At the Trust, quality improvement projects which include service users as full, active members of the project team is known as ‘Big I Involvement’. This is different to ‘little I’, where service users are consulted on a project but not part of the project team.
On average, 96% of QI projects in London CHS have Big I involvement, and in a Trust first, London CHS has become the first directorate to achieve ‘Big I’ involvement of service users and carers in 100% of QI projects, with all 15 projects in July, 16 in August and 19 in September 2025 including service users or carers as part of the project team. This has meant that teams have benefitted from the lived experiences of those using the Trust’s services to improve care for the better.
Previously, teams across CHS London had not been involving service users to the same degree, and in April 2022, only 42% of projects had achieved ‘Big I’.
In response to low Big I involvement, change ideas were tested, including:
1. Monthly meetings between an improvement advisor and People Participation lead.
2. Inviting project leads to pitch their QI projects to Working Together Groups – meetings where service users come together to discuss the quality of care.
To keep up this momentum and ensure that all future projects continue to have meaningful ‘Big I’ involvement, colleagues have also focused on improving the experience of service users and carers on QI project teams. This has included:
1. Producing a skill survey and a one-page profile to send to project leads, helping members to outline strengths that can be played to.
2. Creating a monthly experience survey for members, so the People Participation lead and improvement advisor can assess in real time how members feel it is going and quickly identify areas where additional support is required.
3. Providing local training to local QI coaches via their QI coach supervision.
Commenting on the milestone, Charan Saduera, Associate Director for Quality, Performance & People Participation, said: “I am really pleased that project teams across CHS London continue to see the value of service user involvement. They bring invaluable insights to everyday work, and I look forward to seeing future projects flourish as a result of co-production.”
If you would like to learn more about the work, take a look at this video, co-produced with service users and carers.
To find out more about the Trust’s QI projects and ‘Big I’ involvement, you can get in touch with the QI team on its website: https://qi.elft.nhs.uk/help-support/contact-elft-qi