You had two jobs…whole organisation approaches to quality improvement

Will Warburton profile picture

27 September 2019

Will Warburton
Director of Improvement
The Health Foundation


If you hang around people interested in quality improvement in healthcare, it won’t be long until you hear someone quoting Paul Batalden’s aphorism that ‘Everybody in healthcare has two jobs: to do your work and to improve it.’  

 

Given the inexorable rise in demand for health and care, and with nearly 100,000 vacancies in NHS trusts and a further 110,000 in social care, managers, clinicians and caregivers might be forgiven for thinking that they are doing the work of two jobs just to keep up with what’s coming through the front door each day, let alone having time to think about how to improve systems, pathways and processes of care.

 

But despite the relentlessness of operational pressures, many provider organisations are making space to ask how they can do these two jobs at an organisational level: both deliver for today, at the same time as improving for the future.

 

Many provider organisations are making space to ask how they can do these two jobs at an organisational level: both deliver for today, at the same time as improving for the future.

Will Warburton    Director of Improvement

 

At the Health Foundation, we’ve been funding and supporting research and practice in health care improvement for 15 years. We’ve seen quality improvement develop from a minority sport of zealots and enthusiasts into a mainstream policy and practice approach, as evidenced by the inclusion in the NHS Long-term plan of a commitment to building quality improvement capability in local health systems, and the appointment of a highly respected and experienced leader in Hugh McCaughey to a new national role as director of improvement. There is significant enthusiasm and energy going into quality improvement throughout the system.

 

But as Mary Dixon-Woods, the health foundation professor of healthcare improvement studies at Cambridge University, likes to point out, wanting to improve is not the same as knowing how to do it. Evaluations of the improvement work we’ve funded show that projects without a supportive organisational framework often run into ‘big and hairy’ structural and cultural barriers such as staffing levels, job plans, and IT systems; problems that can’t easily be resolved in a limited time-frame or by a small clinical team. Equally, the evidence tells us that quality improvement methods, while important, are only one element of a broader set of leadership and management capabilities that organisations need to improve.

 

Evaluations of the improvement work we’ve funded show that projects without a supportive organisational framework often run into ‘big and hairy’ structural and cultural barriers such as staffing levels, job plans, and IT systems.

Will Warburton    Director of Improvement

 

That’s why we, along with many others, have become increasingly interested in understanding what it takes to build organisational and system contexts that support teams leading local improvement. And while there is much we still don’t know about how to achieve the continuously improving organisation, there is plenty of evidence and experience to draw on. So the question becomes how to go, as the theme of NHS Providers annual conference puts it, from ‘ambition to reality’?

 

At the conference on 8-9 October, I’ll be presenting learning from The Improvement Journey, our recent publication summarising what’s meant by organisational approaches to improvement, why it matters, and six steps that trusts go through when putting in place an organisation-wide approach.

 

At the conference on 8-9 October, I’ll be presenting learning from The Improvement Journey, our recent publication summarising what’s meant by organisational approaches to improvement, why it matters, and six steps that trusts go through when putting in place an organisation-wide approach.

Will Warburton    Director of Improvement

 

I’ll be participating in a panel discussion session with Dame Jackie Daniel, chief executive of Newcastle-Upon-Tyne NHS Foundation Trust, and Siobhan Moran, director of quality improvement at Salford Royal NHS Foundation Trust, chaired by David Fillingham, one the pioneers of whole organisation approaches to quality improvement in the NHS.

 

I hope you can take time out of your two jobs to join us for what will be a rich conversation on the practical steps organisations can take to develop their approaches to continuous quality improvement.

 

Will is director of improvement at the Health Foundation. Read the Improvement Journey here.

More information about our annual conference can be found here.

About the author

Will Warburton profile picture

Will Warburton
Director of Improvement

Will is responsible for the Foundation’s work on quality improvement, including the Q Community, THIS Institute and the Flow Coaching Academy. A Generation Q fellow in leadership and quality improvement, he is co-author of The Improvement Journey and The Spread Challenge. Will was previously Forum Director for the World Innovation Summit for Health, Operational Director at the Centre for Health Policy at Imperial College, and an operational manager in the NHS.

We use cookies to ensure you have the best possible experience on our website. By continuing we’ll assume that you are happy to receive them. Read our updated privacy and cookie policy. Close