Learning to Improve - Getting the Right Kind of Practice - David Fillingham

How do we learn? Two examples spring to mind from my experiences this summer.

The first: my four year old grandson kicking a football in his back garden, being coached by his ever patient Dad to get more power and accuracy so that the ball landed in the back of the net at least some of the time. After an afternoon’s practice, some gentle praise and constructive feedback he was getting it between the posts more often than the England football team; maybe a ray of hope for the 2032 World Cup?

The second: it’s Olympic year and watching titans such as Andy Murray and Jessica Ennis-Hill turning in medal winning performances made me think of their own countless hours of diligent practice.

Practice is critical to learning. Yet it’s not necessarily true that all practice makes perfect. Recent research into the neurophysiology of learning has demonstrated that it requires the right kind of practice to get good at something – whether it’s kicking a ball, an Olympic event or improving healthcare. You need to practice not only frequently but also correctly. You need to practice with lots of supportive feedback so you learn from your mistakes and don’t hard-wire self-defeating habits into your attitudes and behaviours.

As it is for grandsons and Olympians, is it also true for health care systems? After two decades of striving to apply improvement method to the NHS are we getting any better at it? And what constructive feedback might help us to improve the way we improve? My own perspective is that of someone who has made many mistakes and not always sufficiently learned from them.

We have had a succession of national bodies leading improvement in the NHS in England: the NHS Modernisation Agency, then the NHS Institute for Innovation and Improvement, followed by NHS Improving Quality, and now, after the coming together of Monitor and the Trust Development Authority, NHS Improvement. I was privileged to lead the first of those bodies, the NHS Modernisation Agency, from 2001 to 2004 and I have worked closely in support of each of the successor organisations.

The NHS has never been more in need of effective national leadership for improvement than it is right now. Overwhelming service and financial pressures are placing a tremendous strain on front line staff and in many places standards of care are beginning to slip.

The formation of NHS Improvement gives me hope. Its new leadership, Ed Smith (Chair), and Jim Mackey (Chief Executive), are on record as saying that they want to see a step increase in investment in improvement method as a response to the challenges we face.

So, if we are to go through another cycle of ‘practice’ – with a new national improvement strategy due in the Autumn of 2016 – how can we make sure it is the ‘right kind of practice’? What sort of reflection might help us to avoid some of the mistakes of the past?

Here are four suggestions based on my own experience. Why not use the comments function below to say what your list would look like?

1. The NHS Modernisation Agency was successful at engaging clinicians in its work but it was much less effective at engaging boards and senior leaders. Investment in strengthening the ability of NHS boards’ to lead quality and safety improvement should be given the highest priority. Without it improvement won’t take hold in a sustainable way.
2. The Department of Health, NHS and other national bodies may provide funding and set overall direction, but it is NHS organisations and front line staff who are the real ‘customer’ for improvement support. We need to generate buy in and give all NHS organisations a genuine stake in being part of an ‘improvement movement’.
3. The wicked problems we face can’t be solved by organisations working in isolation. The ‘Sustainability and Transformation Plans’ in England create an ideal opportunity to develop improvement capability across whole systems of care not just in institutions.
4. If national improvement organisations attempt to deliver all improvement support themselves they pull talented people with good improvement experience away from front line delivery. I’d like to see NHS Improvement keep its core team relatively small and for them to work through a variety of regionally based partners. The aim should be to keep improvement practitioners close to the action, and to network them together in a vibrant learning community. 

The UK Improvement Alliance is made up of organisations whose mission it is to improve health and the quality of healthcare and who are seeking to learn and apply the lessons of the past. We aim to be a strong partner to NHS Improvement in England and its equivalents in Scotland, Wales and Northern Ireland.

Meeting the extraordinary challenges which the NHS faces is a daunting task. To succeed we’ll need to be on top of our game. Let’s commit ourselves to the ‘right kind of practice’ that which is imbued with the spirit of humility, reflection and learning.

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