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Front door to front door - a co-produced improvement programme to understand whole system flow across care systems


Wendy Lewis ,

Advancing Quality Alliance, GB
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Wendy Bell,

Advancing Quality Alliance, GB
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Paul Greenwood

Advancing Quality Alliance, GB
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Background: The Advancing Quality Alliance (AQuA) is an NHS membership organisation based in the North West of England.  AQuA has extensive experience of supporting member organisations with integration and latterly the development of an offer to understand how to apply quality improvement methodology to understand flows across care systems rather than at an organisational level.

We will highlight the practical application of a model for understanding care systems from different perspectives “The 4 Arrows Model” and AQuA’s Whole System Flow programme structure. We have been working with our Lived Experience Affiliates, AQuA members and their populations using a person centred approach, to understand how the interplay between complexity, improvement science, leadership, coproduction and culture can support the successful application of QI methodology in the current context of care systems under intense pressure. Principle outcomes of this work are to create shared system purpose that understands and is enabled to address cultures, norms and values.

The programme has 4 phases:

1. Diagnosing the system and making it visible to itself.

2. Sense checking the diagnostic findings whilst considering current local context.

3. Co-designing optimal pathways with the system, including patients/ service users and carers.

4.  Implementing sustainable improvements with coproduced system measures.

Consistent lines of enquiry:

Person centeredness - staff, patients and community.

Strengthening leadership and approacch to risk and behaviours

Managing beliefs, expectations and priorities.

Defining quality within the system using the Institute of Medicine (IoM) 6 domains of quality (Safe, Timely, Effective, Efficient, Equitable and Person centred)

System impact assessment of poor and improved flows.

Aims and Objectives:

Understand the programme model and framework.

Explore the methodology used to ensure a coproduced programme with people of lived experience.

Consider local application.

Discuss the key learning points from the diverse systems we’ve worked with so far.


5 mins   Introductions and objectives, Wendy Lewis, Programme Lead

20 minutes   Enabling coproduction within an improvement programme beyond tokenism,  Wendy Bell, Lived Experience Representative

20 minutes   What are the benefits and solutions to embedding a commitment to coproduction within care systems? Table work/ group discussion

15 minutes    An overview of the Whole System Flow Programme and key learning, Wendy L

20 minutes   How could delegates apply the model and any identified learning to their own practice?   Wendy L and Wendy B

10 minutes    General feedback   

Target audience: This workshop will be of interest to people engaged in pathway redesign and the development of care systems aross organisational boundaries. It will be delivered to meet the needs of patients, community representatives as well as professionals within care systems and its leaders.

Learnings/Take away:

How AQuA developed an organisational approach to coproduction.

How an appreciative approach to understanding systems with its staff and service users can create conditions for integration and improvement.

How the 4 arrows model could be of benefit in strengthening leadership and managing beliefs, expectations and priorities.

How to Cite: Lewis W, Bell W, Greenwood P. Front door to front door - a co-produced improvement programme to understand whole system flow across care systems. International Journal of Integrated Care. 2019;19(4):26. DOI:
Published on 08 Aug 2019.


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