Making improvement more human
17 November 2023
Bev discusses ‘NHS Impact’ – the shared improvement approach to support NHS organisations to have the skills to deliver continuous improvement.
Topics
Following on from the long history of quality improvement approaches in the NHS, NHS IMPACT (Improving Patient Care Together) has been launched. This is the new, single, shared NHS improvement approach to support NHS organisations to have the skills to deliver continuous improvement.
We have been here before, in terms of the centre’s desire to have a consistent improvement approach across the NHS. The focus on improvement is welcome, as is the desire to have consistency of approach, and high-quality support for implementation of improvement approaches.
I can’t argue with the principles identified by NHS Impact as needed to succeed in widespread and sustained improvement:
- Building a shared purpose and vision
- Investing in people and culture
- Developing leadership behaviours
- Building improvement capability and capacity
- Embedding improvement into management systems and processes
Nor can I disagree with its laudable ambition paraphrased here: “to enable the creation of an NHS in which every organisation, has the leadership …, the capability and the capacity, to enable our staff to solve the problems that matter to them, their patients and their populations.”
Particularly welcome is the priority given to collaboration with frontline staff in designing the improvement process: we know that those closest to the action often have the greatest insight about what needs to change and how. By the same token, it also highlights working with people and communities in arriving at the shared purpose for improvement – the what but not the how. I am certain that the tools, templates and guidance for those implementing the improvement approach will be especially welcome.
But with the service under significant pressure, I would argue that the NHS Impact approach is a bit light on the detail of how and – from the perspective of staff – the why?
There is no lack of desire among staff to involve patients in improvement, but what we find is people struggle with how to do it well.
The NHS Impact report rightly talks about creating the conditions for continuous improvement, with a nod to the culture and leadership of organisations being key to the successful spread of improvement approaches.
But what are those conditions?
Lessons from the point of care
We know that successful improvement is not just about technical skills, important though they are. It’s about culture, desire, motivation, and resources. At the Point of Care Foundation, we have learned a couple of important lessons over the past 10 years of working to make care more human.
First, how staff feel about their work is key to the quality of care they can deliver. They are driven by an intrinsic motivation to deliver care that fits with their ethos, training, and values. They suffer moral distress when they are not able to do this.
The Point of Care Foundation has been a core partner in supporting some of the organisations mentioned in the NHS Impact report, and numerous others to address these concerns. We do this through support for high quality engagement with people and communities, particularly through Experience Based Co-Design (EBCD), which involves staff and patients as equal partners working together on the ‘how’ (not just the ‘what’) of improvement.
We see how this collaboration provides motivational fuel for the improvement effort, sharing out the work of improvement between staff and patient partners, and providing reassurance that efforts are focused on doing the right thing.
The other lesson we have learned is that looking after the emotional wellbeing of staff and providing connection between colleagues through initiatives including Schwartz Rounds makes the work of health and care just a little bit easier.
Together, EBCD and Schwartz Rounds can help organisations make the admirable aspirations of NHS Impact a little more achievable.