1:1 observation and support: a quality improvement approach to reducing cost and improving therapeutic input.

Our quality improvement (QI) project aimed to reduce reliance on external temporary staff used for 1:1 observation and support within a recently merged acute, community and mental health National Health Service (NHS) Trust. Temporary staffing costs reached £2.7 million in the previous financial year. Between February 2022 and June 2024, we aimed to establish a more efficient and consistent approach, particularly within acute physical healthcare settings. The project focused on four main patient cohorts and the goal was to reduce temporary staffing costs by 25%. A multidisciplinary team, guided by the 7 Steps to QI methodology, developed and tested two key tools to standardise decision-making and reduce the need for temporary staff. The project was implemented in nine pilot areas across the Trust, leading to a reduction in staffing costs by £600,000 in the first year, with a further £1.2 million in the second year. Additionally, patient falls with harm decreased by 8%. Challenges arose due to communication barriers and the need for cultural change. By empowering local teams to make more informed decisions, the project demonstrated the value of standardised tools and staff training in enhancing both patient care and organisational sustainability.