How do we make 'improving' core business?

Penny Pereira profile picture

09 November 2023

Penny Pereira
Managing Director
Q (Health Foundation)

Enabling innovation and improvement is a central ambition for health services, so how can we make improvement approaches core to how we deliver? This blog shares a few thoughts in advance of a session at the NHS Providers conference, on Tuesday 15 November 4:50pm, on creating a culture of innovation and improvement.

NHS IMPACT provides the national context for prioritising improvement. There's well established evidence about how to make services better and we have people with the skills needed, in at least pockets, in every part of the NHS. The Q Community delivered by the Health Foundation and co-funded by NHS England and partners across the UK and Ireland, has over 5,000 people collaborating to improve the safety and quality of health and care. Yet  in the NHS, we're still far from consistently designing services around the needs of patients and improvement is often limited to projects at the fringes of policy and practice.

If the principles of improvement were really core to how we deliver healthcare, the evidence suggests that we would see more sustained improvements in performance.

Funding is clearly critical to what's possible, but there's growing recognition that extra capital investment and extra staff in key professions alone will not be enough to deliver the breadth and depth of change needed. Improvement approaches can help the NHS make best use of the resources available. These ideas can help us find lasting solutions to the operational challenges that have confronted the sector every winter for decades, and make surer progress towards longer term shifts in the model of care.

Improvement is about giving the people closest to issues affecting care quality the time, permission, skills and resources they need to solve them. It offers a systematic, collaborative and pragmatic set of approaches for really understanding issues. Improvement enables changes to be co-produced and then iteratively implemented so that what emerges is more likely to sustain and scale. The Health Foundation has recently published a briefing on what's needed to make improvement mainstream and an accompanying guide to the evidence.

There are a range of factors that need attention to realise the full benefits that are being seen in providers who have really embedded improvement. Here's three aspects to prioritise to create a lasting culture of improvement.

Understand and use improvement widely to meet multiple goals

The field of improvement has evolved over recent decades, so it now delivers much more than incremental quality improvement in individual services.

Within Q and the Health Foundation's work, improvement approaches are being used to support pathway and model of care transformation, and to effectively target and embed technology and other innovations. There are improvement methods well suited to rapid problem solving when services are under pressure as we saw during the Covid-19 pandemic. As organisations build their expertise, culture and confidence, they see these methods as the way to tackle their thorniest and most complex delivery challenges, such as tackling winter pressures and waiting times or improving financial and environmental sustainability.

Embed improvement methods as core to how the organisation delivers

The most mature organisations when it comes to improvement have drawn on learning from the field, to design an overall operating model that's geared to delivering quality and other organisational goals. Since 2021 the Health Foundation has been partnering with NHS Providers to develop understanding of organisation-wide approaches to improvement and we're excited to now be working in partnership to support Provider Collaboratives to improve equitably.

Given that many providers that have achieved an 'outstanding' rating from Care Quality Commission have a systematic approach to improvement, there's a lot of interest in what's needed to get there. Together we're offering freely available resources and opportunities to learn from those further along the journey.

Focus on the cultural and people aspects of how we improve performance

Enabling continuous improvement is at least as much about the relational as the technical aspects of organisational life. Leadership is critical, which is why it's great that we are partnering with NHS Providers and can support boards in their approach to learning and improvement. 

Purposefully supporting connections between staff is one way that leaders can enable a shift in the organisational culture to support learning and improvement. The evaluation of the NHS partnership with Virginia Mason Institute that the Health Foundation funded, published last year, helps us understand the mechanics of these cultural aspects. Organisations that had invested in creating shared values and a learning culture, showed stronger patterns of collaboration and this appears to contribute to overall performance. Those that were rated outstanding, were observed to foster more connections and these connections were found to be more reciprocal and about actual collaboration rather than 'simple brokering' information exchange. 

There's incredible pressures in the health sector at the moment, and that is making it harder for people to find the time and resources for improvement and innovation, even though this is when it's needed most. Through the Q community, we're supporting thousands of people to connect and collaborate on the key topics that are important to achieve their local performance goals. I'm continually amazed by the energy and ideas that they bring to this work.

Embedding a culture of innovation and improvement is a long term journey, but there's plenty of examples and people with expertise that organisations can draw on. 

NHS Providers has joined forces with the Q Community, with support from the Health Foundation and NHS England to launch a programme of peer learning for senior leaders on how provider collaboratives can develop shared improvement approaches with an equity lens embedded from the outset. Find out more and sign up.

About the author

Penny Pereira profile picture

Penny Pereira
Managing Director

Penny is the managing director of Q at the Health Foundation. She joined in 2011, leading work on improvement capability building, patient safety and improving flow, among other things. She has led the Q initiative since its inception.

Q is a community of thousands of people across the UK and Ireland, collaborating to improve the safety and quality of health and care.

Before joining the Health Foundation, Penny was the director of strategy and service improvement at a trust in east London. Penny has spent her career leading improvement work at local and national level in the NHS, with particular expertise in process and system redesign, leading strategic change across organisations, developing networks to support improvement and collaborative design.

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