Wales: A national approach to improving care

We are fortunate in Wales in that ‘national’ is achievable. We are a small country so when we say we want NHS Wales to be quality-led it feels like a realistic goal.

However, up to this point we have had a number of organisations leading improvements, using different approaches. This has led to some confusion in the past – are we a ‘lean organisation’, do we use ‘six sigma’, do we apply the ‘Model for Improvement’?

The NHS Wales strategy has identified the need for a common language for improvement across the service. We need to be able to understand each other and what we are aiming for. The next step is to achieve the ambition contained in the Welsh Government’s vision for NHS services to train a full quarter of all NHS Wales’ 84,000 staff in quality improvement by spring 2014.

We plan to do this through Improving Quality Together (IQT), a multi-levelled national skills framework that can be accessed online in the first instance. Through IQT we will establish a network of improvement experts in every NHS Wales organisation. Through our universities we will also embed the techniques in the up-and-coming generations of medics, nurses and other NHS Wales staff.

There are other ‘wicked issues’ facing Wales, as in other parts of the UK. We are particularly concerned about the pressure on A&E services. Using work pioneered by the Health Foundation, we have identified that the ‘flow’ through our systems is one of the main causes of pressure building up in the system. We need to sort out the problems at the ‘back door’ to make things better at the ‘front door’.

We have a commitment to making NHS Wales patient-centred and we are actively taking up the challenge to transform our health boards and trusts into ‘listening organisations’. This was the theme of our recent national learning event and a white paper has been launched to begin the discussion of what listening can achieve.

One thing we clearly need to work on are improved measures to help us see the impact of our improvement efforts. We have some targets – training 25% of the workforce in quality improvement; reducing pressure on A&E and other unscheduled care services – but the real challenge is measuring the experience of patients in NHS Wales, and how well we are centring our services on the people who use them.

It’s my hope that this time next year we will know what we should be measuring, we will be measuring it, and we will be acting on what we learn from those measurements. We will be able to use that information to transform our systems, and the transformation will take place organically and naturally by a workforce imbued with quality improvement knowledge and ability. And we will be providing a better patient experience by sorting out the ‘wicked issues’ that dog our systems, damage our patients and demoralise our staff.

Dr Alan Willson is a director of 1000 Lives Plus, Wales’ national healthcare improvement programme, www.twitter.com/dralanwillson