Background From November 2020 St Wilfrid’s Hospice participated in the six-months Hospice UK ECHO quality improvement (QI) programme upskilling hospices in bereavement support for those affected by COVID-19. Our QI project built on a pilot we had set up early in the pandemic, extending our hospice bereavement support to the community, in response to what we knew and anticipated – a significant gap in services and a tsunami of COVID-19 related need (Pearce, Honey, Lovick, et al, 2021). Our challenge at the start of the QI programme was immediate sustainability of the pilot. Our questions at that point were about uncertain demand, impact and the long-term future for this new service.

Aims

• To extend our community bereavement support pilot by six months with precise markers for success (reach, reduction in vulnerability, responsiveness).

• To consolidate delivery using QI methodology.

• To reach an informed decision regarding continuation of the service with significant steps taken towards long term sustainability as relevant.

Methods

• Recruited additional counsellor.

• Widened referral criteria to include keyworkers.

• Introduced outcome measure, evaluation questionnaires, measurement of responsiveness.

• Conducted communications initiatives to raise public awareness.

• Continued networking with external partners to raise profile (e.g. care homes).

• Used knowledge and skills acquired from ECHO programme to fine-tune delivery (e.g. virtual support).

• Used QI methodology and tools to improve (e.g. PDSA cycle, driver diagram).

Results

• 50 referrals responded to (39% above target).

• Response within eight working days for 78% of referrals accepted.

• Consistently positive feedback.

• Senior leadership decision to continue community bereavement offer.

• Future sustainability secured with budget allocation for counselling post.

• Work commenced on staffing restructure to further embed new service.

Conclusion Despite challenges and with learning along the way we have successfully delivered a bereavement project in response to the particular challenges of COVID-19. QI methodology has been instrumental in enabling a swift and courageous response to an unprecedented challenge.