What this looks like in practice

• Engage with people who work in healthcare roles and organisations and those with lived experience to design and implement the improvements based on what matters to them.
• Facilitate opportunities for people to visit other systems and organisations to understand different ways of operating and different organisational cultures.
• Invest and support people to understand and own their work enabling them to make improvements on their day-to-day operations.
• Undertake “cultural readiness work” prior to an improvement programme. Cultural readiness work is defined as planned and deliberate efforts to establish and maintain a shared set of values that all organisational members can align to.
• Use a coaching style of leadership in areas where improvement is required, encourage idea generation and run PDSA (plan, do, study, act) cycles regularly. Encourage the use of measurement to capture improvements.
• Have a locally agreed method to measure and assess organisational improvement culture, potentially using NHS staff survey information. This will allow the organisation to track cultural change.

Guidance and resources

Courses, workshops and events

• Training and Events – Improvement Academy – focus on helping health and care staff to improve the safety and quality of care in everyday practice.
• Bitesize learning – Leadership Academy – Develop new skills and discover new ways to improve your experience of work with short guides developed by experts. Open to anyone in health and care.
• Programmes – Leadership Academy – The Leadership Academy programmes are designed to help everyone in the NHS discover their full leadership potential and achieve the highest standards in health and care.
• 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.
• The Culture and Leadership programme – NHS England – The culture of NHS systems, and those organisations within it, is crucial to ensuring the delivery of high-quality, safe and effective patient care. It also recognises that “inclusive cultures depend on inclusive leaders”.

Free tools and guides

• Leadership Academy: Developing people – improving care – Leadership Academy – A national framework for action on improvement and leadership development in NHS-funded services.
• Integrated care boards leaders – Leadership Academy – Curated resources, supportive tools and coaching for integrated board leaders.
• 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.
• Team Huddles – Turas – The huddle is a communication tool to proactively manage quality and safety within teams, that provides an opportunity to update and discuss information about current improvement work managed within the visual management board.
• How-to guide: Measuring and improving your engagement with staff in major change – Q Community – How-to guide: Measuring and improving your engagement with staff in major change: This how-to guide will help you to understand the 10 principles that underpin how you engage staff well in change and provides flexible tools that you can use to measure engagement.
• Creative Approaches to Problem Solving – Q Community – The Q community’s toolkit of 25 tried-and-tested methods for creative collaboration and problem-solving.

Journal articles, reports and research

• Improving NHS culture – The King’s Fund – It is now accepted that healthy cultures in NHS organisations are crucial to ensuring the delivery of high-quality patient care. The King’s Fund have developed a tool to help organisations assess their culture, identifying the ways in which it is working well, as well as the areas that need to change.
• Listening well guidance – NHS England – A blueprint for organisations to develop a local listening strategy.
• 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.
• Putting improvement in everyone’s hands: opening up healthcare improvement by simplifying, supporting and refocusing on core purpose – British Journal of Healthcare Management – This article proposes a simple framework with three components to help healthcare systems avoid the common barriers to introducing quality improvement interventions.
• Fostering an Improvement Culture: Learning from East London NHS Foundation Trust’s Improvement Journey Over 10 Years – Institute for Healthcare Improvement – This publication by the Institute for Healthcare Improvement (IHI) describes East London NHS Foundation Trust’s 10 years of experience with learning how to apply quality improvement throughout the organisation and embed a culture of improvement.
  The report reflects on the improvement journey and learning thus far, informed by interviews with nearly 30 people, in a range of roles, who have been part of the 10-year journey in some form — both within and outside the organisation.

Case studies

Examples of this happening in practice:

Further case studies to demonstrate investing in people and culture:

• Case studies – Care Quality Commission