Integrating digital into the quality agenda

Maxine Power profile picture

23 January 2023

Maxine Power
Director of Quality, Innovation and Improvement
North West Ambulance Service NHS Trust


Our journey bringing together improvement and digital expertise at North West Ambulance Service NHS Trust began with thinking about how we could better organise for improvement and regulatory excellence. In 2016, the organisation had just received a disappointing Care Quality Commission (CQC) inspection resulting in a 'requires improvement' rating.

Consequently, improvement became an immediate priority for the board
, and they took the chance to consider board leadership for improvement. As a result, my post was agreed bringing together the traditional 'quality agenda' with improvement and innovation. Very quickly I saw the opportunity of integrating digital into the directorate, under 'innovation', to ensure that we could more effectively harness and align our improvement and digital capacity and capability.

The pandemic, system pressures and challenges with workforce have highlighted how improvement is really the only way forward if we are to continue to deliver high quality care.

Maxine Power    Director of Quality, Innovation and Improvement

The board has embraced the need for the organisation to 'think differently' moving forward – and to start with itself. We have undertaken board development sessions on regulatory excellence, improvement and digital and have developed a suite of board strategies, both quality and digital, to support our overarching strategy. These articulate our intentions to reach 'outstanding', deliver high quality care and be a digital exemplar. The work of the board provides the foundation for hardwiring improvement into the operating model and day to day, our focus is quite simply on 'solving everyday problems' and harvesting the ideas of our staff to help us learn and improve.

The pandemic, system pressures and challenges with workforce have highlighted how improvement is really the only way forward if we are to continue to deliver high quality care. Specifically, our improvement is focused on the safety of staff and patients with a relentless focus on equality and outcomes. Improvement helps us to better understand variation and how we can use isolated pockets of exemplary outcomes, learn quickly and scale this to the rest of the organisation. Our digital systems help us to monitor our improvements at system and programme level and give visibility from ward to board. As a board we understand that we cannot do our work without timely, accurate data and we cannot change quickly unless we are skilled at improvement.

Now that the direction has been set by the board, we have clarity about 'what we are trying to accomplish'. Operational pressures do impact from time to time, however, since the launch of our strategy we have continued to pursue a programme of improvement work, running a number of system wide change programmes and improving our digital maturity to the point where the board now have substantial assurance with regard to cyber security (which moved from a risk of 25 on our risk register to 12, which reflects the volatility of the cyber space).

We have had to slow down some of our innovation work until we have been able to secure additional funding, but have been purposeful about accessing funding from the NHS England Unified Tech Fund. This has allowed us to roll out personal issue mobile devices to all staff and introduce an electronic patient record.

Our most recent appointment of our chief clinical information officer, with our digital champions, is harnessing the clinical leadership of improvement and digital.

Maxine Power    Director of Quality, Innovation and Improvement

Since we started our journey, we have seen real impact from the strategies and measures we have implemented, moving from 'requires improvement' to 'good' on the CQC rating, and anticipate that in the next round of inspections we will be able to shift the dial on several elements of the framework to move to 'outstanding'. We have been able to lead a number of system improvement programmes around key safety imperatives such as hospital handover, with the North West climbing from 9th to 4th in the hospital handover performance standards.

The appointment of our chief of digital and innovation and chief of regulatory compliance and improvement have been instrumental in driving forward the improvement, innovation and digital agenda. We have re-purposed capital and revenue funding streams to support new posts in both improvement and digital, and have aligned the skills of the teams to the requirements of the business and delivery of the strategy. Our most recent appointment of our chief clinical information officer, with our digital champions, is harnessing the clinical leadership of improvement and digital.

Our next steps are to integrate our strategic approach into a streamlined integrated programme of work. Our focus is on building the infrastructure to become a learning organisation and to have a robust quality management system in place to deliver brilliant basics. More specifically, in bringing together improvement and digital at scale we have developed a digital innovation pipeline and agreed an approach to this as a system. This will help us to agree a process for large scale deployment and evaluate the benefits. Also, perhaps more importantly we have brought together our people into a single team and through shared conversations and pooling of expertise, we have developed mutual respect and cross team support.

We need consensus that improvement within our systems, and improvement through digital, is part of how we expediate innovation and navigate the future challenges we face in the health and care system.

Maxine Power    Director of Quality, Innovation and Improvement

Progress so far has been part cultural and part operational. The culture change is about ensuring that all our staff see that their ideas are important and that we will listen and support them to improve. In practice this has meant creating an incubator where staff can go to develop their ideas. Our vehicle for this is our Digital Design Forum which meets fortnightly and gives staff the opportunity to collaborate with our digital team, get support with the development of their ideas, be protected from unnecessary barriers and then have a belief that these ideas can be taken to scale for patient benefit. We have proven this can happen and that we can be consistent in our approach.

The operational challenge is to ensure we don't become overwhelmed by multiple competing projects and ensure that our precious workforce and their expertise feel valued and supported. We also need to be robust in our conversations about funding, and challenge traditional beliefs that our resources are only impactful if they are invested in buildings, equipment, vehicles and people. We need consensus that improvement within our systems
, and improvement through digital, is part of how we expediate innovation and navigate the future challenges we face in the health and care system.  

About the author

Maxine Power profile picture

Maxine Power
Director of Quality, Innovation and Improvement

Maxine Power is the director of quality, innovation and improvement at the North West Ambulance Service NHS Trust. She is a Health Foundation and IHI Quality Improvement Fellow alumni.

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