Improving how we improve

Failure is a normal part of life. Personally, Grade 3 piano, my driving test, and asserting some semblance of parental authority over my daughters all have proved or continue to prove beyond me. But as both Professor Haushofer of Princeton’s CV of failures and Silicon Valley’s Start-Up Funerals signal, failure is often one of our richest sources of learning.

I was reminded of this when reading Bill and Melinda Gates’ reflections on $40 billion worth of charitable investment.

In aiming to reduce child mortality or eliminate polio, they found that funding for new vaccines wasn’t sufficient when it came to bringing about change in ‘remote villages where nothing happens as expected.’  

Innovation in medical technologies needed complementary investment in women’s empowerment and education to ensure vaccinations were given, or that breastfeeding rates increased. The results were great strides in reducing child mortality and a radical reduction in polio cases globally.

In other words, scientific discovery and ambitious goals are crucial, but not enough on their own. We must pay equal attention to supporting people to apply new ideas in ways that makes sense in their local context.

That’s why one of the most significant investments that organisations like the Health Foundation often make is in building people’s skills and knowledge to lead and deliver change within their own context – what we call capability building.

For us this means working together with our partners to develop a critical mass of health care professionals in the UK with the confidence, knowledge and skills to lead improvements to health care – whether they are working at the front line of service delivery or delivering change at a national level.

We do this in a number of ways, but a common thread is helping people to develop the technical skills of improvement and change alongside the relational skills (engaging with others) and personal capabilities (being highly self-aware and authentic) needed to lead change in complex, stressful and demanding operational environments; not quite in the ‘remote villages’ of polio eradication, but still in places within the NHS and wider sector where it often may seem ‘nothing happens as expected’.

We therefore fund a number of fellowships for individuals, all of which include leadership and personal development:

• Our Clinician Scientist Fellowships enable clinicians to undertake clinical academic research into new tools, technologies and approaches.

• Our Improvement Science Fellowships, open for application until 5 July 2016, offer a unique post-doctoral fellowship for applied research in improving health care. We also fund PhDs in improvement research to support the long-term development of the field.

• Generation Q is a masters-level Quality Improvement and Leadership programme for senior leaders in health care.

We are also working with partners in Sheffield, Warwick and Bath to learn how to apply team coaching and technical improvement skills at care pathway level, in order to improve patient flow through a health care system.

Perhaps most ambitiously of all, we are developing Q, a partnership with NHS Improvement that seeks to build and support a community of people working in improvement across the UK. The Q community is made up of a diverse range of people including those at the front line of health and social care, patient leaders, managers, researchers, policymakers and others.

Our recently published report describes the co-design process we undertook with a founding cohort of 231 members over the past year. While there is much still to do to fulfil its promise, the report concludes there are early signs that Q can help boost the effectiveness and confidence of those doing improvement, enable new collaborations across regional and professional boundaries, and contribute to the acceleration of the spread of innovation.

In the next six months we will be beginning to grow Q as new members come on board, and over the coming years we aim to connect thousands of people to share ideas, enhance their skills and work together on ways to improve patient care.

This investment in the development of individuals, teams and communities is critical, but not sufficient. We also need complementary attention to building our knowledge and understanding of how improvement happens; seeking, as Haelo Chief Executive and Health Foundation Fellow Maxine Power described it to me, ‘to improve how we improve’.

This is one of the reasons we have recently launched a landmark funding call for partners to develop an improvement research institute. The institute will build on our history of investment in improvement research, and will not only develop new knowledge about how to improve care but also work with a wide range of partners to help put this knowledge into practice in the NHS.

After a few small tests of change, I did eventually pass my driving test, though dreams of parental authority and musical expression look like they will remain out of reach for some time. But when it comes to the infinitely more complex task of improving health care, one of the surest bets I think we can continue to make is investment in developing a system that is capable of continuous learning, with people equipped with the skills to deliver for today, as well as to adapt and improve for tomorrow.

Will Warburton is Director of Improvement at the Health Foundation. @will_warburton2