Table 5 An overview of the service improvement protocol

Stage 1: storytelling and initial reactions

The team is told a composite story illustrating service user experiences in relation to one of the six expected experiences and has an opportunity to give some initial reactions. The aim is to provide everyone with an opportunity to air and ‘park’ any initial thoughts, reactions, questions or concerns so that they do not become a distraction during the following stages

After listening to the story, please invite team members to give one initial thought/impression and make a note of them here

Stage 2: identifying areas for improvement

Team members consider their activities and ways of working and how these may have influenced the story they have heard using the relevant logic model (the one which relates to the story they have been told) and a series of questions and prompts. The aim is to identify areas for improvement by identifying activities which the team tend not to engage in

Looking at the diagram, where did things go right in the story? What was working well for the service user? What activities did we seem to do?

Where did things go wrong in the story? What wasn’t working well for the service user? What didn’t we seem to do?

Use the boxes to indicate the things you did/didn’t do. Even if this isn’t clear from the story itself, use your experience to identify things you are likely to have done/not done

Stage 3: selecting an area for improvement

Team members select where to focus their service improvement efforts by discussing the results of the previous stage using a series of prompts. At the end of this stage, teams use the protocol to record their decisions about the activities that they have decided to focus on. If the process is to be carried over to a second meeting, teams also record the person who will lead/coordinate those efforts and the date by which they will have devised a concrete service improvement plan

Which activities are likely to have had the most influence on the service user story?

What should we keep doing/do more of to deliver positive experiences for our service users?

What do we need to start/fix to deliver better experiences for our service users?

Stage 4: developing a service improvement plan

Team members develop concrete plans for improving the selected activities using a series of prompts based on the ‘five whys’ principle [36]. This aims to uncover the root causes of teams’ ability or inability to carry out the activities which influence service user experiences which can act as a precursor to developing solutions. Guidance to help team members think creatively and positively about possible solutions is also included to counteract the tendency for teams to focus on what they are unable to do. At the end of this phase, teams complete a service improvement action plan which includes their planned activities, who is responsible for the activity, and the expected completion date

Why doesn’t this activity happen? Why don’t we do it?

What can we do to address this?

How can we check that this activity is important to our service users?

How can we get feedback from our service users about our improvement plans?

How can we monitor the success of our planned activities?