Three questions to health check your organisation’s improvement approach

With the health service facing a large funding gap and increasing demand for care, effective improvement work is going to be more important than ever over the coming years. Improving quality and safety could also help to find vital efficiency savings while improving the quality of care you provide to patients and service users. So now is the time to focus on a strategy for quality improvement – both at an organisational and team level.

But how can health care organisations maximise the impact of their quality improvement projects? Here are three practical questions which will help to examine whether an organisation is creating the optimum conditions for improvement success.

1: Is the organisation maximising its improvement assets?

Many organisations don’t really know which of their employees have already developed improvement expertise, meaning they are not using this resource to its full potential. People build valuable skills and experience when they are involved in improvement projects – including a detailed understanding of the quality improvement methods needed to measure, test and study change – but this can lie untapped once the project finishes.

It’s worth doing a proper skills audit to check what expertise lies hidden in teams. Organisations can develop capacity and capability by nurturing the talent they already have and encouraging in-house experts to mentor others. Bringing together small multidisciplinary teams of these in-house experts can create a vibrant programme of improvement ideas and work, led with skill and enthusiasm. This approach also helps to generate positive energy from collective working.

South Eastern Health Trust in Belfast have done just this. Building on the initial handful of staff who received training in improvement methods through the Health Foundation’s Safer Patients Initiative, they developed an in-house programme to mentor others in these approaches and thereby cascade skills through the organisation. They now have over 100 clinical teams involved in quality improvement projects addressing the key organisational priorities of safety, quality and experience every year. This has led to a varied and innovative programme of improvement work and the development of an improvement hub.

2. Is the organisation’s current improvement work of good calibre and does it align with the wider strategic agenda?

Quality improvement is a discipline and improvement projects work best when that discipline is applied with rigour. If the idea is good but the methods are sloppy the outcome will not be as strong. Ensuring teams have the right measures and evaluation methods is key, as is the ability for staff to be sufficiently reflective and self-critical when thinking about what needs to change. This is where bringing in external quality improvement expertise can be useful, adding a fresh perspective and acting as that all-important ‘critical friend’.

It’s also important that improvement work aligns clearly with the organisation’s main strategic priorities, rather than being driven by an individual’s particular interest or treated as a bolt-on activity. Outcomes from the Health Foundation’s Flow, Cost, Quality programme show that taking a strategic and system-wide approach to change can have dramatic results. The programme has helped organisations to develop the tools and techniques needed to really understand and analyse their health systems and see where the true problems lie. This approach creates a strong consensus for change before anyone starts talking about testing potential solutions.

3. Is the organisational environment conducive to improvement?

Creating an ‘improvement organisation’ is as much about developing the right culture and behaviours as it is about applying technical skills. The real legacy of successful improvement projects is the organisational mindset they cultivate that change and improvement are possible.

So are people displaying the right culture and behaviours? In clinical areas, do staff act in a way that supports improvement, valuing the perspective of everyone in the care team, including patients and their families? Is it usual for people to see shortcomings in service standards as an opportunity to learn or a reason to blame?

The Health Foundation has seen time and time again how stability and ongoing commitment at board and senior executive level can really help to drive long-term change, allowing the space and time for innovations to embed and spread.

Do senior staff in the organisation understand the value of improvement efforts and methods and are they committed to supporting long-term change (which might not bring immediate results)? While the enthusiasm and passion generated through shared endeavour can take teams a long way, senior executives need to be realistic about the time and resources needed to support effective measurement and provide time for reflective learning. They also need to empower local teams to lead their own improvement work.

A learning report looking at the Health Foundation’s Shine programme highlights this. Shine’s ‘bottom-up’ approach to improvement encouraged strong local ownership of projects, with teams needing to identify the problem and their case for change, using their own data. ‘This process meant that clinical teams not only agreed that there was a problem to be fixed but they were involved in developing the local solution to it.’ A powerful driver for change.

Find out more:

• The NHS change model website
• Health Foundation quick guide: Quality improvement made simple
• Health Foundation research: Overcoming challenges to improving quality - Lessons from the Health Foundation's improvement programme evaluations and relevant literature