Building a culture of continuous quality improvement in an acute trust


At the start of this work there was no visibility or organisation approach to quality improvement (QI). This resulted in missed opportunities to optimise the benefits of improvement work and share learning across the organisation. Vision: "Everyone is an improver" Aim: To build a culture of continuous quality improvement (QI) Objectives: - Increase staff engagement and awareness (ambition) of QI - Increase staff capability - Increase QI activity and use of QI methodolog

Physiotherapy involvement in QI has resulted in
50% reduction in number of stroke breaches (delays)

Reduced MSK physio waiting times from 18 to 3 weeks
21% reduction (2.6 days) in length of stay of patients over 75 with frailty


The Model for Improvement (MFI) has been used and embedded across the organisation to support this work. Quality improvement tools such as a fishbone and driver diagram were used to understand the problem, engage staff and create a theory of change. Measurement for improvement is a major part of the approach incorporating both quantitative and qualitative data. Staff interviews were carried out and data was analysed using run charts and SPC. Communicating successes via celebration events, social media and conferences has been a key part of our organisation approach to share learning


Results: The initial survey identified a low level of understanding of QI methodology and how to use the appropriate tools and techniques. Many staff identified the need for training, access to support (coaching) and opportunities to share learning. A 3 tier QI training programme to train QI practitioners and coaches was developed. An organisational approach was agreed based on the MFI underpinned by a trust QI strategy supported by the board. As a result - 3 QI conferences have taken place with up to 40 staff showcasing their improvement work and >100 attendees on each occasion - 280 improvement ideas registered. We now have an average of 8 new projects per month - 500+ followers on twitter - 65% of completed QI projects have shown measurable improvements - Increased capability with 143 trained QI practitioners and 20 QI coaches (includes 3 physios) - All QI practitioners on the development programme are assigned a QI coach to support their learning needs

Conclusion(s): Physiotherapists can play a leading role in organisational strategy development, culture change and leadership. An organisational approach to QI with appropriate training and support for staff can improve organisational culture with increased staff engagement and empowerment and improved patient care. This was noted in our recent CQC report.

Cost and savings

No further information. 


In addition to improved organisational QI capability and awareness there have been significant service improvements involving or led by physiotherapists using QI methodology:

· 50% reduction in number of stroke breaches (delays). Resulting in an improved rating in the National Stroke Audit from C to B.

· Reduced MSK physio waiting times from 18 to 3 weeks

· 21% reduction (2.6 days) in length of stay of patients over 75 with frailty

Top three learning points

No further information.

Funding acknowledgements

Wessex Health Education England provided some funding towards supported a specific project to develop our QI coaches.