Improving access to services through a collaborative learning system at East London NHS Foundation Trust

Abstract

Early intervention following initial referral into healthcare services can have a significant impact on the prognosis and outcomes of patients. Long waiting times and non-attendance can have an immediate and enduring negative impact on patients and healthcare service providers. The traditional management options in reducing waiting times have largely revolved around setting performance targets, providing financial incentives or additional resourcing. This large-scale quality improvement project aimed to reduce waiting times from referral to first appointment and non-attendance for a wide range of services providing primary and secondary care mental health and community health services at East London NHS Foundation Trust (ELFT). Fifteen community-based teams across ELFT came together with the shared goal of improving access. These teams were diverse in both nature and geography and included adult community mental health teams, child and adolescent mental health services, secondary care psychological therapy services, memory services, a musculoskeletal physiotherapy service and a sickle cell service. A collaborative learning system was developed to support the teams to come together at regular intervals, share data, test and scale-up ideas through quality improvement and have access to coaching from skilled improvement advisors in the ELFT central quality improvement team. Over the course of the 2-year project, waiting time from referral to first face-to-face appointment reduced from an average of 60.6 days to 46.7 days (a 23% reduction), non-attendance at first face-to-face appointment reduced from an average of 31.7% to an average of 20.5% (a 36% reduction), while referral volume increased from an average of 1021 per month to an average of 1280 per month (a 25% increase).

Aiming for quality: a global compass for national learning systems

“…“Learning systems” is an emerging concept that was first formally defined by the Institute of Medicine in 2007 [ 87 ]. Therefore, there is some, albeit limited, evidence on the positive impact of learning systems on patient outcomes [ 85 , 88 , 89 ]. However, there is guidance on the core features of learning systems and the process used to develop them based on examples from both HI and LMIC.…”

“…The second feature of a learning system is having a common goal and commitment to improving one or more areas in the delivery of health services. This shared purpose fosters a sense of community among participants of the learning system where collaboration is a fundamental requirement for learning [ 84 , 85 , 94 , 98 – 101 ].…”

Improving access and flow within Child and Adolescent Mental Health Services: a collaborative learning system approach

“…► A support structure, with a project board, an executive sponsor for the whole collaborative learning system, local sponsors for each project and improvement advisors coaching each project team. 7 Shared goal and purpose across all the teams Each project team was supported to develop a measurable aim relevant to their individual context and project. These were devised using knowledge of their services, feedback from service users and service data and are detailed in table 1.…”

“…A support structure, with a project board, an executive sponsor for the whole collaborative learning system, local sponsors for each project and improvement advisors coaching each project team. 7 …”

“…Previous work at ELFT have combined this approach with collaborative learning systems to accelerate improvement in efforts to reduce violence on inpatient mental health wards 6 and waiting times and DNA’s across community teams. 7 This allowed us to begin to develop an understanding around the impact that bringing people together in a collaborative learning system can have in improvement work.…”