Following the recent launch our paper A Sense of Urgency, A Sense of Hope at a joint event with The King’s Fund, our Chief Executive David Fillingham takes a further look at the need for health and care organisations to adopt systems for quality improvement.
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| David Fillingham |
It has been a long, difficult Winter for the NHS. Staff have worked incredibly hard to care for increasing numbers of patients at a time of tightening finances. Sadly, despite these great efforts, we have inevitably seen too many stories of long waiting times and a worsening experience in many places. Whilst the NHS has a marvellous ability to cope in adversity, the sense of it being in crisis is growing.
On one of the snowiest days of the year, the 1 March (allegedly the first day of Spring!) over a hundred hardy NHS folk battled their way through blizzards to a King’s Fund / AQuA event in Manchester where we launched AQuA's framework on building a system and culture of improvement, entitled A Sense of Urgency, A Sense of Hope.
On one of the snowiest days of the year, the 1 March (allegedly the first day of Spring!) over a hundred hardy NHS folk battled their way through blizzards to a King’s Fund / AQuA event in Manchester where we launched AQuA's framework on building a system and culture of improvement, entitled A Sense of Urgency, A Sense of Hope.
By a show of hands delegates indicated that they were very familiar with the extreme pressures facing the NHS. They also recognised that the current political and economic context is such that, the sustained and large-scale investment needed in health and social care is unlikely to happen anytime soon.
The 'hope' rests in the fact that there is a strong evidence base, in other sectors and in healthcare, that the strategic application of improvement methods can improve both quality and productivity. This is not to say that more spending isn't needed, it is, but until the day it arrives there is a great deal that the NHS can do for itself to tackle the waste, delays and duplication in the system that are such a source of frustration for staff and patients alike.
The problem is that our improvement efforts are too often small-scale, piecemeal and not sustained. Organisations which have achieved transformational results, such as Jonkoping in Sweden, Virginia Mason in the US or Salford Royal and East London Foundation Trust here in the UK, have adopted a long-term approach to building their respective improvement systems.
The 'hope' rests in the fact that there is a strong evidence base, in other sectors and in healthcare, that the strategic application of improvement methods can improve both quality and productivity. This is not to say that more spending isn't needed, it is, but until the day it arrives there is a great deal that the NHS can do for itself to tackle the waste, delays and duplication in the system that are such a source of frustration for staff and patients alike.
The problem is that our improvement efforts are too often small-scale, piecemeal and not sustained. Organisations which have achieved transformational results, such as Jonkoping in Sweden, Virginia Mason in the US or Salford Royal and East London Foundation Trust here in the UK, have adopted a long-term approach to building their respective improvement systems.
AQuA's publication is based both on a review of the published evidence about how they have done that and on reflections on leading and supporting improvement efforts on the ground.
Our framework has five interdependent elements:
Our framework has five interdependent elements:
- Vision and Strategy - developing a plan that inspires and engages everyone. It should have bold aims, measurable goals and commit the organisation to building improvement capability at every level.
- Leadership and Culture - in an improvement culture patients and families are full partners in their care. Staff are empowered and supported to use their energy and creativity to solve problems, and leaders are positive role models who coach others in their chosen improvement approach
- Building Capability - there is a commitment to train all staff in improvement method and to give them the time and encouragement to use those skills. Leaders and coaches will have more advanced know how and there will be a small number of genuine experts. The Board will itself commit to receiving development to carry out its own improvement leadership role effectively
- Developing an Operating System - improvement methods will become 'hard wired' into the organisation with goals being cascaded via a process of 'catchball' and expertise focussed onto the biggest challenges. Over time an improvement approach will become "the way we do things around here" and an accepted part of daily work
- Aligning Support Services - staff working in HR, Finance, IT/Information and Estates have a great contribution to make. They will be fully engaged and these functions redesigned to support an improvement culture.
Last year NHS Improvement, alongside other national NHS bodies, published their strategy Developing People,Improving Care. This exhorts NHS organisations to make just these kind of investments in their own improvement capability.
The newly revised CQC inspection framework asks questions as to what progress is being made on the ground. Not only do organisations need to adopt such an approach if they want to emulate the best, now they are actively being encouraged to do so by inspectors and regulators.
This kind of work takes time and is a difficult path. It's all too easy to become overwhelmed by day to day pressures. Succeeding requires courage, curiosity, persistence and optimism.
This kind of work takes time and is a difficult path. It's all too easy to become overwhelmed by day to day pressures. Succeeding requires courage, curiosity, persistence and optimism.
But the prize is a great one...that of seeing staff glow with the pride using their own experience, energy and ideas to transform the care that patients receive.
Feel free to share your thoughts with us via Twitter @AQuA_NHS or get in touch via AQuA@srft.nhs.uk to request a hard copy of our paper.
