Background CQI is uniquely placed within a vertically integrated health and care alliance; the One Croydon alliance-spanning Croydon Health Services NHS Trust, CCG, Local authority, Primary care and the Voluntary sector. We present initial phase 1 reflections.

Interventions *Training: A tiered approach, equipping individuals with a calibrated skillset in QI methodology, providing mentorship & leadership.

*Communication: Establishing a designated CQI team & social media presence, developing a strong ‘CQI’ brand.

*CQI Hub: A physical space enables staff engagement and provides a ‘visible’ reminder of CQI.

*Integration: The CQI Board was created to ensure that all stakeholders were engaged and adopt one methodology across Croydon systems.

Measurement of improvement: Utilising the IHI ‘Improvement Capability self-assessment’ tool, generated benchmark results. These show a predominance for ‘just beginning’, ‘developing’ or ‘making progress’ with greatest developments seen in ‘Improvement of Knowledge and Competence’, 36.11% selecting ‘making progress’.

Additionally, a CQI repository with over 100 QIPs enables analysis of trends. Projects are allocated domains for levels of complexity and note their level of engagement; 45% team-based, 47% single organisation and 8% multi-organisational.

Impact The start of a ‘process’ of change with CQI has been shown, however we must reflect on the challenges below;

*Capacity and focus : With multiple demanding pressures.

*Initiative fatigue: Risk of repetitive ‘initiative’ roll outs.

*Integration: Importance of building further stakeholders’ engagement across systems.

*Training: Challenge of time and enthusiasm.

*Leadership and ownership: To drive and sustain the collective vision of CQI.

Reflections CQI is uniquely Croydon, by celebrating the opportunities towards collaborative working with our shared focus, we shall sharpen our alignment as we strive towards CQI being harnessed within our everyday practices.