If you are a leader in healthcare and you are thinking about implementing Quality Improvement (QI) within your organisation, we’ve gathered together some hints and tips that might be useful before you get started and that will give you some guidance on bringing about transformational change.
There are some great examples of how organisations have started their QI journeys. When the East London NHS Foundation Trust (ELFT) launched their quality improvement programme in 2014, they started with a specific vision, to: 'Improve the quality of life of all the people we serve'. This vision served as an excellent starting place, and their quality work has since grown so that almost 300 teams across the organisation are now using continuous improvement methodology to approach complex issues and to bring about change. ELFT use Life QI to run and track improvement work.
In a King’s Fund report, leaders who participated in the study were able to identify the exact moment that had encouraged them to start on their QI path. This may have been a serious safety incident, or something quite different – but it was a moment in time that helped them realise they should start making changes to the quality of care within their organisation. Maybe this moment has happened for you already - if so, keep reading!
How do I to get started?
If you are a leader working in healthcare and you are thinking about implementing QI within your organisation, there are a number of points you might find useful before you get started. The King’s Fund outlined 10 lessons for NHS leaders which gives a great starting point for those wanting to embark upon QI, which we are going to explore in more detail.
- Make quality improvement a leadership priority for Boards
Evidence points to the fact that good leadership is linked to positive patient safety outcomes. Other studies have shown that a Board’s commitment to QI can also be linked to enhanced patient care. In some cases, a serious incident might have given Boards a ‘wake up’ call – demonstrating that they were not in touch with what was going on within their organisation. If you can embed quality care at Board level, your chance of embedding a safety and quality culture across your teams is much more likely. ‘We decided that it had to come from the Board and it had to start with the Board... I think that it’s really important that your Chair supports you 100 per cent on this.’ (NHS provider Chief Executive). 
Share responsibility for quality improvement with leaders at all levels
Team engagement at all levels is absolutely vital if you want to embed QI successfully within your organisation, and shared responsibility for QI is an even better approach. A ‘Staff Compact’ is an agreement that sets out the responsibilities of the organisation and the team, and shares expected behaviours. Some organisations have used this as a means of ‘bridging the gap’ between the old way of working and the new QI vision – one which is supported by teamwork and aims to provide the highest possible quality care.
Don’t look for magic bullets or quick fixes
If you want to start to embed a culture of quality and change, it’s really important that you don’t rely on a quick fix. Quality improvement - and the cultural shift it takes to get there - takes time, effort and engagement. A report by the King’s Fund demonstrates the ‘importance of the leadership team committing to quality improvement as a continuous programme rather than something that provides a ‘quick fix’ or is a ‘turnaround’ strategy.’ Introducing Quality Improvement will take time, effort and commitment, but there are tools and organisations which can support you on your journey.
Develop the skills and capabilities for improvement
Investing in developing the skills and capabilities of your team will help you on the path to QI and enhanced patient care. You can use a system such as Life QI to help develop your teams’ skills and draw on experts across the Life QI community, tracking and managing improvement. Using training with well-respected quality organisations such as the IHI and the Virginia Mason Institute can also really help.
Have a consistent and coherent approach to quality improvement
Sharing your quality vision is an important start to a consistent and coherent approach which can lead to quality improvement. Consistency is cited as being vital for embedding quality within your organisation across the board from leadership to team members to patients. The King’s Fund recommend that a coherent strategy and vision is required to implement QI successfully.
Use data effectively
Data is often discussed in tandem with quality, as it can be such an enabler, but also brings up potential related issues: what data do you have? How much data do you have? Is it manageable? In the King’s Fund article, several participants cited data on clinical performance and patient experience outcomes, and the use of this data, as an important driver of staff engagement. So, use this data well and it will help you.
Focus on relationships and culture
Again, a key transformative theme of quality in culture is a focus on relationships – with patients, team members, the board. Working collaboratively at all levels, engaging on the frontline of care, sharing vision on culture all helps.
Enable and support frontline staff to engage in quality improvement
‘Effective team working is an essential factor for organisational success.’. At Central and North West London NHS Foundation Trust (CNWL) the team wanted to “enable a Trust-wide change in culture and shift it to continuous improvement with everyone using the same methodology.” The success of the quality programme relied heavily on dialogue with staff. (Read more about their journey here). In the King’s Fund study, contributors spoke about the importance of being transparent and open about the progress of quality improvement programmes. One Chief Executive shared how he celebrated success by communicating with his staff through a regular weekly publication that was focused on improvement work. A feedback loop such as this can create a virtuous circle whereby recognition of achievements encourages others to emulate this behaviour.
Involve patients, service users and carers
Those who are closest to quality issues – such as patients, service users and carers – are often in the best position to help find solutions to these very issues. Involving these people who are closest to the situation - and enabling change to be ‘co-produced’ - can be key to solving quality improvement problems. Patients, service users and carers often have great ideas on how to solve these problems – although it can be difficult to know how to do this in a practical way. There are toolkits available to help support staff and patient interactions.
Work as a system
If QI methods are used throughout your organisation in a consistent manner and with a systematic approach, you are more likely to see better results and a transformation of culture.
What support will be required within your organisation?
You will need commitment from your Board, from other leaders, from your teams. You will also need a structure, a framework and a vision to help you on your QI journey. A QI council, a system of measuring and monitoring your progress (such as Life QI) and a QI plan will be also be useful. There are a wide range of training methods you can use, to help train your teams and develop your teams’ skills.
Although the prospect of introducing change and a new culture into your organisation might seem daunting, there is plenty of support and enthusiasm from a wide range of team members that you will be able to draw on. Good luck in your QI journey, let us know how you get on!
 McFadden, K. L., Henagan, S. C., & Gowen, C. R. (2009). The patient safety chain: Transformational leadership’s effect on patient safety culture, initiatives, and outcomes. Journal of Operations Management, 27 (5), 390–404. (NHS Leadership Academy, 2013; Dickinson et al, 2013; Walmsley, & Miller 2008https://onlinelibrary.wiley.com/doi/abs/10.1016/j.jom.2009.01.001