Nurturing a culture of improvement: how trust boards can embed organisation-wide improvement

Miriam Deakin profile picture

14 May 2021

Miriam Deakin
Director of Policy and Strategy


This month we are delighted to launch our trust-wide improvement programme, a new development offer for trust boards supported by The Health Foundation.

While different quality improvement initiatives are well established in the NHS, we know they are most effective as part of an organisation-wide approach, led and championed by board members. Trusts that have embedded trust-wide improvement successfully throughout their organisations have boards that share responsibility for continuous improvement with all leaders, at all levels. They have a consistent and coherent approach. And perhaps most critically, they support their staff to engage in and lead improvement efforts by enabling them to both develop improvement skills and capabilities, and by focusing on relationships and culture. Staff in these organisations come to work to deliver 
and improve services.

The sector's response to COVID-19 has shone a spotlight on the way NHS staff can deliver rapid improvements in the way services are organised and how care is delivered.

Miriam Deakin    Director of Policy and Strategy

The sector's response to COVID-19 has shone a spotlight on the way NHS staff can deliver rapid improvements in the way services are organised and how care is delivered. Staff have demonstrated incredible agility and creativity in solving problems, developing new pathways, and building collaborations across historical divides. The value of improvement approaches became all the clearer in a time of pressure: research from the Health Foundation's Q Community shows that organisations that had a well-developed approach to improvement prior to the pandemic were able to use these skills more effectively during the crisis and are now in a stronger position to build on the changes made.

For example, at Surrey and Sussex Healthcare NHS Trust (SASH), staff applied improvement methods and tools to tackle problems with the supply of personal protective equipment (PPE), to introduce lateral flow testing and work through PPE decontamination processes. The climate and culture at the trust meant staff knew they had the freedom to think differently about the way care was delivered and that they would be supported to use embedded improvement tools to innovate at pace. Staff at SASH already had considerable expertise in understanding and designing improvement processes – applying this to the trust's COVID-19 response has enabled the trust to become one of the highest performing for reporting COVID-19 lateral flow test results and to design at pace a vaccination centre through which people flowed efficiently with a focus on great patient and staff satisfaction, no queuing and no vaccination waste.

We believe we now need to take stock of what we've learnt about approaches to improvement as a result of the pandemic.

Miriam Deakin    Director of Policy and Strategy

We believe we now need to take stock of what we've learnt about approaches to improvement as a result of the pandemic. While staff have been able to make changes at pace, staff and patients alike recognise that some of this innovation needs further embedding and there are questions about what aspects of improvement during the pandemic are sustainable and which are not. For many trusts, improvement efforts over the last year have been short term and exclusively focused on COVID-19, and improvement methods have been used in more flexible and partial ways than they may have been previously.

Our new support offer to boards, in partnership with the Health Foundation, will provide an opportunity to step back and learn from peers.

Miriam Deakin    Director of Policy and Strategy

Our new support offer to boards, in partnership with the Health Foundation, will provide an opportunity to step back and learn from peers. As operational pressures continue to mount, trust leaders know that new ways of working are urgently required to support both staff and service recovery and to manage ever growing demand. Through a range of events, resources and action learning sets, uniquely targeted at a trust board audience, we will share practical tips and strategies about how embedding a trust-wide approach to improvement could help sustain the gains made as a result of the pandemic and respond to the scale of the challenges ahead.

As the move to place-based collaboration and partnerships within and between systems intensifies, the programme will also explore what we know about how quality improvement can be effectively driven across organisational boundaries. How are provider collaboratives and wider system partners developing a shared approach? How have they overcome the barriers? What have they learnt that can help others earlier in the journey?

We believe there is now, more than ever, an opportunity to nurture a culture of improvement across the provider sector, building on the experiences and achievements of the last year. We hope our programme will help trusts looking to take the next step on their improvement journey, support boards to navigate and access the wealth of resources on this topic and identify what else the national bodies could do to create an enabling environment for improvement.

About the author

Miriam Deakin profile picture

Miriam Deakin
Director of Policy and Strategy
@MiriamDeakin

Miriam is our director of policy and strategy and is currently leading our programme of work on sustainability and transformation partnerships and accountable care to inform our influencing activities on trusts’ behalf and ensure we are offering the support that trusts and their partners need to deliver new, collaborative arrangements. Read more

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