RCPCH EQIP - Epilepsy Quality Improvement Programme

On 17 June 2019 we launched the first paediatric epilepsy QI collaborative pilot in England and Wales. The RCPCH EQIP has supported epilepsy service teams to identify sustainable improvements within their services for children and young people with epilepsy. Our pilot provided 12 paediatric epilepsy teams with practical training and support, and helped them uncover the gaps in service provision and develop interventions that meet their specific needs.

What is RCPCH EQIP?

RCPCH EQIP | Epilepsy quality improvement programme

The RCPCH Epilepsy12 audit project team, in collaboration with the Organisation of Paediatric Epilepsy Networks in the UK (OPEN UK), has developed a model for a comprehensive Quality Improvement (QI) programme. This is tailored to support paediatric epilepsy teams to work together to define their shared aims and develop practical interventions matching their capacity and resources.

The six-month programme has been developed in consultation with epilepsy practitioners, ensuring that it best suits the needs of teams providing epilepsy care while also borrowing from a similar model delivered with success in paediatric diabetes in the UK. This model was originally applied in Sweden, where it was used by 85% of paediatric diabetes services over the period of three years who, over that time period, managed to significantly improve treatment outcomes and reduce variation between units.1.

Each participating team:

  • completes a comprehensive, multi-skill development training programme, delivered free of charge by a professional team from the RCPCH 
  • receives support in developing a transformative change for their team and care processes, towards lasting improvement
  • has an opportunity to work with other teams from across England and Wales, learning from their experiences
  • shares their improvement projects via the RCPCH QI Central website and other communication channels
  • receives a CPD certificate for all individual team members for every learning event attended.

How does it work?

Participation requires time and energy, which it is sometimes hard to find when stretched by the requirements of day-to-day service delivery. However, putting in that initial time often helps teams find ways to do things with less effort - yet more impact - later on.

For the pilot, teams could apply for a space. We didn't have any restrictions on the size of the team, but lots of enthusiasm and dedication was a must! We received more than 30 applications, and pass on a big thanks to all who took the time to apply.

The participating teams cam together for two bespoke training / sharing events, which supported them to:

  • develop more cohesive teams with clearly defined roles and a shared sense of mission and responsibility
  • identify areas for improvement in care delivery
  • design sustainable interventions to address these areas, that are manageable within their existing set-up.

We gave hands-on support during and between these events to help teams design their interventions.

Our video explains more:

What do we mean by a team?

We know that it can be a challenge to define and identify what an epilepsy team is, given the complexity of the care pathway across a healthcare setting. However, having a cohesive team has been consistently flagged as an important success factor, not just in epilepsy, but across many types of health services. Therefore, one of the key requirements of this programme of work was that participants attend as a whole team and learn together rather than attend as individuals. 

For this reason, in the pilot we asked that each service identify all staff members who regularly contribute to the delivery of their paediatric epilepsy service who were willing to commit to participating in all of the training events and that they undertake the improvement work together. It was really important that everyone was on board and fully committed – half-hearted participation would compromise the team’s chances of success!

What is the cost of participating?

The pilot was free to all participant paediatric epilepsy service teams except for travel.

Where does the training take place?

The pilot's training events took place in the Midlands, at a location with good transport links.

How did the pilot's residential training weekend work?

We provided pre-training material and invited all to join us on a two-day residential weekend in November 2019.

The weekend kicked off with interactive QI training - paediatric epilepsy NHS staff worked together to identify gaps and find sustainable improvements that would be tried and tested over the six-month programme.

The teams worked hard, learning and using many of the QI tools to help support them to refine their local improvement projects. But the programme also included fun action learning sets and networking - breaking those silo barriers. By the end of the second day, each of the teams left the weekend energised and with a plan of action to move forward with their projects.

The spring 2020 edition of Milestones, our member magazine has a piece from an EQIP Pioneer. Here's some more feedback from EQIP team members:

Witnessing the motivation and commitment from everyone, and within the teams.

Interactive games/activities, eg skittles and pasta tasks, which highlighted QI in an abstract way.

All activities associated with practical application of QI models to our projects.

Having the opportunity for the team to write a plan and evaluate out aims, and how to change and improve.

Monthly support calls

This residential training was complemented by monthly support progress calls. 

The training included a mixture of learning QI and children and young people engagement methodologies, alongside team exercises, taught by professional QI trainers/facilitators.

The training is practical and hands on, combining select quality improvement tools, high-performing team development, patient and family engagement, leadership and influencing skills. We deliberately picked and chose elements of quality improvement methodology and combined it with other types of skills training, to provide a package which will correspond to the working reality of epilepsy teams, who we know are often struggling with staffing capacity, fragmented teamwork and limited resourcing.

Response to COVID-19

In the past several months, EQIP teams have discussed the impact of COVID-19 on their paediatric epilepsy services and their response with challenges with team deployment and changes to work shift patterns to name a few.

You can read more about their experiences in the download below.

Participant teams in the pilot

There were 12 teams, and a total of 85 team members, in the pilot.

  • Aneurin Bevan University Health Board
  • Chelsea and Westminster Healthcare NHS Foundation Trust
  • Doncaster and Bassetlaw NHS Foundation
  • Guy's and St Thomas' hospital foundation Trust
  • Luton and Dunstable University Hospital NHS Foundation Trust
  • Manchester University Hospitals NHS Trust
  • Nottingham University Hospitals NHS Trust
  • Southport and Ormskirk Hospital NHS Trust
  • South Tees hospital Foundation Trust
  • Royal Berkshire NHS Foundation Trust
  • Royal United Hospitals Bath NHS Foundation Trust
  • York Teaching Hospitals NHS Foundation Trust

EQIP champions

Each team in the pilot nominated an EQIP champion.

This person motivates the team between learning sessions, reports on progress to the trainers, represents their team at monthly support calls, updates the facilitator on their team's progress and uses additional advice or encouragement.

The faculty team were so impressed with the time and energy that the EQIP teams are putting to their project - despite the challenges that teams may face in terms of available time and capacity and during the COVID-19 pandemic. It really was great to hear the team journeys and what they have since achieved.

World Café event - celebration

The celebratory event for the EQIP teams was rescheduled and took place online on Thursday 16 July 2020. Each of the 12 teams were able to come together virtually online to showcase their improvement projects and reflect on their journey as a team, sharing their lessons learnt and successes. We are very proud of all the teams that were able to continue their QI journey through such difficult times and feel truly inspired by their commitment.

We would like to take this chance to congratulate the first EQIP pioneers who successfully completed this programme.

Here's the list of team project initiatives and titles - you can download the posters below.

Achieving 90% of all 14-16 year old children and young people with epilepsy will have been sent ‘Ready, Steady, Go’ forms. Aneurin Bevan University Health Board team
Accessing the patient voice to influence improvements in cross-site epilepsy care for patients and families that attend their service and West Middlesex Hospitals. Chelsea and Westminster Hospitals NHS Foundation Trust team
Achieving 50% of patients and their families being signposted Information Packs about their epilepsy service. Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Obtaining feedback from patient/families seen in tertiary epilepsy clinic regarding their appropriateness of the time interval between follow up and appointments. Guy's and St Thomas' NHS Foundation Trust
Developing an integrated care pathway for children and young people admitted with Seizures. Luton and Dunstable University Hospital NHS Foundation Trust
Improving patient experience in outpatient MDT ketogenic diet clinics. Manchester University Hospitals NHS Trust

To achieve quality routine EEG recordings in 95% of all paediatric patients referred within 4 weeks from referral.

Nottingham University Hospitals NHS Trust
Children and young people presenting in A+E with a first seizure provided with telephone contact from an Epilepsy Nurse within 2 weeks of presentation. Royal Berkshire NHS Foundation Trust
Developing and implementing a pathway for patients with first seizure events; are reviewed by paediatricians with special interest in epilepsy. Royal United Hospitals Bath NHS Foundation Trust
Implementing an ongoing feedback loop with patients and their families with the aim of establishing a feedback forum. Southport and Ormskirk Hospital NHS Trust
To obtain feedback on how the epilepsy service can support their wellbeing from 50% of children aged 12-16 years with a diagnosis of epilepsy attending their review clinic. South Tees Hospitals NHS Foundation Trust
Improving epilepsy information on electronic records including emergency health care plans becoming more easily accessible via an electronic record. York Teaching Hospitals NHS Foundation Trust

Pilot programme evaluation

An evaluation of the outcomes and achievements of the RCPCH EQIP pilot will be reported on and shared with epilepsy service staff in England and Wales, commissioners and NHS England and Welsh government.

A chapter that summarises the RCPCH EQIP up until 1 April 2020 has been published within the 2020 Epilepsy12 Combined organisational and clinical national report.  A selection of EQIP teams will present at the Epilepsy12/OPEN UK national conference, the same day as the published report.

    • 1. Samuelsson, U. et al. (2016). “Continued improvement of metabolic control in Swedish paediatric diabetes care”.Pediatric Diabetes, 3 November, 2016