With Quality improvement (QI) rightly being a key focus in health care today, how do you know when you and your organisation are ready for real change? In B Weiner’s article, ‘A theory of organizational readiness for change’[1], QI readiness is described as ‘a shared psychological state in which organizational members feel committed to implementing an organizational change and confident in their collective abilities to do so.’ This might seem like quite a feat – but there are tools and processes available to you which will help you assess your organisational readiness for change.
B Weiner goes on to say that: ‘When organizational readiness for change is high, organizational members are more likely to initiate change, exert greater effort, exhibit greater persistence, and display more cooperative behavior. The result is more effective implementation.’ In this article, we’re going to be talking you through what you may want to consider to achieve a more effective QI implementation and what might help you get ready for transformational change.
The Health Foundation has created a really helpful list which sets out how you can check out QI readiness before you start your QI journey. In their report: ‘Are you ready to build and sustain improvement? An organisational checklist’, this high-level list presents some very practical considerations - from testing your organisation’s preparedness, right through to sustaining improvement. These will all help you to assess your QI readiness and then support you on your QI journey.
One of the first elements you need to consider when testing the water for organisational preparation for change, is whether your board is ready to support your QI journey and whether it also has ‘readiness for change’. The Health Foundation’s report ‘The Improvement Journey’ sets out the behaviours required from teams which could be helpful as a starter for an organisational readiness assessment. You can also read more of our suggestions for achieving your board’s support in this article.
The Health Foundation’s checklist also suggests that you build the right foundations and have in place business cases for quality and safety improvement, as well as establishing a central improvement team which will help you set up your processes.
You might also want to have a look at our piece ‘10 top tips to consider when starting your Healthcare Collaborative’ to get some further ideas.
One of the key steps to take before starting out on your QI journey, is to identify gaps in skills in your organisational approach. If this sounds like a daunting task, there are a wide range of tools to guide you through this process. These include a tool from ORCA, AQuA’s QI maturity matrix and the Health Foundation checklist, among others.
While the Health Foundation makes clear that very few organisations will be able to tick off all the change criteria when starting their improvement journey, by going through this process you will at least be able to identify where your organisational gaps are, you can also be prepared by preparing a plan to address them.
In its 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. The guide outlines the IHI ‘dosing’ method and how providers can identify the type and ‘dose’ (level) of improvement skills they need to develop in each area of the organisation. It also states: ‘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.’
East London NHS Foundation Trust’s started work on a successful ‘dosing’ approach in 2014, when the IHI helped them to identify objectives and map out plans for building QI capacity and capability.
Although assessing your organisation’s QI readiness might initially seem like a daunting task, there are lots of resources available to help you. If you spend time looking through the checklist, identifying organisational skills and gaps and you have got your board ready to act, you should be ready to start taking the next steps to transformational change within your organisation.
[1] Weiner B. A theory of organizational readiness for change. Implementation Science. 2009; 4: 67.