Building improvement capability and capacity
What this looks like in practice
- Identify or create an improvement methodology to use across your entire organisation, ensuring a local and systemic way of practising improvement.
- Give all people access to improvement training and support, so that everyone can run improvement projects and continuously improve their daily work.
- Determine how success will be measured at an early stage, use appropriate tools and frameworks, and include feedback from people working at the point of care and people with lived experience.
- Demonstrate the impact of co-producing quality improvements with people who use services as an integral part of daily work.
- Set an expectation that there is an organisational focus on data and all staff are empowered to make and track changes in their workplace.
- Create and embed a training strategy to increase improvement capability.
- Leaders attend teams daily huddle boards and work to unblock issues which teams are facing.
Guidance and resources
Courses, workshops and events
- The Advocating and Educating for Quality Improvement (A-EQUIP) model – e-learning for health hub – This course describes the Advocating and Educating for Quality Improvement (A-EQUIP) model of professional nursing and midwifery leadership and clinical supervision.
- Information Analysts Development Programme – East Midlands Academic Health Science Network – A high quality, structured programme for Information Analysts who will develop new skills to improve patient care.
- Quality Improvement 101: Introduction to Health Care Improvement – This course launches you on your journey to becoming a health care change agent.
- Training and Events – Improvement Academy – Improvement Academy training courses, both virtual and online, focus on helping health and care staff to improve the safety and quality of care in everyday practice.
- Learning and Improving Across Systems Peer Learning Programme – NHS Confederation – Connect with leaders across the UK navigating the opportunities and complexity of leading change through health and care systems.
Free tools and guides
- Capability Pyramid – Aqua – Capacity must be built at all levels in the organisation, and must include meaningful engagement of people, families, and carers. A multi-level approach has been designed and adapted from the IHI’s ‘dosing formula’ and can be tailored to any organisation.
- The Aqua Six Step Improvement Model – Aqua – This guide explains how to use the AQuA Six Step Improvement Model in your organisation or department to structure your improvement efforts.
- Quality Improvement resources – East London NHS Foundation Trust – Useful tools and resources for quality improvement.
- Resources – King’s Improvement Science – King’s Improvement Science resources for quality improvement projects, implementation science research, patient and public involvement and evaluation.
- NHS England – Making data count – These practical guides are suitable for those working at all levels in the NHS, from ward to board, and will show you how to make better use of your data
- Huddle sheets and supporting guidance – NHS England – The huddles sheets aim to encourage open reflection to further embed learning from patient safety incidents. They expand upon existing safety standards and toolkits, facilitating systematic evaluation of the impact of patient safety events on clinical sessions/days and team members, identifying any potential additional support and training required.
- A guide to making the case for improvement – The Health Foundation – This Health Foundation guide is divided into four broad areas where improvement approaches can benefit: the health and care workforce; patients, service users and society; organisations; and system-level bodies.
- Quality improvement made simple – The Health Foundation – The Health Foundation have launched a new edition of Quality improvement made simple, a useful guide for those thinking about how to re-design or develop new processes, pathways and services as we shift from the emergency phase of the pandemic.
- Skills for collaborative change – The Health Foundation – This practical tool sets out the skills and attitudes needed for collaborative and creative problem-solving.
- Quality Coach Development Programme – The Health Foundation – Developed by a group of subject matter experts from across the quality improvement (QI) community in the UK, this programme aims to build improvement capability and capacity by training staff in the essential skills and knowledge needed to successfully coach teams and individuals through QI work.
Journal articles, reports and research
- How to embed quality improvement into medical training – The BMJ – This article was based on a literature search for systematic reviews about medical training in quality improvement and on the personal experiences of the authors in developing integrated curriculums for workplace based education.
- The habits of an improver – The Health Foundation – Thinking about learning for improvement in health care.
- Got a question about health and social care? | The King’s Fund – The King’s Fund Library team can help you answer questions about health and care, as well as carry out in-depth research for you.
- Research Outputs Archive – The Healthcare Improvement Studies (THIS) Institute – Browse an expanding evidence base for the NHS about how to improve quality and safety in healthcare.
Case studies
Examples of this happening in practice:
East London Foundation Trust
East London NHS Foundation Trust identified the levels of quality improvement skills needed to deliver their strategy at all staff levels, including lived experience partners.
This includes training for those at board level (both non-executive and executive), and a basic introduction to quality improvement for all starters as part of induction.
All people in management or leadership roles are expected to undergo the six-month improvement leaders programme, to equip them to run and lead quality improvement projects.
Directorate leaders are responsible for assessing capability within their teams, and identifying which people need training. They have a variety of learning options for staff to access, in addition to the intensive 6-month course, alongside many refresher masterclasses, workshops and webinars.
Oxford Terrace and Rawling Road Medical Group
Oxford Terrace and Rawling Road Medical Group is a GP practice with a long history of embracing quality improvement (QI), enabling the practice to meet population need, including increased demand. One of its earliest QI projects built the improvement skills of practice nurses who were able to save 280 appointments per week by reducing waste. With a promise of longer appointments to manage long term conditions, the nurses used QI approaches to reduce failure demand with people who would have previously attended 20 times a year, now attending 3 times a year with better outcomes. Further QI activities in the practice saved 8 sessions of GP time, extending service provision to supporting 9 care homes.
Many members of the leadership team have participated in the NHS General Practice Improvement Leaders Programme, each member attending with a practice specific project, supported through mentorship from the practice manager.
This approach has also been extended to people working in the wider primary care network (PCN). The PCN pharmacist has recently undertaken a QI project for a standardised approach to structured medication reviews across the 3 PCN practices. Developing QI capability and capacity is enabling the practice to invest in people and build a culture of safety through reliable design. The practice has grown, is serving people better and thriving as a result.
Further case studies to demonstrate building improvement capability and capacity: