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QI case study: Closing gaps
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What is a QI Case Study?
Case Studies invite you to explore invaluable insights through a collection of compelling improvement projects from across the Trust. Read below for a quick take on how the Luton Falls Service used the Think QI model to develop refined referral processes to improve its Strength and Balance programme.
Improvement Name: Falls Prevention - Closing the gap in Falls and enhancing opportunities
Date: April 2024
Deep Dive: Understanding the Problem
Falls are a major population health problem that will increase with ageing demographics, this will result in increased pressures on the NHS and social services to provide relevant treatments and ongoing care. The negative impact on the covid pandemic on levels of activity in older people will add to this.
Understanding the problem to define the goal and implement change:
The current Falls referral process in Luton is fragmented and complex with multiple entry points and significant duplication for patients with regards to providing information and history taking. For patients that have sustained a fall or are at risk of falls, they can frequently move between services (CCS, Virgin Care, Luton and Dunstable Hospital) in the current pathway which can cause confusion, delays, and a poor patient experience.
The current gaps in the Luton system against the key components of the BLMK offer are:
- No single point of access for falls prevention
- No population education on falls prevention
- Low integration between services managing falls patients
- No shared care records
- Limited therapy input into the CCS falls service
- No level two strength and balance programme, limited to level 1.
- No Fracture Liasion Service.
Deep Dive:
Investigation:
The Falls team spent time with other providers in Bedford, Luton and Milton Keynes (BLMK) to understand how they deliver their services and how the implementation of a Strength and Balance Programme and a triage process could work for them.
Data Insights:
Analysis was undertaken to understand the breadth of referrals into the system, the source and the waiting time for initial assessment. This gave us a baseline and wider understanding of where efforts need to be focussed.
Engagement:
Initial workshops with staff and patient representatives took place to get insight into their barriers, frustrations and thoughts on what we wanted to focus on as a provider.
Design: Designing the Change
Strength and Balance Programme:
Workshops were held with the project group, external partners and patient reps to design and co-produce pathways for the new S& B Programme. This allowed the team to look at all aspects of the design, what was working elsewhere and to test out thinking in a joined up and collaborative way.
Triage:
The team again worked with system partners to discuss and look at how triage processes were being managed in other areas. There were a lot of ideas bouncing around regarding the implementation of a new triage structure. The Falls team therefore set up a pilot of the desired changes to see how it would work, if any problems would occur and to ensure it was manageable. The pilot went well, and the team were able to make tweaks. This gave them confidence to proceed with the new process.
Deliver:
The project was initiated after the successful application of a business case that set out how the team would close the gap for Falls prevention in Luton in April 2022. The anticipated timeline for the project was 1 year, however, it took 2 years to complete the deliverables due to extensive recruitment requirements. The first step was to get recruitment rolling, however, there were some elements that the team could begin with, such as strengthening relationships with other providers, identifying hot spots in the system and starting with the design principles of the programme.
Recruitment:
The project needed Physiotherapy/Occupational Therapy roles in post to deliver the Strength and Balance Programme. These roles were new to the service.
Co-production:
The team worked closely with patient representatives on all aspects of the project including recruitment panels, design workshops, venue testing, educational materials communications and public information. This gave extremely valuable insights into lived experiences and helped manage expectations.
Workshops:
Multiple workshops with the team and stakeholders took place to ensure engagement and accountability in the delivery of this work. A whole team workshop in Autumn 2023 enabled shared learning and identified continuous improvement opportunities.
Competencies:
The team's skillset has grown to meet the new service offer and supports their continued professional development.
Demand and Capacity Planning:
Modelling for the new triage pathway was completed to give confidence and assurance that the changes would be impactful.
Evolve: Continuous Improvement
Outcomes:
- 58 Strength and Balance classes to date.
- As a result of attending the Strength and Balance classes, a 92-year-old lady said she felt confident to start using public transport.
- 76 Self-referrals recieved.
- A gentleman set a personal goal to walk his daughter down the aisle at her wedding, he achieved this following the completion of the Strength and Balance programme classes.
- 18 patients have completed the 8-week Strength and Balance Programme
- A patient who completed the full set of classes has now become a volunteer to support new patients starting their journey.
Benefits/Successes:
- Strength and Balance Programme initiated
- Improved education programme
- Refined triage process
- New Falls MDT with the support of an Acute Consultant
- Increased public knowledge and communications
- Implemented a self-referral pathway
- Improved data reporting across the service
- Built great relationships with system partners through collaborative working - which strengthened other areas wider than Falls work
- Upskilling/development of staff
- QI Knowledge and confidence to manage change within the service
The falls team will feed into the wider service Single Point of Contact work to ensure it can deliver against this objective. The Falls team have identified key areas for continuous improvement and has set up a Kanban board to manage demand within the team.
Lessons learnt:
Recruitment: Getting people into posts was challenging - tried to network, skill mix, looked at rotational. Next time we could have put posts out with slightly different requirements at the same time to save time and see what comes first.
Patient Engagement:
Lots of engagement/co-production worked very well and contributed to the overall development of changes being made. Included some patient reps with NHS knowledge and background.
Pilot:
The pilot worked very well and allowed the team to safely test out ideas and learn from experience before going live. This settled some nerves.
QI Tools:
Using a mix of project tools has helped with the development of the project as well as understanding and confidence to use them in the future.
Adaption to change:
Lots of change was happening across the team and it was hard to manage this along with staffing challenges and managing the caseload. Everyone's way of learning is different - was hard to manage and meet all needs.
You can find more information about the Luton Falls Prevention Programme and their QI Case Study below.
Download the full Case Study here
If you'd like to dive into more examples of projects, head to our Case Studies page for inspiration.
Last reviewed:
1 March, 2025