The NHS has been using the principles of improvement science for a number of years – whether that be Lean, Institute of Healthcare Improvement model, Virginia Mason or others. From the use of all those models a common thread has emerged, namely that there is a desire for the development of a consistent improvement-focused approach and culture at all levels of the NHS – national, regional, ICS and STP, and for all sector providers to support services to become safer, better and faster for patients.
Organisations with well-established systematic organisational approaches to improvement tend to seek continuous improvement everyday rather than focusing on compliance with external assurance frameworks, thereby regaining the balance between assurance and improvement.
The journey to developing an embedded approach to improvement in your organisation will require an understanding of the conditions of your organisation and its readiness, and how you can align your aims for improvement with a systematic approach to improvement across the organisation – not project by project. What is your capability and capacity for improvement and not least how will you sustain improvements?
There are lots of resources on the challenges around embedding a culture of improvement so that it becomes ‘the way we do things round here’.
Creating a culture of improvement which becomes ‘the way we do things round here’ can be very challenging, here are a selection of resources to support you.
Publication: ‘Embedding a culture of Quality Improvement’ – The King’s Fund Overview of the conditions and steps required to embed a culture of quality improvement.
Report: Making the case for quality improvement: lessons for NHS boards and leaders – The King’s Fund. This briefing draws on existing literature and examples from within the NHS of where quality has been improved and describes how this was done. It identifies the potential benefits from investing in quality improvement – including for patients, staff and the financial sustainability of the system.
Report: ‘Quality improvement in hospital trusts: Sharing learning from trusts on a journey of QI’ Care Quality Commission.
Quick Guide: Quality improvement made simple – The Health Foundation – a useful tool for engaging colleagues who may not have met improvement science before.
Report: The improvement journey – Why organisation-wide improvement in health care matters, and how to get started – The Health Foundation – outlining the rationale for work inside organisations, though the principles are as pertinent to systems. However there may be additional challenges in creating or dovetailing approaches to improvement across systems.
Briefing: The measurement maze – The Health Foundation
Guidance: Developing People – Improving Care Framework – a national framework to guide action on improvement skill-building, leadership development and talent management for people in NHS-funded roles. The framework focuses on helping NHS and social care staff to develop four critical capabilities:
- systems leadership
- using established quality improvement methods
- inclusive and compassionate leadership
- talent management
Case studies: NHS Partnership with Virginia Mason Institute NHS Improvement are part of a five-year partnership with Virginia Mason Institute and five NHS trusts to support them to develop a ‘lean’ culture of continuous improvement which puts patients first, using lean techniques.
Example: Leeds Teaching Hospitals NHS Trust – how Leeds Teaching Hospital integrated their improvement methodology with their values.
Resources: The Improvement Hub is a resource hosting tools and case studies around specific areas like workforce, safety, finance and more.
Skills: Improvement Fundamentals is a programme of online, self-directed mini-courses in quality improvement (QI) for those involved in heath or social care services.
Modelling: The Demand and Capacity model will help you to understand the demand and capacity needs of services with a simple pathway. The core model is suitable for elective services with ‘simple’ pathways e.g. where patients are referred in, booked ahead (more than one day) for an appointment, and then move on to their next stage of treatment after being seen. You can use these models to inform decision-making and planning in supporting the delivery of timely care to patients.
Skills: The Quality, Service Improvement and Redesign (QSIR) programmes are delivered in a variety of formats to suit different levels of improvement experience and are supported by publications that guide participants in the use of tried and tested improvement tools, and featured approaches, as well as encouraging reflective learning. It’s suitable for both clinical and non-clinical staff.
Resources: Innovation and the NHS – Nuffield Trust looks look at opportunities, barriers to success and how change can be successfully implemented.
Guide: Creating the culture for innovation – NHS Institute 2008 – seven key dimensions of culture that distinguish highly-innovative organisations, forming a framework which leaders can use to assess the culture for innovation within their own organisation.
Resources: NHS Innovation Accelerator supports uptake and spread of proven, impactful innovations across England’s NHS, benefitting patients, populations and NHS staff, delivered in partnership with NHS England and England’s 15 Academic Health Science Networks (AHSNs).
Online community: The Health Foundation’s Q community is set up to improve health and care processes by developing links between people and organisations with shared interests.
Video:Spotify’s engineering culture has a great model to engage staff and support them to have conversations to solve problems. The first nine minutes of this video are most useful.
Membership platforms and networks supporting collaboration across health and social care are a great way of keeping up to date with the latest on innovation and improvement. Some have member profiles to enable new and wider collaboration:
NHS Networks supports innovation and improvement in health and care, and the role of networks in promoting learning and change. To provide a common space in which leaders, clinicians, managers and support staff and their partners beyond the NHS can explore ideas, pool experience, solve problems and share information.
FutureNHS is an online community open to anyone working in or for health and social care, with an active member base from many local, regional and national organisations. It offers a safe and secure space to share work and connect with others.
CHAIN – Contact, Help, Advice and Information Network. CHAIN is open to anyone working in health and social care who is willing to share experience and aspirations. Being prepared to respond to other members’ questions is the only criteria for joining CHAIN.
Source4networks is committed to curating and sharing the most comprehensive and best knowledge around network leadership in health, social care and charity sectors. It shares the latest academic research and reflects current practice through practical case studies.
Fab NHS Stuff is an online resource that enables and facilitates the sharing of innovative ideas and best practice from across the NHS. It includes over 3000 examples of ‘stuff’ – improvement approaches that have improved patient experience, safety and care.