution.

Resources:

PDF: Exhibition stand
Slides: Quality and improvement strategy
Slide: Keeping Patients Safe in the Stack update
PDF: South East Ambulance Service recruitment process

#allofusimprove - Quality and improvement the South West Yorkshire Partnership Foundation Trust way 

South West Yorkshire Partnership NHS Foundation Trust's quality improvement (QI) approach, also known as '#allofusimprove' is a systematic and consistent approach to QI.

The QI team provides support to individuals, teams, and care groups seeking to carry out improvements. Tools like the model for improvement and a six-step process are available to everyone. The board has received training on QI, with data and measurement, and have identified progress to embedding the five components of NHS IMPACT including areas for improvement.

A tailored training offer is open to everyone and over 500 colleagues have been trained on QI. They also have an improvement network and an online platform called 'I Hub' for sharing ideas and collaboration and is working to integrate QI into one-to-one discussions, supervision, and appraisals. QI is part of everyone's induction.

Successes have included a 59% reduction in restrictive practice and a 69% reduction in physical restraint. Creative practitioner work has increased staff wellbeing and capacity, and a low-level community time-limited pathway has reduced formal Child and Adolescent Mental Health Service referrals — with none of the individuals re-presenting within the following 12 months. 

The trust are proud of the #allofusimprove approach and offer it to their staff as a vital part of our mission to be relevant today and ready for tomorrow.

Resources:

PDF: View the exhibition stand here.
Slides: Diagrams of quality improvement approach
Document: #allofusimprove approach explainer