We’ve been looking at how you can set up your organisation for quality improvement (QI) success and transformational change, and now we’re going to explore in a bit more detail about how to align and monitor all your QI projects. It’s all about making your approach integrated and organisation-wide, while getting buy-in from teams and monitoring quality improvement.
Put quite simply - and as demonstrated in the Care Quality Commission (CQC) report ‘Quality improvement in hospital trusts: Sharing learning from trusts on a journey of QI’ - ‘Putting the patient at the centre of the QI journey sharpens the focus on delivering high-quality patient care and aligning improvement activity to outcomes and experience for patients.’ Wise words, and a key area to focus on to motivate transformational and QI change in any organisation.
How to align your QI activities
Aligning your QI activities with your organisation’s vision is one of the six key steps set out in the Health Foundation report: ‘The improvement journey: Why organisation-wide improvement in health care matters, and how to get started’. This report recommends: ‘An integrated, organisation-wide approach to improvement, through which local activities are aligned, coordinated and appropriately resourced.’ This can help avoid the problem of multiple projects taking place in a disjointed manner and means that your organisation will get more benefits from QI change.
As part of your preparation for QI, you will have created an overall vision that is in line with your organisation’s strategic vision and which will support you throughout all your activities. However, as your improvement activities increase, it can seem challenging to align the multiple activities across your organisation and to ensure that all those involved in QI activities are all pulling together - and in the same direction.
Aligning activities brings multiple benefits. The Health Foundation say: “It also provides the strategic constancy of purpose, momentum and infrastructure needed for complex, multifaceted improvement initiatives to emerge and become embedded. Without such a supportive context, many promising interventions have found it hard to gain traction and show a lasting impact.”
Achieving QI at scale means you will need tools, access to data, good staff engagement and a great culture. You can make the most of tools that are available to you and use technology to help you develop your digital infrastructure to support your QI journey.
How to monitor your QI activities
It is really important to monitor and benchmark your QI activities. There are QI tools that can help you monitor all your quality improvement projects in one place. Solutions such as Life QI can help you keep all your QI projects in together and enable you to monitor your improvement portfolio in many different ways.
Tools such as Life QI provide quick and easy access to accurate data and can help you to quickly and easily see what activities are going on and where - not simply to monitor progress, but also to track and celebrate wins.
Dashboards to monitor quality improvement
The BMJ article: ‘Using report cards and dashboards to drive quality improvement’ states: ‘The use of dashboards to encourage reflection on quality of care is expanding.’ The article goes on to say that a respected QI method is ‘Measuring quality of care and comparing this against agreed-upon standards of practice or peer performance (ie, audit) and delivery of the results to healthcare professionals and/or administrators (ie, feedback).’ Measuring your activity is vital to success.
Some sites, such as the Northumbria Healthcare NHS Foundation Trust, use using real-time data to enable improvements in quality. Other sites use specifically designed QI dashboards, such as those from Life QI . These can help you keep a keen eye on your organisation's QI performance – and also help you to interpret your QI data easily, make data-driven decisions and gain insights into your projects.
How to work towards priorities
Successful QI leaders will help work towards priorities and engage QI staff. We are going to take a look at some examples of good practice in working towards QI priorities, sharing how to take into account the views of staff and patients to help shape organisational strategy and improvement priorities.
Northumbria Healthcare NHS Foundation Trust has a quality strategy which aims to strike a balance between meeting both national and local priorities. It prioritises quality issues which are important to patients and staff and looks to meet those priorities by ensuring that its plans align directly with the trust’s strategic vision. This approach of focusing on a small number of core quality priorities each year has worked really well for the trust and has enabled them to demonstrate measurable improvements in quality and continuous improvement.
East London NHS Foundation Trust (ELFT) sets clear, organisation-wide priority areas for improvement – bringing together lots of teams from across the organisation to meet these priorities, while also encouraging QI teams to work on what is important to them and their patients.
Once more, if you have solutions and a digital infrastructure to support your QI journey, you can have easy access to tools that help you work towards your priorities.
How to enthuse, involve and engage QI staff
Part of achieving success in QI is aligning your organisation’s vision with your activities and encouraging staff buy in, motivation and to engage QI staff. But how do you this?
One of the key themes to share with staff is to be clear that the journey towards QI can be slow. Communicating this means that people will not lose motivation due to the length of time it can take to see real results across the organisation. As the route to QI success can be slow, it’s really important to celebrate when you can. This can be a really good way to enthuse and engage staff.
Going back to the Health Foundation report, ‘The improvement journey,‘ the report states that ‘A positive organisational culture has been consistently associated with a range of improved patient safety and quality outcomes.’ One of the key elements to a good transformational change strategy is to have enthused improvement leaders who can motivate staff, so that teams feel motivated and empowered to identify improvement areas and carry out improvement projects.
The QI team at ELFT recommend in their handy guide: ‘One of the best ways to keep the momentum going in your team as you try different ways of improving wellbeing and satisfaction is to share stories regularly within your team and the rest of the world about how you are getting on.’
If QI team leaders have the motivation and skills for QI, they will be able to imbue this same feeling in the people they work with. A supportive culture is also important for enthusing and engaging staff – and for staff to feel they have the backing to try out new areas of improvement themselves.
There are some great improvement stories of trusts such as ELFT, who have demonstrated that it can be a good idea to visit other trusts who are doing great QI work. EFLT’s visits to pioneering trusts such as Salford Royal and Tees, Esk and Wear were shown to have a motivating effect on board members.
There is also great merit and worth in working with other external QI providers, such as the Institute of Healthcare Improvement (IHI) and the Virginia Mason Institute and creating QI ‘outreach programmes’. It has shown to be helpful to encourage organisations to share proven improvement stories which can deliver long-term value.
Establishing specific social and professional networks can also be a really helpful way of embedding QI and is another core enabler of organisation-wide change. This is how people cluster, connect and coordinate to deliver a coherent and quality integrated service.
To finish with the words of Jane Bradley, Deputy Director of Patient Safety and Quality Improvement at Northampton General Hospital NHS Trust “My key lesson from this journey would be – don’t gallop to the start line. Take time to build the aeroplane before you take off. Sort out the governance. Make sure you have a way to record every project. Ensure you have metrics and use national metrics (where possible) to align projects. Time spent on engagement is invaluable and will reap dividends down the line – harnessing the creativity and drive of your staff is the only way you’ll shift the culture.”