Embedding an Improvement Culture Across an Integrated Frailty Pathway Through a Multidisciplinary Quality Improvement Programme

Background
The NHS 10 year plan outlines the ambition to shift care from a Hospital centric model, to integrated community based systems, but little is known about how to implement this change. The integrated frailty crisis multidisciplinary team working across acute and community settings were motivated to improve services but lacked the confidence/knowledge to lead quality improvement (QI). A whole pathway QI practitioner development programme was established with projects aligned to the overarching system strategy to embed the change.

Methods
A structured training and coaching programme was introduced, aligned to the Trust’s A3 QI methodology and underpinned by testing using Plan–Do–Study–Act (PDSA) cycles. The programme aimed to build sustainable improvement capability across Advanced Clinical Practitioners and Specialty Doctors. A fishbone analysis identified barriers to applying QI in daily practice. Staff received training in QI methods (including driver diagrams, measurement, and PDSA cycles) and were supported to deliver improvement projects. The programme was refined through multiple PDSA cycles and tests of change in coaching methods used.  

Results
Nine MDT members completed projects and achieved QI Practitioner certification. Confidence and knowledge in QI improved significantly (70% reporting limited/ no confidence/knowledge at  baseline vs 85% reporting some/good knowledge/confidence afterwards). Wider impact of the programme through QI initiatives included:

• Frailty identification in ED increased from 0% to 79%.
• Use of triage tools with CFS and NEWS2 rose from 0% to 100%.
• Standardised UCR board rounds improved collaboration and decision-making.
• A lunch club initiative enhanced patient activity, social connection, and staff morale.

Conclusions
It is possible to embed a culture of QI and align this to an overarching strategy to improve integrated frailty pathways across previously fragmented services. It is recommended to develop QI practitioner skills among frontline staff to maximise the benefits to transformation of pathways and services. Using QI methodology to design the QI programme and Testing and refining this through PDSA cycles ensured engagement, ownership, and measurable improvement. This model is scalable across any healthcare system.