What's it like putting in a proposal for personal development in your organisation at the moment? How would you feel about making the case for investing in training groups of staff to support the improvement work you're doing?
From where I stand, I predict a growing divide between organisations that are prioritising capability building in recognition this will be key to their improvement objectives, and those that have been squeezing investment in improvement expertise and training budgets.
Given the really hard choices all NHS organisations are facing about where to make savings, we should expect increasing scrutiny of any plans for investment in capability building.
So, how can you maximise your confidence that the investment your organisation makes in capability building will result in significant improvement? We brought together a group of fantastic people with expertise in this area in May to help us advise those developing capability building plans locally and nationally (download a report summarising the discussions).
These five key insights from the event have changed how I'd been thinking about improvement capability:
1. You need an explicit strategy
If you look at the organisations and systems that have achieved significant and sustained transformation in quality, they have invested in building skills, often with an aim for how many people will be needed different levels of expertise.
The value of target numbers for people trained enables an explicit conversation among decision makers about the scale of expertise required to realistically achieve your objectives. Having a goal to develop, say, 1% of your workforce in advanced improvement skills does however have limitations, not least because...
2. Improvement is a team sport…
…so counting individuals trained is only part of the story. People bring skills, experience and energy that evolve over time and are developed through taught courses but also largely ‘on the job’ as part of work they do with others.
You need to give attention to how people will work with each other, not just what they can individually do. You might want to think about what approach to building and deploying the team will work best in your context: a netball model, where people are trained for relatively clearly defined roles and places on the court? Or a basketball approach, where people can go anywhere when the skills, energy and opportunity present themselves?
3. Think expertise rather than just experts
Collating the curricula from prominent safety and quality improvement training courses highlights more than 70 different substantial dimensions of expertise. Your organisation probably does need a grip on all of these areas to have a good chance of investing improvement effort wisely and achieving any reasonably complex quality agenda.
It’s clearly unrealistic to imagine any one individual can hope to master everything you need to know. Rather, it's more productive to think about expertise generated by groups of people connected with each other and with wider knowledge resources (contacts from elsewhere, journals, websites etc).
4. Recognise that there are many ways up the mountain
Given the range of skills and experience needed, it follows that flexible means of developing and recognising these skills are likely to be required.
This is not to devalue courses that give a strong broad grounding in quality improvement, of which we identified a number of great examples. However, a menu approach – that allows people to tap into development and ideas in ways that recognise their learning style and the time they have available – is likely to be important to complement this. It also offers the potential to reach out to people who may traditionally have not been so involved.
When thinking about the skills needed for a particular improvement project, we probably need to give greater recognition to the skills and time required to bring together an appropriately formed team, rather than allow teams to form in a largely ad hoc way on the basis of who’s available.
5. You need space and resources to get anywhere
To continue the mountain analogy, you can assemble the most highly skilled group of mountaineers available, but if you don’t have lots of energy, sufficient decent kit, food, a map or good back up from your guide, then you’re unlikely to get far.
Attendees at the workshop highlighted that improvement expertise only becomes real through application. While people often manage to achieve amazing things despite little organisational or financial support, we should recognise that these practicalities are often the key constraint as much as the expertise.
A strong improvement capability strategy needs to demonstrate how people trained will have the opportunities and support to be able to use what they are learning. Once this is in place it can be expected to, in turn, release further engagement in skills development.
The full report is well worth a read: it includes an inspiring overview of examples of leading edge practice. It’s great to see that despite the financial pressure, there are places from across the NHS and beyond that have created ambitious strategies for expanding improvement capability. If your organisation isn’t investing in this area, can you really be confident you’ll have what it takes to meet your objectives?
Penny Pereira (@PennyPereira1) is an Assistant Director at the Health Foundation,
Summary of a workshop discussion and examples of ways to build safety improvement capability.
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