Dave’s QI journey20 September 2022
On a sunny Friday afternoon, HSCQI caught up with Dave Milliken, Chair/Co-founder of the Belfast Co-production Learning and Development Team, HSCNI service user and data enthusiast.
Zoom glitches aside, Dave welcomed us almost immediately and his readiness to dive into the purpose of the interview and share with us his Quality Improvement journey demonstrated his passion for the topic at hand.
Dave shared with us a bit about himself. Dave has always been a data-driven, pragmatic person, which has stood by him well in his work as a coder. Dave’s disability means he relies on a wheelchair. It was his passion for removing disability prejudice, coupled with his problem-solving nature and his thirst for knowledge and change, that steered him towards Quality Improvement and made him resolute in his journey.
HSCQI Hub Team rep: “So Dave, how did you get involved in Quality Improvement (QI)?”
Dave: “My first involvement with Quality Improvement, from a Trust perspective, was actually through Ann Purse, who was the acting manager for Belfast Trust Adult Services Learning & Development Training Team. Ann has a strong focus on co-production, especially in terms of development and delivery of training. So when one of her trainers, Patricia Burns, was interested in running a Quality Improvement awareness course for Belfast Trust staff, Ann naturally wondered if there was an opportunity to get a service user on board at the ground level. I had a little bit of exposure to QI theory through my degree (computer science-based) and pre-disability employment, but that had been years ago. So, I was a bit nervous about moving into a training role about something I didn’t feel I had sufficient skill or experience with.
As luck would have it, a Belfast Trust initiative called Safety Quality Belfast (SQB), which used a participant-selected project to teach QI skills and foster QI experience, was accepting applications for its next cohort. With a lot of assistance from Patricia (those Trust application forms can be very intimidating to non-Trust folk) and a very informal and supportive interview with the awesome Dr Iain McDougall, I was accepted on to the programme.
Iain was great for bouncing ideas off and offering advice to help keep me on track and up to date. It was these interactions with Patricia and Iain that gave me the confidence to see the programme through.
My project topic for this initial programme was aimed at increasing the number of completed and meaningful support plans (under the Self-Directed Support framework). To be honest, after initial chats with staff, I didn’t think that much change could be made at all. But, in the end, I was really surprised by the results.
I later went on to complete the Scottish Improvement Leader (ScIL) course also.
For the ScIL programme, I was initially hoping to work with Kris McKeever (the Service Manager for Children’s Psychological Services including autism spectrum disorder (ASD) services) on reducing the size and increasing the impact of the ASD parent report. But shortly after we touched base, Covid kicked in.
So, in the end, I was able to make use of a project that was already in progress and I was already involved in, led by Dr Iain McDougall. Its aim was to collect information on what service users felt about remote consultations.”
HSCQI Hub Team rep: “How did you find the QI programmes? In particular, did you face any difficulties and what did you enjoy the most?”
Dave: “Both the SQB programme and the ScIL programme were great, although I did feel a bit more isolated during ScIL (Covid notwithstanding). The pace and expectation were excellent. Unfortunately, I had some technical troubles during ScIL too, which cut me off from the community and made it a particular challenge even asking for help. But with the support of Iain, I managed to make it though.
In terms of difficulties, I think, as a service user, I suffered in terms of trust and credibility. People were less likely to share necessary data with me – even when that data was anonymised and public.
Despite challenges (or perhaps because of them), I really enjoyed the pace of learning and knowing that, in some small way, I was making a difference. That was very rewarding. And it was amazing to work with such motivated and dedicated people.”
HSCQI Hub Team rep: “What data were you measuring and how did you record it? Did you use Excel, Life QI or something else?”
Dave: “During SQB, we were measuring the number of support plans completed in a month. This was recorded by the social work team, so all we had to do was collate the data, which we were able to do automatically.
With ScIL, it was a bit different. We started using Life QI, but when my internet access became unstable (and finally non-existent), we started recording the data using Excel. This worked out well as the survey platform gave us a CSV (Comma Separated Value) file, which was easy enough to pull into Excel and work on offline.
Once we had an idea of how we wanted the data visualised, we were able to migrate the CSV files into an online database and allow team members to log on and access the data relevant to their service area in chart form. It also made my life a lot easier because I still had no internet access or phone reception at home, so I could update the database from my phone when out for my one hour of exercise (due to the Covid restrictions). While this wasn’t entirely necessary for the success of the project, it was really great to be able to offer the clinicians access to the results of what their patients thought of their remote consultations.”
HSCQI Hub Team rep: “What was your biggest takeaway from the QI programme?”
Dave: “My biggest takeaway was this: over the pandemic, a period when I would be expected to bunker down, we were able to make a meaningful contribution to how services would be delivered in the future. So during a pandemic, one of the most unstable, unpredictable times, we were able to draw something positive. The data we collected could not have been collected under ordinary circumstances. Credit needs to go to Dr Iain McDougall, who inspired and led the project exceptionally during very challenging times. I got to use my own set of skills to rein in and present the data in a way that was meaningful and useful to the professionals.
It really felt like an achievement to get a sense of what people thought about remote consultations on weekly basis. I don’t believe this would be possible, to get data in such a pure form, without something as tragic as the pandemic, unfortunately.”
HSCQI Hub Team rep: “Based on your own experience, do you think there is anything additional that could help support service users?”
Dave: “I did, as you would expect, experience imposter syndrome. It’s hard not to when you are working with such motivated and dedicated professionals, and it can be strange and surprising how that manifests.
I think it would really be beneficial for service users to have some sort of support place – be that a peer or a professional who has graduated from the programme. I am in two minds which would work best, service user and peer, or service user and professional. I think I was allocated a professional mentor, but it felt very intimidating. But maybe that is more my problem than something that can be solved in a generic way. I can’t emphasise enough the anxiety of feeling like you are totally out of your depth going in. Having a peer to support you could be really useful.”
HSCQI Hub Team rep: “Where do you see your QI journey leading to and what do you hope to contribute to QI?”
Dave: “That is a really good question.
I definitely see myself contributing, although I might have to do so off my own bat. I have been involved with training and worked with Patricia Burns to put together a QI Awareness training session, I would like to continue with that.
I guess there are other opportunities for my newfound skills, but I fear that I am labelled as a ‘service user QI person’ – meaning that I can really only be involved with projects directly relating to service users. I guess I can understand this due to data protection and accountability considerations. So, to answer the question, I am not sure. I would love to continue to be involved, practise what I have learned, and develop it further. But we will see what the future brings.”
HSCQI Hub Team rep: “What would you say to encourage other service users to get involved with QI?”
Dave: “Well, it is a special type that would want to get involved. They have to be willing to commit to the bit, be willing to learn, happy to read a lot, and be open-minded (not all problems can be fixed at once, and there are constraints upon the professional staff).
I would tell people it is hard work, but totally worth it. I would tell them that after they get involved, the way they see the world will never be the same.
And, most importantly, I would tell them if the opportunity comes their way, grab it with both hands and don’t let go!”
The interview ended on a profound note, after an hour of captivating and inspiring conversation. Dave exuded passion and commitment to Quality Improvement from the beginning and spoke openly about his experience as a service user. This authentic and informative first-hand account of the world of Quality Improvement, through the eyes of a service user, brings the perspective needed to encourage individuals to follow in Dave’s footsteps and turn their Quality Improvement interest into action. In addition, Dave’s honest narrative provides the professionals with imperative insight into a service user’s experience, which is a catalyst for changing and improving the system for everyone.
If this interview has inspired you to get involved or if you have any questions about Quality Improvement, please reach out to the HSCQI Team at firstname.lastname@example.org and feel free to reach out to Dave Milliken on Linked In.