NHS IMPACT baseline for improvement
- The NHS IMPACT baseline for improvement was completed in August 2023 and collected a rapid and measurable overview of improvement across the entire NHS, including NHS England national and regional teams.
- By focusing on resources and methodologies, the Baseline for Improvement acted as an initial ‘needs assessment’ enabling informed decisions and to identify areas of existing capability.
- The Baseline for Improvement is complimentary to the NHS IMPACT Self-Assessment which a developmental tool for organisations and systems to use to assess their current position against the five components of NHS IMPACT and to frame their improvement development plans.
Results
Baseline for improvement | Providers
| Leadership | Tools | Governance | Capability |
| Exec responsibility | Improvement methods | Reporting | Staff training |
| 96% | 95% | 84% | 41% |
| Most providers have an exec responsible and accountable for improvement. | Most providers are using an agreed improvement method or approach with quality, service improvement and redesign (QSIR) the most cited followed by LEAN. | Have a quality strategy with a measurement framework monitored by the board (in addition to the regulatory requirement for a quality account). | Include improvement training as part of staff induction. |
The methods providers reported using to identify those with improvement capability included:
- networks and academies
- PDR reviews
- improvement databases/directories
- organisation-wide assessments
- informal/ad-hoc means.
Prioritisation of improvement challenges are led in two different ways:
- A ‘top down’ approach via executive, board, specialist improvement team, etc.
- A ‘bottom up’ approach via individual requests submitted to a central improvement team, or from improvement projects undertaken as part of improvement training, eg QSIR.
Approaches to prioritisation involved:
- A3 problem solving/scientific thinking, triangulated quality data, improving together methodology/tools
- assessment against trust priorities
- improvement specialists’ analysis of individually submitted improvement needs.
Baseline for improvement | Integrated care boards (ICBs)
| Leadership | Tools | Governance | Capability |
| Exec responsibility | Improvement methods | Reporting | Staff training |
| 90% | 46% | 89% | 1% |
| 90% report having an Executive responsible and accountable for improvement, not just assurance. | Are using an agreed improvement method at system level. | Report receiving a regular report on improvement. | Include improvement training as part of staff induction. |
A number of ICBs reported that they do not yet have a co-ordinated ICB approach to recognising those in the system with improvement capabilities. Others reported:
- work is underway to identify improvement capabilities
- some use a structural approach to identifying improvement activity across the ICB
- unlike some providers, there were no ICB-wide databases or logs of improvers.
On how ICBs prioritise staff with improvement capability to respond and focus on particular challenges, responses included:
- happening organisationally rather than systematically
- using a QI Strategy to address how system resource is allocated more efficiently
- establishing communities of practice around some of the biggest challenges.
Responses to how ICBs pivot improvement skilled individuals to work on unexpected challenges record that challenges are often addressed at local level. Some response acknowledge the need to respond across system level.
Baseline for improvement | Regions
| Leadership | Tools | Governance | Capability |
| Exec responsibility | Improvement methods | Reporting | Staff training |
| 100% | 71% | 71% | 0% |
| 7/7 regions report having an Executive responsible for improvement. | All but two regions report using an agreed improvement method. | All but two regions reported they receive regular reports on improvement activity ongoing within each ICB, that are used proactively e.g. for shared learning. | No region include improvement training as part of staff induction. |
The QSIR network is utilised to identify those in a region with improvement capability. Two responses include examples of regional approaches to connecting those with improvement capabilities.
Regional teams reported working with systems/organisations/teams to respond to challenges.
Prioritisation of challenges is determined by a number of approaches:
- An operating model aligned with improvement offers with systems and organisations in line with segmentation and SOF status, performance measures and in liaison with system co-ordinators.
- National and local priorities including mandated/targeted support needs in relation to SOF, tier levels and specific quality concerns which are agreed on a regional cross-directorate basis.
Baseline for improvement | National
| Leadership | Tools | Governance | Capability |
| Exec responsibility | Improvement methods | Reporting | Staff training |
| 70% | 80% | 40% | 10% |
| 7/10 Directorates report having an SLT member responsible for improvement. | 8/10 Directorates report using an improvement method. | 4/10 report their SLTs receive regular reports on improvement activity within the Directorate. | One directorate reported that improvement training is included as part of staff induction. |
Directorates reported recognising those with improvement capability mainly through PDRs/reviews/CPD and evaluations within the team.
One reported a plan to develop a future network, with many colleagues indicating an interest to work together to develop improvement practices within the directorate.
Several responses to prioritisation of staff with improvement capability to focus on a particular challenge indicated that they were planning to introduce new approaches. Some described approaches previously implemented for example specifically focussing on a clinical challenge. Other responses reflected a networking approach.
In responses to how directorates pivot improvement skilled individuals, most acknowledged the need for an agile improvement resource in order to respond to unexpected challenges.
How this information will be used
- This information provides a better understanding of improvement across the NHS, identifying where resource exists.
- It allows organisations and systems to understand their current state and plan for their future.
- The results will be used to share and spread best practice and enables linkages to be made to embed strong and sustainable peer to peer learning and support networks.