Five key lessons on building improvement capability

Building the foundations for improvement is our report which explores how five health and social care trusts have successfully built quality improvement capability within their organisations.

Using detailed and in-depth case studies, the report provides an insight into how and why each of the trusts embarked on their improvement journeys; the steps they took at each stage; the impact they achieved; and the challenges they encountered along the way.

Here we summarise the main lessons from the case studies. These are provided in more detail in the report and are aimed at provider organisations considering building improvement capability at scale, commissioners and leaders of national arm’s length bodies.

1. Getting early board-level support is essential for any provider organisation considering building improvement capability at scale

Without the active and visible support of the board, it is extremely difficult to put an organisation-wide improvement capability building programme in place. As well as unlocking the investment needed to fund the programme, board-level support is vital in helping to ensure that the programme and its goals are aligned with the rest of the organisation’s corporate objectives.

For some of the trusts included in the report, board approval has been relatively straightforward to secure. Other trusts, however, have had to use different tactics to gain support from their board members. Taking boards to visit trusts that have already built improvement capability at scale – and can point to improved service outcomes as a result – is one such tactic.

2. Provider organisations need to think carefully about how they will fund improvement capability programmes

Building improvement capability at scale requires resources – not only the upfront costs of planning, developing and promoting a training programme, recruiting coaches and programme administrators, but also the recurrent costs of sustaining the programme over time.

Having said this, it is perfectly possible to set up an effective programme for a relatively modest cost. Of the case studies in the report, South Eastern Health and Social Care Trust’s ‘Safety Quality and Experience programme’ is a good example of a programme which has been designed, and largely delivered, in-house.

3. Provider organisations need to find ways of freeing up staff time to take part in training programmes

For a number of trusts, the biggest challenge they have faced has been in freeing up staff time to attend training sessions.

With limited resources available to provide cover for staff while they are training, trusts have focused instead on making their programmes as flexible as possible and making the most of the time they have with staff.

To minimise the amount of time staff have to take out from their day jobs, most trusts have tried to make some training content available online, or use video conferencing to remove the need for staff to travel. Delivering content through short lunchtime sessions is another successful tactic.

4. Commissioners need to do more to support organisations developing improvement capability building programmes

Commissioners need to think carefully about whether they are doing enough at present to support providers who want to invest in building improvement capability at scale within their workforce.

Few organisations that have gone on this journey can point to the overall return on investment they have achieved. But they can all demonstrate impressive improvements in patient and service outcomes in a whole range of areas. This success should encourage commissioners to be more generous in their support of this type of work.

5. Arm’s length bodies need to give organisations the time and space to develop and embed their quality improvement programmes

System leaders in arm’s length bodies, particularly those with regulatory roles, need to ensure that organisations developing quality improvement programmes have the time and space to do so.

A number of trusts pointed out that by investing in capability, focusing on quality and safety, and showing a constancy of purpose over time, they have managed to meet and frequently exceed their mandated targets. They recognise, however, that ‘normal variation happens’. Staying true to their original intent can be difficult in such situations, especially if an executive team are still finding their feet, which is why trusts need breathing space.

Find out more

For the full case studies, download the report from our website.