Background The hospice submitted its first Quality Accounts in 2013, with little engagement across teams. Quality Improvement Priorities (QIPs) form a key focus of this process. QIPs are now embedded and one example of an evolving quality improvement culture.

Aims To demonstrate:

• Quality Accounts as a key process to describe clinical activity;

• How QIPs lead the clinical agenda;

• Emergence of a quality improvement methodology culture.

Method When Quality Accounts were first submitted there was limited understanding of the process and implementation of QIPs.

In subsequent years there has been engagement of staff and volunteers in the creation of QIPs. The responsibilities for QIPs has been strengthened with a work plan which is discussed and monitored within People with Personal Experience (PPE ) and Clinical Effectiveness meetings, which reports to the Clinical Governance Committee.

PPE initiatives are completed for each QIP.

The Quality Improvement Lead has introduced Quality Assurance Forums for staff and volunteers. These aim to ensure high quality, safe and effective care is provided and builds a quality improvement culture.

Results The knowledge, engagement and use of Quality Accounts has increased significantly with their production involving many staff across teams, including board members.

QIPs are connected with the business plan, clinical strategy and values. They are used to develop goals for staff as part of their annual appraisal cycle. PPEs have shown staff engagement with service users and stakeholders and gained feedback to inform service development and innovation. The Quality Improvement Lead is now well established. Clinical Leaders are engaged with quality improvement methodology and its impact on care delivery.

Conclusions Embedding QIPs into different tiers of the organisation creates a common goal for employees and volunteers to demonstrate continuous quality improvement. They have provided a route to build quality improvement methodology as part of the hospice’s culture, whilst ensuring connection with the hospice strategy.