Foundation Trust Listens to Improve


11 / 04 / 2014

East London NHS Foundation Trust (ELFT) have developed a framework for listening to improve which aims to support culture change. Dr Amar Shah, Quality Improvement Lead & Consultant Forensic Psychiatrist at the Trust shares their ideas.

The framework developed by the Trust aims to support a culture change within the organisation that puts patients and carers firmly at the heart, to listen more to frontline staff and service users, and to support staff to innovate and test new ideas that could make a real difference.

About the trust

ELFT employs approximately 3700 permanent staff and provides a wide range of community and inpatient services and operate from 49 community and inpatient sites.

Key aims

To ensure that every member of staff feels listened to, that they have a forum where they can raise ideas for improvement or concerns about the quality of care being provided.

How it works

ELFT are supporting the development of listening to improve at each level of the organisation. This is supported by their Listening to Improve Framework. 

At senior leadership level they hold regular listening sessions which includes a frequent Chief Executive open forum and three times a week executive WalkRounds. They have implemented a transparent WalkRound process, with the key points being fed back to the clinical team, shared at internal quality and safety committees, and published monthly as part of the Trust Board papers.

Dr Amar Shah says "We are also supporting individual directorates to embed listening within their operational structures, and to support frontline staff to raise their ideas. The directorate leads are encouraged to feedback comments and ideas promptly to all staff, with a “you said, we did” framework for ensuring that ideas lead to positive change."

The organisation is supporting all clinical teams to ensure there is a regular space where all staff can come together to focus on improving quality. This will provide an opportunity to think openly about the quality of care being provided, to share ideas about what could be improved and to use rapid-cycle testing of change ideas.

Key challenges and learning

The enthusiasm of frontline staff to work together to improve systems and processes, and the richness of ideas that has come from asking frontline staff for their thoughts and ideas is really encouraging. The concept of empowering frontline staff is critical to quality improvement.

The main barrier has been releasing frontline nursing staff from the wards to attend the listening to improve sessions.

Dr Amar Shah says "We want the listening sessions to be embedded within the organisation’s structure, so that it becomes part of each clinical team and directorate’s DNA, and the way that things are done in East London."

"Our goal is to provide the highest quality mental health and community care in England. The quality improvement programme that we are embarking upon is aimed at delivering this, through engaging all staff in quality improvement, building up improvement skills within the organisation, and ensuring patients and carers are at the heart of our improvement efforts."


For more information on the listen to improve framework please contact

Dr Amar Shah, Quality Improvement Lead & Consultant Forensic Psychiatrist

Telephone: 020 7655 4200

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