Creating a culture of continuous improvement

Building an improvement culture and introducing behavioural change requires consistency and dedication. However, the benefits are great.

Having a positive organisational culture is cited in the Health Foundation report, 'The improvement journey', as being ‘consistently associated with a range of improved patient safety and quality outcomes.’

That said, you may need to be careful in your approach towards healthcare professionals with regards to Quality Improvement (QI), as highlighted by Don Goldmann, MD, Chief Medical and Scientific Officer at the Institute for Healthcare Improvement in his article: ‘7 Rules for Engaging Clinicians in Quality Improvement.’ He explains: 'If you get off on the wrong foot with a physician or any clinical provider you’re in trouble and you’re in recovery mode. The first thing that I’ve learned is that a lot of physicians in particular associate quality improvement with quality assurance and quality assurance is generally felt to be more punitive, judgmental, you’re being compared to somebody else and obviously that’s not in the spirit of quality improvement.’ This might be something to bear in mind for anyone who is about to start introducing a culture of continuous improvement!

Why you should develop a continuous improvement culture

The Health Foundation defines Quality Improvement (QI) as consisting of an ‘overarching improvement vision that is understood and supported at every level of the organisation.’ Continuous improvement is really important for your QI journey. You don’t want to improve - then stop the good work; you want to improve, then try again - even if your efforts are not successful the first time.

It is important to develop a continuous improvement culture so that you can continue to build your skills and those of your team. Once you have the board on side, and your team of QI experts – you can use tools such as flexible and remote learning options, which are a real benefit to QI teams. This leads to a continuous building of skills. Keeping a focus on your training is important - there can be a tendency to lose focus and momentum after your first QI training sessions – which means continuous skills are not kept up.   

Solutions such as Life QI can help support you in your quest to develop a continuous improvement culture. The solution allows you to manage all your QI needs in one place, sync all of your users and update all your users of what is going on – communication being another key method in the QI armoury for success.

A range of providers – such as the Virginia Mason Institute (VMI) - who’s goal is to provide the ‘perfect patient experience - can help leaders and learning organisations get closer to transformational change, and help healthcare leaders inspire a culture shift within their organisations. You can also read more in our series of blogs to find out how you can be supported in your continuous improvement journey in healthcare and your quest towards organisational improvement.

6 steps to building an improvement culture

In order to introduce an improvement mindset, you need to prepare your teams well and check in on your organisation. The Health Foundation report, ‘The improvement journey‘, sets out the six steps an organisation should be prepared for when building QI culture. Revisiting these steps can help you plan and prepare.

1. Assessing Readiness

Take time to set the scene for the QI process and ‘check the pulse’ of your organisation. Is the culture right for change? Is the climate for learning good? It may sound like a daunting task, but there are tools that can assist you with assessing readiness, including the Health Foundation’s ‘Are you ready to build and sustain improvement? An organisational checklist’, which will really help you work through your goals.

2. Securing board support

Securing support from the board is vital to the success of your QI journey. With the CQC stating that those organisations with a ‘mature quality improvement approach often have made improvement a priority at board level,’ you will need genuine commitment from your board.

3. Securing wider organisational buy-in and creating a vision

You also need buy-in from the wider team and from others, as well as commitment from your board and other leaders in your organisation. You can really start to embed QI and introduce organisation-wide improvement by identifying other potential QI enthusiasts and sharing your vision with them, in the early stages.

4. Developing improvement skills and infrastructure

Developing specialist improvement skills is vital, as is building your infrastructure. There are a range of tools and frameworks that can support your improvement journey. Life QI is an online system that is used by QI teams to help streamline and speed up the working processes associated with quality.

5. Aligning and coordinating activity

Once you have your team on board, a vision and a sound infrastructure, it’s time to align and coordinate activity. Again, this can seem like a daunting task, but there are tools to help you with this element of the programme.

6. Securing wider organisational buy-in and creating a vision

Once you’ve achieved a culture change, it’s really important to maintain this momentum and sustain the approach – not only in your immediate team – but across your organisation. QI wins can sometimes be fragmented and return on investment is taking time, but you need to keep encouraging the board to remain motivated and focused on the project.

As well as following the six steps above to prepare you for QI change, you could also consider using the dosing approach mentioned in the Health Foundation report, which says: ‘The impact will only be delivered with a clear organisational approach to support immediate and continuous skills application. Organisations should plan to gradually ‘dose’ key individuals’ at all levels of the organisation.’

All these steps help create preparedness for creating a sustained quality improvement culture.

Bringing about a cultural change

Bringing about cultural change can be a slow process – and there can sometimes be reservations about the proposal of a culture shift, but this should not put you off! There are enough examples of successful behavioural change and transformation across healthcare organisations which should motivate you and your teams.

While reservations about culture change can be common and can present themselves in many ways, and although winning hearts and minds of people who are resistant to change can be difficult - often making that first step towards change can be the most difficult one.

This is where behaviour change techniques can come in. A good transformational change strategy backed up by shared learning, collaborative techniques and supported by enthusiastic improvement leaders who can motivate staff, will encourage teams and empower them to identify improvement areas and carry out improvement projects.

One of the key steps to a successful behaviour change method in the improvement process is to use your QI ‘vision’ which then can then be outlined and communicated to your team. This encourages your team to buy in to your quality vision. Communicating your vision is really important.

In the 2017 guide ‘Building capacity and capability for improvement: embedding quality improvement skills in NHS providers’, NHS Improvement worked with the Institute for Healthcare Improvement (IHI) to set out how organisations could prepare themselves to embed QI and bring about a continuous improvement culture. The guide outlines the IHI ‘dosing’ method which identifies the type and ‘dose’ (level) of improvement skills they need to develop in each area of the organisation.  This could be a good start for anyone looking at continuous improvement.

You really need to encourage and motivate your QI team and create an atmosphere of engagement and excitement. Supporting your team and engaging with them can help create behavioural change – as a supportive culture makes staff feel they have the backing to try out new ideas for improvement themselves.

Key drivers to QI culture change

The Health Foundation defines Quality Improvement (QI) as consisting of an ‘overarching improvement vision that is understood and supported at every level of the organisation.’

Some would question whether you can categorise key drivers to QI culture change for each organisation. In the Health Foundation report, ‘The improvement Journey‘, the authors argue that often there is no single driver for the development of a QI programme. It could be the result of a range of different factors, which could include: ‘a major patient safety incident that reveals systemic failings and highlights an urgent need to do things differently; the arrival of a group of senior leaders or clinicians with a shared interest in improvement; or the realisation, from a peer learning visit to an influential provider elsewhere, that the organisation is not performing as well as it imagined.’ They also say that external drivers, such as a critical inspection, can also have a major effect.

Intrinsic motivation can help drive QI culture change, because it is the key to motivating people for collaboration, creativity, and supporting sustainable change.  It may not always be easy to spark intrinsic motivation in teams who are busy and under pressure, but it will be worth it.

Whatever happens to be the key driver for your organisational change, it’s great that you’re in the position to get going on your QI journey. Now it’s time to start mapping out what your changes are going to be, what your vision is and what you can do to create a quality improvement culture and create behavioural change in healthcare.