Frail people at end of life need rapid access to palliative care services. CLAHRC NWL were commissioned by St. Luke’s hospice to use the systematic approach to quality improvement (QI) to improve access to end of life day services, create a culture of continuous improvement, and build QI capacity.

Building on the successful application of the CLAHRC NWL systematic approach at project level we are investigating uptake and embedding of the approach at organisational level. Collaborating with St Luke’s Hospice, our approach has been used at an organisational level and led to reducing waiting times from 22 to 11 days. Analysts at St. Luke’s Hospice were trained to create and interpret control charts using their organisational data warehouse, enabling sustainable support for improvement work.

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At Woodgrange Day Centre, part of St Luke’s Hospice in Harrow, north west London, “we’d always done as we’d always done,” says Charles Daniels, medical director. It’s a claim perhaps too many in healthcare could make, and at St Luke’s it wasn’t felt to be good enough. “Actually, we were frustrated because we’d have liked to do things better,” he says. “But the first step was recognising that something needed doing.”

With support from north west London CLAHRC (Collaborations for Leadership in Applied Health Research and Care) they set about systematically looking at what they did and how it could be done better. The centre sees about 60 patients a week and involved some of them in a public engagement event, which identified speed of access to the centre as a concern. “Once they were in, they got wonderful care,” he says, “but the admission process was taking too long.”

Looking at how this might be improved was, he says, the eureka moment for staff. They had feared that change would mean more work, but by focusing on dividing the task up and evaluating each small change successively, they gained ownership of the process.

Duplication of effort was eliminated, systems were changed, and the time to access was halved, from 20 to 10.5 days. The improvement has been sustained, and with patient input staff are now looking at other things they can improve, such as fewer internal doors blocking wheelchair users and better information before arrival. Just because a service is good doesn’t mean it can’t be better.

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St Luke’s Hospice Woodgrange Centre Care Team are shortlisted for the BMJ Palliative and Hospice Care Team of the Year Award 2018.

Editors Note: Content of this post is taken from the BMJ Award article (BMJ 2018;361:k1669) written by Nigel Hawkes, freelance journalist for the The BMJ Awards 2018: Palliative and Hospice Care Team of the Year feature. The full article can be read here.

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