Improvement culture - securing wider organisational buy-in

As we have explored in other articles in this Improvement Journey series, one of the key elements of building an improvement culture is securing board support. To enable a shift towards Quality Improvement (QI) and an improvement culture, you will also need to secure a wider buy-in from across your organisation.

Staff motivation is important when you are laying the foundations for an improvement culture and can be achieved in a number of ways. There are also many tools to help you plan your improvement journey, secure these wider buy-ins, and support your QI transformation.

Building an improvement culture

We’ve already looked at the six steps to building readiness for an improvement culture in an organisation and in its report, ‘The Improvement Journey’, The Health Foundation sets out four key strategic approaches to building an improvement culture. These are: leadership and governance, infrastructure and resources, skills and workforce and culture and environment.

For a leadership and governance approach, the report explains why it is so important to have a solid leadership and buy-in from the board. It also highlights that effective governance and management processes are required to ensure the alignment of all QI activities with the organisation’s vision.

In order to achieve successful staff motivation to support your QI plan, you also need a capable management system and associated infrastructure in place. This will equip your teams with the resources they need to build transformational change. Getting the foundations right is vital for QI success.

A focus on skills and workforce is also needed – as is establishing where there may be gaps in skills and what the gaps are. This may take the form of a programme to build these skills across the organisation, which will also help to develop the right culture.

You will also need to highlight the cultural benefits of organisational improvement to your teams, as culture and environment are so important in QI. You will need to build a supportive and inclusive workplace culture, where teams are happy to collaborate. This will set the scene for trying out new QI approaches and will make the change to an improvement culture easier.

Once you have created your culture and your teams are on side and motivated, you also need to think about creating a vision, which will lead you to cultural change. This vision needs to align with the overall organisational vision and - once set - will need to be clearly communicated, so that it is understood across your organisation at every level. All your activities to achieve cultural improvement will support this vision and it will help you to prioritise activities that are aimed at enhancing patient outcomes and improving quality and safety.

Driving culture change to increase value

To quote the Health Foundation’s report, ‘The Improvement Journey’: ‘There is increasing evidence that a positive organisational culture is associated with improved patient safety and quality outcomes.’

One of the main results of a successful culture change programme can be increased value for your organisation. This could be value in the form of enhanced patient outcomes, happier teams or more connected and aligned visions. It might seem like a difficult goal to achieve at the start of your journey, but there are tools that can help you every step of the way.

Transformational change takes time and dedication (as good QI results take time and can be difficult to quantify) so you will also need resources to commit to your QI project. East London Foundation Health Trust has demonstrated good use of resources with their successful QI work and have created a framework for evaluating return on investment from QI which is really useful.

Organisations who embrace QI don’t simply change the core values or services - they develop an improvement focused culture and let that culture flourish. This culture, when nurtured, can increase value and enhance patient outcomes.

Persuading staff to embrace improvement

There are various ways in which you can persuade your teams to embrace improvement and support your QI journey. However, it can be a challenge to persuade others across the organisation to join in.

In its report, the Health Foundation suggests: ‘Improvement leaders need to understand and tap into the intrinsic professional motivations of staff at each level of the organisation, and ensure that any initiative does not become caricatured as a top-down programme, or driven by cost-cutting.’ The report suggests that you could avoid this by starting with a small group of improvement enthusiasts, which – once they have demonstrated a positive impact on patient care and staff experience - will then convince others to follow their lead.

By creating QI champions and QI teams across the organisation, you can signal change and encourage others to join in and embrace improvement. A communication by the board or senior figures to champion improvement may also help persuade teams to feel less anxious about adopting a different approach.

Creating, sharing and communicating about your improvement vision is also vital step in this process. As you will be engaging with people across job roles and disciplines in order to get people on board – you could even be forgiven for overcommunicating!

The importance of building ownership of QI by divisional or departmental leaders

Part of the reward of all your hard work, are the cultural benefits to your organisation. Leaders have a vital role in making change happen and can have a significant impact on quality. It’s therefore really important that you build ownership of QI among your leaders – whether they are divisional or departmental.

The team at Central and North West London NHS Foundation Trust (CNWL) provide a great example of how careful structuring of QI teams and creating divisional leaders can lead to QI success. Their small, centralised team coordinated their QI programme effectively and supported staff through their new QI journey.

So, by getting key team leaders on board, you can really engage with people across the organisation and get closer to achieving your QI goals.

As stated by the Health Foundation: ‘An integrated, organisation-wide approach to improvement, through which local activities are aligned, coordinated and appropriately resourced, can help to avoid this, and enable an organisation to derive maximum benefits from its improvement capability and the enthusiasm of its staff. It also provides the strategic constancy of purpose, momentum and infrastructure needed for complex, multifaceted improvement initiatives to emerge and become embedded.’