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What role do leaders have to play in spreading quality improvement work?

Tom Buckley NHS Leadership Academy 15 November 2016


Quality improvement initiatives are not new in the NHS; the Modernisation Agency was formed in 2001 to support the improvement of the quality and patient experience of care, and organisations such as the Health Foundation have been running and supporting quality improvement projects across the country for over a decade.

I had first-hand experience of quality improvement methodologies while working at Leeds Teaching Hospitals, and had the privilege of working with fantastic people who were really passionate about improving the quality and experience of care for patients. Through a concerted and consistent effort over 18 months, the team at Leeds Teaching Hospitals managed to significantly reduce the incidences of in-patient falls. I also recently had the pleasure of learning how clinical teams are being supported by The Point of Care Foundation to deliver Patient and Family Centered Care for those nearing the end of their life, and hearing of the positive feedback they had received from patients and their families.

So, with a long history of quality improvement work and evidence to show it works, why are quality improvement methods not an integral part of day to day practice in the NHS?

Quality improvement projects take time and a consistent effort to see measureable benefit. It is rewarding to measure and celebrate improvements to the quality and experience of patient care. But if you take a step back and think of how many other thousands of services could benefit from a quality improvement approach, it is easy to become disheartened by the sheer scale of the task. If quality improvement methods are to spread throughout the whole of the NHS, they need to become a part of everyday practice.

There are clear roles for leaders in supporting the spread of quality improvement methods. The Health Foundation considered the importance of context for successful quality improvement work and defined three structural levels within the health service: system level, organisation level and clinical team level. There are leadership tasks at each level:

  • At the individual clinical team level, the role of leaders is to support clinical staff to make improvements. After all, the people closest to a problem are often the most likely to know the solution. Instead of prescribing how improvement should be, leaders can help by actively removing barriers (for example, by ensuring there is protected time for QI projects) to ensure clinical staff have the time and space to make improvements.
  • At the organisation level, the backing of QI projects by senior staff within organisations – particularly senior clinicians – can help build a culture of improvement; the more an organisation draws on the inherent motivation of staff to improve patient care, the less they will need to rely on top-down performance management of clinical teams, which risks nurturing fear and blame and can stifle innovation.
  • At a system level, clear direction and support for QI across the whole NHS is needed. Earlier this year, The King’s Fund called for a national quality improvement strategy and, alongside events and webinars to support the spread of improvement, NHS Improvement has since pledged to create such a strategy with its publication due later this year.

Quality improvement is not something that can be forced upon staff – it needs to start from the bottom-up, harnessing the drive and passion of staff who want to improve care. This is why the programmes and support provided by The Point of Care Foundation and others are so vital – it gives staff the backing and permission to make changes that matter to patients and their families.