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Archive for April, 2014

Engagement is a critical factor in attempting to improve quality at scale

25 Apr, 14 | by BMJ Quality

Dr Amar Shah is the associate medical director for quality improvement and consultant forensic psychiatrist at East London NHS Foundation Trust

Dr Amar Shah is the associate medical director for quality improvement and consultant forensic psychiatrist at East London NHS Foundation Trust


This series of blogs chronicles the journey of East London NHS Foundation Trust in embedding continuous improvement to achieve transformational change. This blog is brought to you by BMJ Quality. For more quality improvement resources go to

Engagement is a critical factor in attempting to improve quality at scale. Our aim for engagement is to harness the energy of a critical mass of people into purposeful activity aligned to our system-level goals.

Stage 1 of our programme was about direction – working with the board and our senior leaders to understand what quality improvement would mean for the organisation, consulting widely to develop a shared mission, and developing measurable aims that will be the focus of all our improvement work.

We’re now deep in stage 2, which is about building the will within our organisation for improvement – trying to create ‘pull’ from the frontline. We’re taking a two-pronged approach to this, using traditional communication methods alongside a more campaign-style approach aimed at building a grassroots movement for change.

Traditional tactics have included a launch event (in February and attended by 250 people). We’re taking this deeper into the organisation, with a series of events aimed at inspiring and exciting the front-line staff and patients about quality improvement. We’re using the existing structures and hierarchies to gradually embed continuous improvement within our approach to quality, engaging service and clinical leaders to take ownership for nurturing improvement within their departments.

However, much more exciting is the emerging campaign. Many months ago, before we formally launched the programme, we brought together a Q30 group of staff representative of all areas and levels of our organisation.  We asked them to help us think about how to engage front-line staff, and the messaging that would help us connect with people’s internal motivations for wanting to give their best to their patients. Alongside this, we had a Q12 group of patients, carers, and governors, to give similar input from their perspective. This has been hugely valuable in helping us develop a compelling narrative and communication plan to help us reach and unleash every person in the organisation.

We’ve also tried to make every aspect of the programme as accessible and transparent as possible. We have spent many months consulting widely to develop our vision, mission, and measurable aims, and continue to ensure frontline staff and patients are integral to all our improvement and redesign work. We have developed a microsite for our QI programme that is purposely not hosted on our intranet, making it accessible to staff from anywhere and from any device, and also to make it accessible to patients, families, governors and the wider community. Even though it may sound strange to some, the use of social media channels at East London remains extremely limited. Our launch event and communications are harnessing the power of Twitter, Storify, SlideShare and other channels to extend our reach and encourage the building of more networks within our community. Finally, we chose to allow our staff to design our QI brand image, running an internal competition. We had patients, staff, and senior leaders on our shortlisting panel, and all staff were invited to vote for the winner. The response was overwhelming, with over 500 staff voting in total, and 90 votes in the first five minutes.

We recognise that engaging our staff and patients in this work is critical to success. We are beginning the long road, and starting before we’re fully ready, but trying hard to be the change that we want to see – listening, learning, involving, and innovating at every stage.

If you’d like to find out more about the East London QI programme, please visit

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