Blog: Magic in the Mundane - The Chemical Solution

Emma Walker - Portfolio Lead, - Academy, Safety
& Mortality and Shared Decision Making

Writing in 1988, Avedis Donabedian suggested that the key markers of high-quality care are outcomes. The likelihood of achieving these outcomes is increased if organisations have the necessary structures and processes of care in place to meet quality standards.

In other words, to deliver a high quality outwards-facing ‘product’ requires continually improving internal structures and processes.

This was reinforced for me when a team from AQuA made the short trip to Ellesmere Port in Cheshire to visit Innospec, a specialist chemicals company, traditionally specialising in octane additives used in making motor fuel. With demand for lead in petrol decreasing, in 2006 the entire existence of the business was under threat. They were faced with two choices: innovate or disband.

Ten years on, not only have Innospec survived, but are thriving, adding whole new lines of business such as 'performance chemicals' (that’s ingredients for shampoo to you and me). What’s been behind their success? Five factors became apparent.

1. Focusing on leadership
   Innospec have demonstrated strong, stable and decisive senior leadership from the very outset of their improvement journey. They have clearly set the strategic vision, established acceptable standards, and followed through on promises to drive the business forward. This ability to look ahead and make long term plans about how to transform a business to meet the changing demand of customers is something that has perennially challenged NHS organisations all too often caught in management flux.
   
   
2. Pre-empting failure
   All members of Innospec staff to speak up and articulate "What might go wrong here?" By identifying which mistakes could lead to a major incident, they are confidently able to predict the consequences of each error (e.g. would it lead to major harm?). By developing systems to mitigate human error they have made it easy to do the right thing and hard to do the wrong thing. This proactive approach to anticipate and be prepared for problems chimes with the Health Foundation and Professor Charles Vincent’s framework for measuring and monitoring safety.
   
   
3. Learning from errors
   Innospec were keen to demonstrate how they learn from incidents, errors and near-misses, with a culture focused on learning not blame. They design processes with the customer at the centre, proactively ensuring there are sufficient measures in place to catch errors before they lead to harm. Initiatives such as ‘Near Miss of the Month’ awards help make safety everyone’s responsibility.
   
   
4. Behavioural safety
   Innospec have developed a specific ‘behavioural safety’ training programme in order to embed a strong safety culture in all their staff. They utilise the risk elements of processes to drive safety improvements rather than as a ‘box ticking’ exercise. Impressively, all members of staff we spoke to felt able to detail potential hazards without hesitation or fear of reprisal – a real testament to their open and transparent culture. This approach links with AQuA’s approach to psychological safety, with programmes including resilience, appreciative inquiry and human factors.
   
   
5. Culture
   The culture of Innospec is supported by leadership, but encourages a “bottom-up” approach to improvements. Their focus was on utilising the appropriate tool or technique in the right situation, rather than being hung-up on a specific methodology. The primary focus is on making incremental changes and process improvements using whichever technique fits the need of the business within a particular situation. This approach has the benefit of having the flexibility to vary depending on what they are trying to improve.

At this point you may well be thinking that this is nothing new, that there’s nothing here you haven’t heard before.

If so, you’re absolutely right.

Innospec didn’t go from the brink of failure to market-leading because of a magic bullet – the creation of an 'accountable fuel additive care organisation' if you will – but rather because they focused on the basics, and didn’t let their attention waiver for year after year. Mundane? Maybe. Effective? Certainly.

In our work at AQuA we have seen many times that such a focus on the basic components of improvement delivers results in healthcare (a point also made by Nigel Edwards in his recent blog on the Vanguards). Our work programme has been designed to help our members innovate, improve and develop – all while building a culture now which will sustain improvements into the future. To find out more, visit the AQuA website.

You can follow Emma on Twitter at @EmmaCherub or follow AQuA @AQuA_NHS.

This blog was originally published by the UK Improvement Alliance (UKIA). To find out more about their work please visit their website, or follow them on Twitter @theUKIA.