**2. The SILC story**

#### **2.1 Setting**

To overcome the challenges of effective service development, a CLN was devised to support TSOs in the collection and use of data to inform the future development of operational practice. Inspired by the Institute for Healthcare Improvement's (IHI) [12] 'Breakthrough Series' Collaborative Model and implementation science research [11–14], this initiative intended to break new ground by working in close partnership with TSOs to generate evidence and inform quality improvement. The framework integrated implementation techniques using plan, do, study, act (PDSA) cycles [10] focusing on specific areas of service delivery and, as modelled by the QIF, create a structure for implementation [8, 9]. This would become known as the service improvement learning collaborative (SILC).

Working in partnership, TSOs were invited to upgrade their measurement system to a more sophisticated software platform providing additional reporting features relevant for service operation and development [17]. Services were required to verify their commitment and autonomy at a managerial, board and trustee level to commence on a year-long journey to profile and engage with subject-relevant resources and attend monthly mentorship sessions and quarterly overnight residentials. A memorandum of understanding was devised to emphasise that membership was contingent on full-service participation and this was incorporated into the development of an implementation plan [8, 9].

This project took place over the course of a year, focusing on a different challenge each quarter, including a focus on data collection, session attendance, endings, and clinical outcomes. The project commenced with a planning meeting involving introductions, training and attitudinal surveys. With reference to the QIF, these steps were undertaken to assess the fit between the organisation's aspirations and readiness for change, allowing for open discussion and early feedback [8, 9]. Across the project, there were monthly supportive calls with an assigned mentor from the research team, and quarterly in-person residential meetings with fellow TSOs, each supported by in-depth data profiling throughout. The purpose of the mentorship and residential sessions were to support participants in monitoring aspects of service quality and provide supportive feedback mechanisms which, according to the QIF, are critical post-implementation support strategies [8]. To improve future applications, the end of the year culminated in a summative conference with fellow mental health services to share the findings from the project's first year in operation [8–10]. A diagram of the SILC CLN model, including the induction, mentorship, residentials and summative conference, is outlined in **Figure 1**.

#### **2.2 Characters**

The QIF emphasises the criticality in creating an implementation team to oversee its rollout and set targets and agree off-track remedial action [8, 9]. The SILC project team was assembled in 2016, consisting of academics and clinicians

**Figure 1.** *The SILC CLN model, adapted from the IHI [10] 'breakthrough series' collaborative model.*

with extensive experience in the field of talking therapies and service design [9]. This team was responsible for developing learning resources, providing mentorship support and tracking data through the relevant quarterly themes of service development. The team also worked directly with individual service leads to cascade learning and implement practice change, compiling routine reflective case notes and disseminating learning throughout the network.

A series of prospective pilot services were approached and recruited in early 2017, subject to expressions of interest and eligibility criteria. The SILC initiative was specifically aimed at mental health care TSOs using CORE IMS computerised quality evaluation systems [17] to obtain evidence on their delivery and strengthen their position for funding and benchmarking. Those eligible had been using CORE outcome measurement systems for over 5 years, primarily as an administrative tool to log clinical activity. Within all but one TSO expressing interest, there was little analysis of the data being undertaken, and no indication of it being used clinically or to enhance service quality. Prospective services were using traditional pre and post-therapy measurement approaches, acquiring outcomes data for around 40–50% of clients; a rate which is representative of the field and this methodology generally [18]. Many were also experiencing high rates of non-attendance and attrition, plus modest clinical outcomes for those with outcomes data.

The exploration phase of Aarons, Hurlburt and Horwitz [11] conceptual model for implementation identifies the importance of inner and outer contexts. In this project, it seems early withdrawal during the recruitment stages was due to a combination of socio-political factors and lack of absorptive capacity which impeded progress [11]. What had started as 12 prospective members soon halved to only six. Various reasons were given but discontinuation was mostly cited as being due to managerial turnover, lack of capacity for change, and workforce restructuring, or resistance. By contrast, the remaining TSOs demonstrated their levels of commitment via an initial attitudinal survey which, when disseminated to all practitioners (n = 49), achieved a high response rate of around 80%.

The six services joining the project ranged in size, geographical location and clinical specialism. Annual throughput ranged from around 80–300 clients per organisation. Clinical support specialisms included psychological support for female victims of domestic abuse; women on low incomes; parenting; unpaid carers; and general counselling support. Informed by QIF support strategies, each service was assigned a mentor from the SILC project team using a consultation and matching process [8, 9]. Members received regular updates via a monthly blog post on the project's website (www.silcuk.org) and a quarterly newsletter via email. Resources were shared via the website and there were opportunities to contribute in online discussion forums. The combination of online meeting platforms and email correspondence enhanced the sharing of stories, communicating learning and progress, and helped to sustain the network.

*Evaluating the Efficiency of a Collaborative Learning Network in Supporting Third Sector… DOI: http://dx.doi.org/10.5772/intechopen.84294*
