Sustaining an organisation-wide approach to quality improvement

You’ve shown that you are committed to delivering high quality care and transformational change across your organisation – well done on making an impact in your journey towards quality improvement (QI)! Your next challenge is to keep on delivering sustained improvement!

A lot of the work that will help sustain your approach will have already been carried out in your preparation for QI. Having followed the principles of the organisational approach, which include : leadership and governance, infrastructure and resources, skills and workforce and culture and environment, will ultimately help sustain this transformational change.

Why organisation-wide approach to quality improvement matters

In the Health Foundation report: ‘The improvement journey: Why organisation-wide improvement in health care matters, and how to get started’, the report recommends an: ‘integrated, organisation-wide approach to improvement, through which local activities are aligned, coordinated and appropriately resourced.’ This approach ultimately: ‘provides the strategic constancy of purpose, momentum and infrastructure needed for complex, multifaceted improvement initiatives to emerge and become embedded.’

In their report ‘Quality improvement in hospital trusts: Sharing learning from trusts on a journey of QI’ the Care Quality Commission (CQC) says: ‘The difference that we see in trusts using a systematic QI approach is the confidence that we are given about the sustainability of the quality delivered, and the trajectory of ongoing improvement in the quality of care.’

Organisations with a ‘mature quality improvement approach’, have, among other things, prioritised improvement at board level, put in place a plan for building improvement skills at all levels of the organisation, and developed structures to oversee QI work and ensure it is aligned with the organisation’s strategic objectives.

We will be exploring this further in this article.

The long journey to sustained QI

QI is not a ‘quick fix’ and transformational change could take decades – but don’t let this put you off! The CQC say about QI: ‘this is a challenging endeavour, changing behaviour in complex organisations and developing an effective leadership and organisational culture.’

However, this long journey can really be worth it! Professor Ted Baker, the Chief Inspector of Hospitals has said, ‘QI has been shown to deliver better patient outcomes, and improved operational, organisational and financial performance when led effectively, embedded through an organisation and supported by systems and training. When QI is used well, it gives us confidence about the long-term sustainability of the quality of care. More informally, when we visit trusts that have an established QI culture, they feel different. Staff are engaged, they are focused on the quality of patient care, and they are confident in their ability to improve. This is also reflected in surveys of staff and patient satisfaction.’

How to embed your QI approach and maintain a sustained approach to quality and QI success

The CQC has stated that it feels confident about the ‘long-term sustainability of the quality of care’ at those NHS trusts where it finds ‘an established quality improvement culture’ across the organisation.
However, there is differing thinking about how to structure an organisation-wide approach to sustained QI. Some teams enable sustained QI across their organisation by creating a QI team which leads – and is responsible for - QI activities. Other organisations do not establish a QI group, with the thinking that creating a central team could mean that people over-rely on a small group of experts to drive improvement.

In the CQC report: ‘Quality improvement in hospital trusts’: the East London NHS Foundation Trust is held up as a quality improvement leader, with the CQC saying in an inspection report, that the trust’s well-established quality improvement programme was an important factor in it retaining its outstanding rating. The CQC found that QI continued to remain central to the work of the trust, with a growing number of staff receiving improvement training and getting the chance to use their skills to improve care.’

Regular reporting on QI successes

As achieving organisational-wide QI can be a slow journey, it is really important to celebrate success both widely, and whenever you can, as this has been shown to inspire others within the organisation. But how can you keep on top of all your successes? How do you know where these QI successes are taking place, in order to spread the word?

Using a tool such as Life QI means you can use dashboards to monitor successful QI projects – as well as easily access and keep an eye on them. You can therefore monitor your successes and make it easier to share them within your organisation and further afield.

Organisations have fed back that Life QI helps document, celebrate and share successes and good practice and across the wider improvement community. It has been stated that it moves people towards measuring for improvement rather than measurement for judgement.

The team at the East London Foundation NHS Trust celebrate QI wins and successes regularly and says: ‘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.’

In the CQC report Helen Gilbert, Kaizen Promotion Office Lead, Leeds Teaching Hospitals NHS Trust
says: ‘you can see that teams enjoy measuring changes when you give them easy ways to do it and you celebrate the improvements in a meaningful way.”

At Midlands Partnership NHS Foundation Trust, there has been an emphasis on celebrating learning and success as a means of engaging staff in QI. Friday afternoon ‘report outs’ are used to share success from a Rapid Process Improvement Workshop (RPIW), a Kaizen event or at the end of a ‘Leading QI’ project.

Other QI teams have found that regular sharing and learning events help teams to celebrate QI work, while also learning from others.

Well done on getting so far in your QI journey – and we hope that some of these ideas and examples will help pave the way for you to continue to deliver sustained improvement!