Mainstreaming improvement across the NHS

I’m feeling both inspired and optimistic about the once in a generation opportunity that has been created by NHS IMPACT (Improving Patient Care Together) to mainstream improvement across our NHS in England. I have been privileged to join several forums recently where Professor Sir Chris Ham has both presented the findings published in his recent report, Improving health and care at scale: learning from the experience of systems and facilitated conversations with system leaders about creating the best possible conditions for success.

Two things have resonated with me from these discussions. The first is the magnitude of what we are trying to achieve. Chris describes how no other country in the world has attempted improvement on this scale in such a complex environment. This is exciting, another great example of the NHS leading globally. However, with this comes a huge responsibility as I commit to remember the advice from Chris that we will need to do more over time to emulate the successes of countries doing this on a smaller scale. He reinforced that to create the conditions for success we need to create optimism, hope and belief.

It’s particularly vital to hold onto these positive drivers as we keep in mind a very challenging reality for the NHS – stretched budgets, workforce challenges and long waiting lists.  It’s the ability of improvement to respond to these challenges in a way that engages staff positively that will enable us to genuinely mainstream improvement, as described in this recent Health Foundation briefing.

The second takeaway is the critical importance of peer-to-peer support when creating a learning system. The way in which partners across the country are taking the learning from empirical evidence and designing support offers for those leading this work across our systems is fundamental in creating the conditions for success.

Let me share a couple of examples of this; we have recently seen the launch of the ‘Learning and improving across systems’ programme for improvement leaders from NHS Confederation, the Health Foundation and the Q community in partnership together. They have taken the learning from the report they commissioned from Chris (mentioned above), and from the many existing successful improvement practices outlined within it, as one of the foundations of the programme.

I have applied to join the programme along with colleagues in my ICS as we have seen first-hand the benefits of learning from peers in networks such as Q and the Flow Coaching Academy; we understand that learning from other systems will be a key driver for success.

Locally in Lancashire and South Cumbria, this week we have had discussions across our ICB and Provider Collaborative Board and have committed to take the learning from Q as we design our Quality Management System, in partnership with AQuA. Q has been facilitating Quality Management System resources, events and special interest groups to make the most of the learning and action happening across the UK, supporting the 5th domain of NHS IMPACT []. This will enable us to work together to align our systems and priorities across the ICS.

As a National Improvement Board, we have been focused in recent weeks on system leadership. I’ve been fortunate to have had many opportunities to discuss NHS IMPACT with boards, new chairs and Non-Executive Directors, improvement directors, senior leaders and frontline teams and have been energised by how colleagues across the NHS, at all levels of the system, are using this as an opportunity to reset their vision and ambition with partners across the system, carefully considering how we design our approach for system level improvement.

So many of our leaders have engaged in completing the NHS IMPACT self-assessment and are focused on how we can intelligently learn from the best across the health and care sector, as they plan the next stage of their work, maximising the impact of their improvement capacity and capability in drafting their development plans. The NHS IMPACT team are currently collating examples of best practice so do access the resources available and please do share your work with us.

As the improvement director for the National Improvement Board, part of my role will be to work with improvement directors through the Improvement Directors Network where we will be sharing best practice, challenges and aligning our improvement expertise to our national and local system’s priorities.

We will be contacting NHS organisations through your improvement teams to find out more about the work which you’re doing and to see if there is any support you need in facilitating a conversation with your board or system about creating the conditions for success for improvement, so please engage with your improvement teams and start to think about how we could support you in your organisation or system.

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Ailsa Brotherton is the Executive Director of Improvement, Research and Innovation at Lancashire Teaching Hospitals NHS Foundation Trust and an Honorary Professor at the University of Central Lancashire.

Prior to joining the trust, Ailsa was Director of Transformation for the Single Hospital Programme at Manchester Foundation Trust. She has also held the positions of Interim Clinical Quality Director for the North of England with the Trust Development Authority/NHSI, Associate Director for Quality Improvement Programmes at the Haelo Innovation and Improvement Centre based at Salford Royal NHS Foundation Trust, and post-doctoral Senior Research Fellow at the University of Central Lancashire.

Ailsa is a Health Foundation Generation Q Fellow, graduating from Hult Ashridge with a Masters degree as part of this improvement fellowship. Her PhD and programme of research were in the field of clinical nutrition. Ailsa has experience of designing and delivering quality improvement and large-scale change programmes at national, regional and local levels.

Ailsa has a particular interest in system level improvement, working across organisational boundaries. She is currently working with the improvement directors and clinical leads across Lancashire and South Cumbria in collaboration with Professor John Clarkson FREng, University of Cambridge, to test the Engineering Better Care framework across the ICS. As part of this collaboration, the team is designing a bespoke Improving Improvement Framework, building on the learning from their initial work at system level.