As a board, getting closer to our staff members' experience of improvement is critical if we're going to really understand how to enable and empower our colleagues to make positive changes for our patients, and adapt to solve the problems we all face today. Yet it can be a challenge when time is tight.
At Robert Jones and Agnes Hunt, we've been building the infrastructure for a systematic approach to improvement over a number of years, including training and support to create a number of quality improvement (QI) champions who can lead improvement across the trust. Our board members remain involved, going beyond strategic direction and investment, to play a visible role. For instance, we help to launch each round of champions training, attend regular 'Breaking the cycle' week-long improvement workshops alongside staff, and consistently celebrate success together.
The advantages for the board are huge; witnessing enthused staff and benefitting from collective problem solving. Non executive directors (NEDs) especially feel it brings them closer to the ambitions of the trust in practice, giving them a chance to see and appreciate the journey that staff are on. You can hear more on our wider approach in the webinar that I and members of my team spoke at recently, part of NHS Providers trust-wide improvement programme (supported by the Health Foundation). You can see here some examples of a few steps I personally take to help ensure our actions match up with our rhetoric on leadership for improvement, which I hope may be useful insight for others.
We seek to lead by example and my own way of doing this is to always try to give the 'real' Kerry in all interactions with our staff.Director of Performance, Improvement and Organisational Development
One of the most important things I keep in mind, is the power deferential that is an inherent part of any organisation with a hierarchy. This needs to be proactively levelled if we, as the strategic decision makers, are to successfully encourage distributed leadership for improvement, along with the openness and relationship-building across the organisation that we need in order to be sighted on risk and opportunities for better care. We seek to lead by example and my own way of doing this is to always try to give the "real" Kerry in all interactions with our staff. I often say my job is what I do, not who I am.
This means sharing more about myself and my life in a conscious effort to balance the part of my leadership skillset that does not come naturally to me. I actually find it easier to be the listener, asking people about themselves – people may not realise that it can feel daunting for introverted board members to visit wards! Leadership for me involves this willingness to be vulnerable; for instance sharing my own – warts and all – experiences of improvement and where it's gone wrong. I find this builds a more personal, trusting connection between myself and my colleagues, and provides an opening for others to do the same.
When I attend our regular in-house improvement champions training, which I do for at least a day of every week-long cohort, a key message to communicate is that I am here to help enable their improvement work. I work in tandem with the improvement trainer, who plays an important role in reinforcing an understanding amongst staff that it's acceptable – and encouraged – to expect me to be an active facilitator. I can't be in the room for a whole week of training sessions unfortunately, so when I'm not there, the trainer sign-posts staff members to me, offering reassurance that it's ok to put half an hour in my diary to discuss an idea or a problem they're facing with their QI project.
The trainer and I will also catch up after each course, so that I can make any necessary connections in the background such as building bridges between teams and taking down silos that might be standing in the way of change. This explicit and implicit permission-giving is really important, and by working together in this way with the trainer, we reinforce for our champions that it really is ok to come directly to me for help, and that we are a team rowing in the same direction.
I don't want the inevitable busy-ness we face to be an accidental road block.Director of Performance, Improvement and Organisational Development
My personal assistant (PA) is also primed to know to always make the time available in my diary if a staff member taking part in our QI programme reaches out – I don't want the inevitable busy-ness we face to be an accidental road block (incidentally, my PA has completed the improvement champions course too). I see the confidence it takes to sit down with someone more 'senior' as we discuss their issue, so I prioritise the action they need from me in order to unblock the part of the system standing in their way. I do this straight away, which I find gives them the confidence to go ahead and take the next steps themselves. I think this shows them that we, at board level, have their back, want them to proceed, place an equal value on their time as our own, and trust them.
As a trust with a relatively small budget for our improvement ambitions, we've capitalised on free external support too. I am a member of the Health Foundation's Q Community, and have in turn encouraged members of staff interested in improvement to apply. Through Q visits, we were able to gain first-hand opportunities to learn from others involved in improvement across different professional sectors which we found very useful, and our QI champions have collaborated with others via Q lab to share learning. It's helped to supplement the offer we can make to those members of staff with a real passion for improvement, giving them a wider network for support and insight to draw on.
In my role I have the benefit of that strategic, systemic viewpoint so I can support our improvement leads by taking an active note of the overall direction of travel we're taking; for instance, our course is open to all, but over time, we noticed that fewer nurses were taking part. We then worked on ensuring that time was given to nurses to be involved. I am very aware though that as our work happens across a relatively small footprint, I can get my arms around the improvement going on, and be visible across the organisation, building relationships. A question I've been asking myself recently is, how do we achieve this across a bigger area? As we now try to put in place improvement infrastructure at a system level, it feels like a different challenge, and one we'll need to rise to in the coming years.
Kerry is happy to hear from other board members, to discuss her approach or other relevant challenges around trust-wide improvement. You can email her or connect via twitter at @kegs_kerry.