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COVID-19 placed unprecedented pressure on the UK’s health and care systems and triggered a series of rapid changes in service delivery. 

Q – an initiative led by the Health Foundation and supported by partners across the UK and Ireland – recently published The role of improvement during the response to COVID-19. Based on a survey and interviews with members of Q’s 4,250-strong network of people skilled in improvement approaches, this report explores their experiences of delivering rapid service changes in response to the pandemic.  

The importance of existing improvement skills and mindset 

The improvement methods and approaches used by Q members played an important role in supporting the unprecedented changes in service delivery needed due to COVID-19. Improvement was used most extensively for rapidly reviewing and improving processes and for engaging staff in change. 

People have taken their skills and those principles and used them to address the challenges that are in front of them and done that well.’ (Interviewee) 

Existing expertise in improvement methods and approaches emerged as a key advantage. For example, when rapidly reviewing and improving processes and practice, the simplicity of PDSA cycles was particularly useful. Methods such as Liberating Structures proved effective when engaging staff. People working in organisations that had cultivated improvement work prior to COVID-19 were particularly well placed to use it as an asset in their response to the pandemic. Their knowledge provided a vital foundation, empowering teams to apply the mindset and principles of improvement when undertaking service change. Staff were able to apply key principles flexibly and rapidly, organised around short-term goals. 

Respondents acknowledged that some important but less developed areas had fallen away under the pressure of COVID-19: specifically, patient involvement in changes and the measurement rigour needed for effective long-term change. This is understandable given the crisis situation practitioners were working in, but prioritising these areas remains important to ensure changes are sustainable. 

Building the improvement muscle 

There is a strong case for embedding improvement into core ongoing work in health and care services. It can be useful to think of how improvement approaches are used in terms of the ‘muscle memory’ of individuals and organisations. By investing in and supporting people to learn and apply improvement tools and methods in practice, the improvement ‘muscle’ is built and can then be flexed more easily to respond to different contexts – both in the COVID-19 crisis and in the longer term. 

Staff who are experienced in these techniques and those who support them should build on the positive momentum created by the pandemic. This means reflecting on which ways of working and solutions developed to date should continue, so that improvement can continue to play a central role in the pandemic recovery, while also supporting longer-term service transformation efforts. Further galvanising efforts around shared system priorities will also be key to achieving the service change needed. 

We experimented with a whole range of different approaches that brought structure, energy and intention to [daily] team briefing spaces. So, gradually, looking at getting that better and better, so that the team is checking in for half an hour a day, but that time is really productively used, and people leave with a sense of energy and joy.’ (Interviewee)

Using improvement to support both staff and service recovery 

Meeting the demands on the NHS in the coming months and years is going to require skilful and rapid innovation. Waiting lists are at an unprecedented high even before the expected ‘hidden demand’ of people who avoided seeking care during the pandemic is uncovered, and demand for mental health services is also expected to rise. At the same time, many health and care workers will need support to recover from their experiences of the pandemic.  

Given the need for rapid changes to services, respondents said they used improvement approaches most in reviewing and improving processes and practice. They were also frequently used in engaging staff. Tools that supported staff resilience and psychological safety, and those that helped to rapidly adapt ways of working and respond to change, were seen as particularly useful. This highlights the important dual value of improvement approaches in supporting both staff and service recovery.  It is important to recognise that sufficient time and the right context is needed to make the most of existing improvement expertise to support COVID-19 recovery. Respondents identified several key enablers that were important through the pandemic response and will continue to be vital: empowering leadership, resources, capabilities, and positive cultures. 

To build improvement capacity it needs to be integrated culturally and systematically. [There] needs to be a national mindset that improvement work is not an optional extra delivered by passionate staff in their own time but a core part of work.’ (Survey respondent)

Find out more about Q

The Q initiative offers people a way to learn, share and collaborate so that individuals, teams and organisations can access ideas and support from across the health and care system. Anyone with an interest and expertise in improvement is welcome to apply for free at any time, and many of our offers and resources are open to all. Visit the Q website for more information. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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