Improving quality, service delivery and patient experience in a rural, coastal, community based pulmonary rehabilitation service: A quality improvement project.

Project overview, including who was involved in the project
People with long term respiratory conditions have improved outcomes from regular attendance of formal exercise and educations programmes- such as PR. These are group sessions, requiring specialist health care facilitation, and are not always accessible for people in rural locations, often requiring travel to central venues with associated cost and disruption. Furthermore, these are often designed around a broad set of standards and not adapted to local language and cultural attitudes required for coastal communities.

A workshop was held by the PR team for patients, friends and family members that had completed PR in this coastal community to discuss options for improving completion rates and reduce barriers of attendance. Initially, the project focused on referral, attendance, and completion rates. However, based on the workshop group feedback, it evolved to incorporate patient focus groups, using their insights to evaluate and improve the education programme's effectiveness.

Feedback from the workshop and subsequent focus groups has been regularly reviewed and implemented as appropriate. Referral rates have increased and regular patient and public involvement sessions are now embedded into the programme to regularly provide patient feedback to inform ongoing improvement.
Project outcomes/impact
This project has changed our practice. The time, location and layout of venues have changed in response to tailored feedback from those living in the local community accessing this service. Interactive displays, videos and volunteers have helped improve interaction during the education and the content has been altered to reflect the focus group responses. In addition, further volunteers have been recruited, a patient information leaflet co-created, and patients and members of the public regularly invited to give feedback for ongoing service redesign.

We have seen a reduction in waiting times, evidence of patients feeling more confident to self-manage their conditions and more patients attending ongoing exercise classes to maintain their improved fitness following completion of the programme.
If you were to run the project again, what would you do differently?
Patient feedback included a request for improved access to the education content so in the future we hope to continue to enhance the patient experience by co-creating immersive multimedia resources that reduce physical and educational barriers to health information. By enabling remote access to high-quality content, we hope to further empower patients with the clarity and inspiration they need to engage fully with their rehabilitation and then support engagement in further focus groups to keep patient voices at the heart of our continuous improvement.
Advice you would have for others undertaking the same type of project.
I would advise others to include and engage patients and members of the public from the beginning of any project ideas to check that the perceived priorities of the service align with patient priorities.