Background A review of Day Therapy (DT) services was required due to the challenges of increasing numbers of people with complex multi-morbidity needing services over a longer time period (Commission into the Future of Hospice Care, 2013). A need to provide more diverse and flexible services, able to meet the needs of a wider range of people was identified through service evaluation and user feedback. Transformational changes to services can be challenging to embed and maintain and the use of a framework can enable effective and sustainable service improvement (NHS England Sustainable Improvement and Horizon’s Team, 2018).

Aims

• To evaluate the current model of day therapy

• To identify changes required to ensure services remain appropriate for our current and future patient population

• To use a service improvement framework to ensure changes are embedded effectively and sustained.

Methods The Model for Improvement (ACT Academy, 2018), was used by the DT staff team as a basis for redesigning and implementing the changes required. This model starts with three key questions, including ‘what are we trying to accomplish?’, followed by a Plan, Do, Study, Act (PDSA) cycle, allowing for continual analysis and improvement. The ‘Fresh eyes’ redesign tool was also used to facilitate viewing the redesign from the perspective of people using the service.

Results

• Evaluation of current service completed – identified elements that work well and those that are less effective

• Identified shared purpose for DT services: ‘To provide a range of rehabilitative, holistic outpatient services to those with a variety of life– limiting conditions in a format that is individualised and flexible.’

• Identified proposed service changes, including outcome measurement and used PDSA cycle to implement

• Studied impact of changes using OACC data, attendance figures, user feedback.

Conclusion The Model for Improvement was an effective tool for planning and implementing change within the DT setting. It ensured focused planning and careful study which led to successful implementation of service improvement.