• Led by the Advancing Quality Alliance (AQuA).
  • Worked with a range of teams across North West England in a variety of clinical areas.
  • Aimed to reduce the harm associated with transition from children’s to adult services for young people living with long-term conditions.
  • Used an education programme to embed shared decision making and self-management support tools and techniques into professional practice.

Young people with long-term conditions who transition into adult services are frequently ill prepared for managing their condition, often due to a lack of specific, appropriate and integrated support.

Self-management support and shared decision making can arm young people with techniques to make the transition more effectively; enhancing their knowledge, readiness to transfer, confidence, personal management strategies and self-care.

This Closing the Gap in Patient Safety project involved seven sites across the North West of England taking part in an education programme developed and delivered by AQuA. The clinical teams then tested the tools and techniques with their identified transition population using improvement methodology. 

Evaluation of the project was carried out by RaFT Research and Consulting and involved the use of ‘developmental evaluation’, whereby the evaluation methods were adapted as the project changed and progressed. Originally the evaluation included interviews with patients, carers, clinicians and members of the AQuA team; this was developed further to include ethnographic case studies of each clinical team.

One of the main findings of the project was that the attempt to implement shared decision making triggered a process that was much more complex than most teams anticipated. They discovered significant gaps and inadequacies in their transition processes, and subsequently used the programme to address these.

Focusing on measuring whether a reduction in harm can be achieved through better transition was a significant challenge. As quantitative measurement was a particular challenge for teams, many shifted their focus to qualitative measurement, focusing on patient case studies, for example.

The project has led to a number of changes in the way services are delivered to patients in the North West. For example, a number of teams chose to start involving patients in co-production of services and sharing their views; transition clinics have been introduced; and the use of ‘Ready Steady Go’ (a personal care plan) to support young people has meant they are better prepared for the transition.

The RaFT evaluation revealed that the main factors behind achieving improvements in the transition process were: the commitment of the teams; the framework and legitimacy of an outside programme; closer working relationships between paediatric and adult colleagues; and the informal exchange of knowledge and experience via the learning events.

Teams are starting to share the learning and successes of the project in order to enable spread and sustainability, including holding engagement events and producing films sharing young people’s experiences to promote awareness within organisations.


Three of the teams involved produced films of young people sharing their experiences of transition:

Contact details

Visit the Advancing Quality Alliance website: www.aquanw.nhs.uk

Contact Rachel Bryers at Rachel.Bryers@srft.nhs.uk and Emma Walker at Emma.Walker2@srft.nhs.uk.

About this programme


Closing the Gap in Patient Safety


This programme ran from 2014 to 2017, and offered funding for projects to implement and evaluate...

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