What is improvement?
Improvement can involve saving time, saving money or being more efficient. It can also be about simplifying a task, making the experience of something more positive or improving productivity. With an improvement mindset approach, the right methods and tools, and working together with people using services based on what matters, we can improve the quality of care and health outcomes.
By identifying improvement opportunities, we can help tackle the problems we face in our everyday lives as healthcare staff in NHS England.
There are often many demands on our roles and whilst our work can be challenging, it is critical that we can manage change and look to maximise improvement opportunities.
Quality improvement
Quality improvement is a systematic approach to solving a simple or complex issue, involving those closest to the issue in understanding it deeply, developing ideas, and then testing these out using rapid cycles of testing, utilising data to learn and adapt.
It helps meet the ‘quadruple aim’ of ‘better health and wellbeing for the whole population, better quality care for all patients and sustainable services for the taxpayer alongside the reduction of health inequalities.
1. Improving health – local community
- mortality rates
- reduced inequalities
- improved wellbeing
2. Best possible care – service users
- safe
- effective
- efficient
- timely
- equitable
- patient-centred
3. Joy and pride in work – staff
- morale
- wellbeing
- workforce development
4. Value for money – taxpayers
- efficiency
- productivity
- financial Balance
- reduction of waste
Why is improvement important
We operate in a constantly evolving environment which makes improvement a necessity. At NHS England, we strive to deliver high quality services for all, but high-quality services in 5 years’ time will not, and should not, be the same as what we consider this to be today. A combination of multiple small, localised improvements alongside large scale, transformational improvements will enable the NHS to achieve this ambition.
Crucially, the first step in improvement is noticing that there is an opportunity to make something better. The next step is taking action to do something about it, recognising the value of collaboration in driving change forwards, and improving with people with lived and learnt experience. The ultimate goal is found in the impact of that change – the value added.
Lastly, the evidence base is clear. The best healthcare organisations across the world, including in the NHS, invest time and effort to build an improvement culture. It is at the heart of how they operate and means that every member of staff is encouraged and supported to improve the work they do every single day.
Developing an improvement mindset
To understand the value of improvement, it is helpful to develop an ‘improvement mindset’. An improvement mindset involves both a way of thinking and behaving so that improvement becomes embedded into our roles and ways of working.
Here are three key steps in developing an improvement mindset:
1. Be curious and motivated
Is there something at work that could be done better or more efficiently and if changed would it be better?
Can you help play a part in creating a supportive team and team culture where collaborative improvement is valued and encouraged?
2. Empower yourself and others to make improvements
Being empowered to make improvements is everyone’s responsibility, individually and collectively, and we need to aim to make our area of work the best it can be.
Share change ideas and listen and act upon the change ideas of others.
Collaborate with people who deliver and receive services to make improvements together.
3. Have confidence to make improvements a reality
Identify places where we can share and generate new ideas to show how improvements have been made.
Understand and share with others what works and what doesn’t – its ok to make mistakes, that’s how we learn.
Collaborate with others to make changes – building confidence together and testing ideas in a safe space.
How to get started
To start your improvement work, we recommend following these steps:
- identify the issue you wish to improve, collaborate with those affected
- analyse the problem with your team to understand it and ensure you are addressing the root cause
- design your improvement, including defining your aim, measures and the change ideas you can test
- test ideas rapidly on small areas
- implement the ideas that have made a difference
Complete the NHS IMPACT Self-Assessment.
Glossary of terms and their definitions
This can be board, executive or senior leader level.
So that change is not ‘done-to’ people, but ‘done with’. Effective and sustainable change always involves:
- staff (the people who do the work and want to improve it)
- stakeholders (people in organisations, systems, and other partners, that are affected by the work done and want to share in its improvement)
- people with lived experience. We describe co-production as “a way of working that involves people who use health and care services, carers and communities in equal partnership; and which engages groups of people at the earliest stages of service design, development and evaluation”.
A structured, systemic and measurable approach for a whole organisation to link goals to strategy to action, in the long, mid and short-term; as follows:
- Develop goals derived the organisations vision, mission and purpose, develop strategy from those goals, and prioritise actions.
- Describe the method by which activity at all levels (leadership, management, and delivery) is aligned with goals, how progress and performance is measured, and how to course-correct to maintain progress, i.e. should have plan, do, study, act at its heart at all levels.
Safe, effective, positive experience (responsive and personalised; caring), well-led, sustainably-resourced and equitable care, in service of better health outcomes
Teaching of a coherent and structured improvement approach that develops knowledge of the principles, method(s), and tools, and how to apply these in practice as an individual, and within teams; to note: NHS IMPACT encourages the use of any established improvement methodology.
Effective learning comes from knowledge applied, ideally frequently, to ‘close the learning loop’.
Improvement training should be available at various levels from basic through to advanced, using a ‘dosing’ approach.
An improvement specialist is responsible for leading the deployment of an improvement strategy, for training others and for providing technical expertise and coaching support for improvement. They have received training in an improvement methodology and have delivered multiple improvements over time.
This means people who deliver quality improvement training, and facilitate quality improvement sessions, and follow-up with coaching support.
An improvement method is the core part of an improvement methodology – it encourages and enables a structured trial-and-error style testing by all.
It is a defined and consistent set of actions that are repeated continuously in a cycle in order to (i) effect process change and deepen knowledge about it that can be shared (ii) practice the method to gain expertise in it, and (iii) become skilled enough in the method to teach and coach others.
An improvement methodology is a systemic, structured and consistent approach to think about, develop, and manage change that is focused on producing process improvements within the domains of; delivery, quality, resource use, and people-related factors, and across all levels of an organisation and/or system.
All improvement methodologies should have an improvement method and teamwork at their heart.
Improvement is usually:
- focused on continuous improvement which is the ongoing, long-term improvement to processes, products and services. This can involve incremental improvements over time or breakthrough improvements made all at once. The goal is to make periodic beneficial changes.
- about having learning at its core
- more iterative and experimental
- based on teamwork, in that it’s the people who do the work that can improve the work, and are full of ideas
- done in collaboration; improvement can bring joy to work and taps into the intrinsic motivation of individuals and teams to make things better for people
- develops a positive, collaborative and inclusive culture focused on the patient.