The BMJ Awards 2018: Palliative and Hospice Care Team of the YearBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1669 (Published 16 April 2018) Cite this as: BMJ 2018;361:k1669
- Nigel Hawkes, freelance journalist, London, UK
Applying quality improvement methods in hospice
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.
Integrated clinic service
Early involvement of palliative care experts in …