Get involved: Quality Improvement

The steps we can take to improve the quality of care for people who use our services

Quality Improvement in healthcare brings staff and people who use our services together. It involves a steady and planned approach to solving a problem using specific methods and tools with the aim of bringing about a measurable and positive improvement in safety, outcomes, and experience of services.

The Model for Improvement

At NSFT we follow the Model for Improvement to explore, plan and work through improvement projects.

The Model for Improvement consists of two parts, ‘thinking and doing’ which are of equal importance.

First the project team work together to understand the quality issue by answering the three key questions asked in the Model for Improvement.

The second and ‘doing’ part involves a project team testing ideas using Plan, Do, Study, Act Cycles (PDSAs) to learn what changes can be made which leads to an improvement.

Carer Expert by Experience — Quality Improvement Falls Collaborative 2024

I was made to feel welcome and at ease during the collaborative session and enjoyed the content and opportunity to hear from the teams about what is working well and how they are planning their next steps.

Service User —  Expert by Experience

I participate in several of the workstreams because I care and want to make a difference in Mental Health.

Service User — Expert by Experience

The QI team has been very welcoming and has allowed me to find my place in the meetings in a comfortable way. It has been interesting to learn about the project and follow it through, seeing steady progress towards its aim.

 

Between November 2023 and June 2025, staff across several inpatient wards in Norfolk and Suffolk took part in a major project to reduce falls and improve safety for older adults.

The Falls Quality Improvement Collaborative aimed to reduce the number of falls and falls causing harm by 20%. Over 50 staff from different roles-including nurses, doctors, therapists, pharmacists, and admin teams-worked together to test more than 50 ideas. These included:

• Daily team huddles to spot and manage fall risks
• Using data to identify high-risk times and areas
• Promoting safe footwear, good nutrition, and regular eyesight checks
• Staff training and better use of falls risk tools
• Reviewing medications and managing postural changes

Lived Experience at the Heart of Change

Two carers with personal experience of supporting loved ones in inpatient care played a vital role in the collaborative. One joined a ward-based project team, while the other contributed to the overarching faculty group guiding the work across all sites.

Their involvement ensured that the voices of service users and families were heard throughout. They helped review ideas, gave feedback on resources, and made sure changes were practical, respectful, and person-centred. Their insights also supported the development of tools that could benefit community teams and external partners.

At the final celebration event in June 2025, one of the carers presented certificates to ward teams, recognising their hard work and commitment to safer care.

Positive Results

• Fewer falls across participating wards
• Longer periods between falls causing harm
• Some wards went weeks without any harmful falls

This collaborative has helped staff better understand how falls affect people and how to prevent them. Most importantly, it showed how lived experience can drive meaningful change and improve care for everyone.

Project Overview

From May 2024 to June 2025, Norfolk and Suffolk NHS Foundation Trust (NSFT) delivered the Outcomes Bundle Collaborative across its Adult Community Services. This initiative aimed to improve the quality, consistency, and person-centred nature of care by embedding outcome measures into everyday clinical practice.

Improving Outcomes for Adults in the Community

The collaborative introduced three key tools to support recovery and monitor progress:

• Dialog+: A structured questionnaire that helps individuals and their care teams explore personal goals and quality of life across 11 domains.
• Global Assessment of Functioning (GAF): A clinical tool used to assess how individuals are managing in areas such as daily activities, social relationships, and mental health symptoms.
• SNOMED CT: A standardised coding system that enables accurate recording of treatments and interventions, supporting continuity and safety in care.

These tools were successfully integrated across adult community teams, resulting in:

• Increased use of paired outcome scores to track progress.
• Improved consistency in recording clinical interventions.
• Enhanced visibility of recovery trends through data dashboards.

Service User Involvement

A key strength of the collaborative was its commitment to co-production. People with lived experience of mental health challenges played a central role in:

• Designing and refining outcome measures.
• Participating in project teams across adult community services.
• Developing accessible resources and guidance for both staff and service users. 

Service users shared how these tools helped them feel more involved in their care:

Dialog+ helped me focus on what was important. I'm proud of how I've managed some of the challenges I have.

Working with my care coordinator to think about my goals helped me take things one step at a time.

Embedding a Person-Centred Approach

The Outcomes Bundle was designed to ensure that care is tailored to each individual's needs and aspirations. Outcome measures were used not only to collect data, but to support meaningful conversations and collaborative care planning.

To support implementation, NSFT:

• Incorporated outcome tools into appointment processes and clinic workflows.
• Provided training and resources for staff.
• Used PowerBI dashboards to link clinical interventions with patient outcomes, informing both individual care and service development. 

The Outcomes Bundle Collaborative demonstrates how a person-centred, co-produced approach can lead to measurable improvements in adult community mental health care. By placing service users at the heart of the process and using data to guide decisions, NSFT continues to deliver care that is safer, kinder, and better.