Supporting health care improvement in 2018

Over the past decade, the Health Foundation has invested over £160 million in supporting improvement in the quality of health care service delivery – through developing people, giving grants to teams to make improvements to care at the front line, and through building evidence about what works to improve health care.

In 2018 we are planning to build on these investments to contribute further to the development of a health care system able to continually learn, adapt and improve.

We support people to gain knowledge, skills and experience in improving patient care through our capability building work. The Health Foundation now has a thriving community of over 400 alumni from our individual programmes in leadership, quality improvement, improvement science, and policy.

Our alumni lead improvement work across the UK; in their local teams, at executive level, in royal colleges and professional bodies, and at national level. Some have built their own quality improvement academies or consultancy organisations. These in turn introduce hundreds more patients and health care professionals to systematic approaches to improving care.

Over time, our aim is that the cumulative impact of this investment is to create a flourishing community of people working in health care able to lead improvement. We also know that any capability building strategy needs to encompass not only the knowledge and skills of individuals, but also to seek to work with partners to create teams, organisations and systems that provide a supportive context and environment for change.

So as well as our fellowships for individuals, such as GenerationQ and Sciana, we are also supporting new models of capability building, for example in the combination of coaching and microsystem improvement techniques to improve flow across patient pathways; this work is led though the Flow Coaching Academy, a collaboration with Sheffield Teaching Hospitals. Bath, Northumbria and Imperial will also act as training centres this year, with three further organisations learning alongside them with a view to becoming training centres in future. We will be looking for new partners this summer.

And as improvement initiatives increasingly seek to go beyond organisational boundaries, we also need new methods to understand whether they are having their intended impact. In 2018, we will develop our partnership with NHS England on the Improvement Analytics Unit, which uses innovative methods to provide robust quantitative evaluation to show whether local change initiatives are making improvements in the quality of care.

We also recognise the importance of avoiding fragmentation or duplication in what we and others are seeking to do in quality improvement. That is one reason why we are partnering with NHS Improvement to deliver Q, a major initiative to develop a community of people throughout the UK with skills and experience in quality improvement. There are now 2,152 members throughout the UK. In 2018, Q will continue its work to surface and connect people leading change, with a new rolling recruitment process due to open in the summer, and to provide high value learning and development opportunities, both with our regional and national partners, through its programme of site visits and the UK-wide Q community event.

Q will also offer an increasing number of ways for members to take collaborative action on priority areas, including through a second Q lab project, and the development of the Q exchange, an innovative approach to grant funding that will use the Q community to help decide which projects should be supported.

Our open call grant programmes have been core to our offer for many years, and will remain so in 2018, for example through our funding calls for the Innovating for Improvement and Advancing Applied Analytics programmes. We will continue to support the spread of innovation and improvement, through our current Scaling Up and Exploring Social Franchising and Licensing programmes, and this will be complemented by the publication of our own research into the challenges of spreading health care interventions, which builds on the insights and experiences of our grant holders, past and present.

We also want to improve the evidence base for improvement, with our largest ever investment of £42 million over 10 years in THIS (The Healthcare Improvement Studies) Institute at Cambridge University, which officially launches on 31 January 2018. The Institute will undertake applied research to provide more clarity on what works, what doesn’t, and why, as well as increasing research capacity through a programme of PhD, post-doctoral and senior fellowships. As well as our investment in the Institute, we continue to fund original research at universities across the UK in efficiency, workforce, behavioural insights, quality improvement and the use of registry and audit data to support improvements in care.

Finally, in line with our overall mission to improve health as well as health care, we will also be working in 2018 to explore what we might do to help NHS organisations support the wider health of their populations.

So why focus our funding on these initiatives, rather than, say, target a particular condition? Well, as the NHS approaches its 70^th anniversary in July, there will be a torrent of debate and opinion on what is needed to ‘save’ the NHS, or what’s needed to ‘transform’ it. Personally, I’m cautious of anyone promising any single solution that can transform a system as diverse as the NHS, whether that’s a funding model, a technology or a structural change. It’s more complex than that. The one thing we can say for sure, is that we need to develop people with the ability to learn and adapt – to changing clinical and technological possibilities, to changing demography, to a changing workforce, to a changing society. That’s why we’re committed to investing in people working in health and care to develop and apply the abilities of quality improvers; iteratively, continuously learning and improving.

Will Warburton (@willwarburtonHF) is Director of Improvement at the Health Foundation