An invitation to Quality Improvement

Be honest. We’ve all been in a situation where we know that something isn’t what it should be, but have reassured ourselves that it’s someone else’s responsibility. This might be something small, like an electric cable that someone could trip on. But in extreme cases this attitude can lead to the situation that we saw in Mid Staffs.

So how do we stop this? In England, a major part of the approach has been to mandate the duty of candour, making it a legal duty for NHS staff to report when treatment or care has caused death or serious injury. So if you see something wrong and don’t report it, you can be held to account. This will (hopefully) ensure that staff won’t ignore problems that aren’t theirs, stopping those problems before they become bigger or more widespread.

In Wales there’s a different approach run by 1000 Lives Improvement. They invited us to Cardiff a few weeks ago to see an overview of their Improving Quality Together programme (IQT), in which staff are encouraged to accept responsibility, but not forced. There are three levels to work towards.

The programme starts with an online training course which helps people learn what good quality looks like, and that everyone is responsible for improving quality, from the new starter in their first job, through to the chief exec. Complete this course and you’ll attain the bronze level of IQT.

The eventual aim is for 100% of Welsh NHS staff to achieve this (currently around 10%), and for thinking about Quality Improvement (QI) to become natural. Progress has even been made with those Welsh universities offering medical training so that QI will be taught throughout the course, to instil QI thinking right from the off.

The aim then is for silver. For this you need to identify an area of your work which you can improve. This could be something about the way you work personally, or a change to the way your team, or even organisation, works that would improve the quality of the service provided (similar to our Innovating for Improvement programme, at an individual level).

There are already examples where these projects have made a difference, such as introducing daily board rounds to discuss the current pathway of each patient, to improving staff attendance at training events. And your attempt doesn’t necessarily need to be a success to achieve silver. As long as you’ve identified an issue, made a genuine attempt to improve it, and learned from the experience then you’ve done enough to prove that you’re thinking in the right way.

There is then the gold award for those few who are champions of QI, working not only to think about QI themselves, but also ensure that other members of staff are thinking about it too.

Finally, and crucially, there’s a focus on the board members, ensuring that they all complete at least the bronze training, and are discussing QI in all of their meetings.

Of course, while we saw much enthusiasm during the visit, this is set against a backdrop of austerity where staff are already being asked to do more, with pay awards that not what they once were. Improving Quality Together could be seen as an extra burden that staff won’t have time for. But where the programme is successful, staff won’t see QI as an addition to their role, rather as an everyday thought process that is a part of their job.

Whatever else, it’s pleasing to see an approach of inviting staff to improve their services, rather than demanding that they do so. I'm looking forward to seeing how the IQT programme gets on in Wales, building on the encouraging uptake that they're seeing already.

Adam is Senior Economics Fellow at the Health Foundation,www.twitter.com/ADRoberts777