How QI training plays a part in building engagement

Building staff engagement is key to successful Quality Improvement and training for Quality Improvement (QI) plays a vital role in this success. Although training for QI might seem like a daunting task at the beginning of your journey, there are many different QI training methods and tools you can use and borrow from, so you do not have to reinvent the wheel.

In this article we are going to look at some of the tools and methods required for shared learning in QI and how training can help you get your team on board, engaged and motivated for their QI journeys!

Why should health professionals be trained for quality improvement?

Rather than being seen as an integral part of what healthcare professionals do, QI can be sometimes be seen as an ‘accessory’. This is where QI training comes in: to embed ideas and to integrate formal and informal learning as part of the QI approach.

In the Health Foundation report ‘Quality improvement made simple, what everyone should know about health care quality improvement', the authors recommend the importance of embedding an understanding of QI into the training and education of all healthcare professionals.

In the Health Foundation’s Evidence Scan ‘Quality improvement training for healthcare professionals,’ the article explores the types of training available for health professionals. They conclude that although there is not yet enough evidence to decide the best format for QI training, they do recommend that 'active learning strategies' - where teams put QI into practice - are more effective than teaching ‘classroom style’. They go on to say that: 'It appears important to include quality improvement methods in both pre-qualification training and CPD. It is also important to upskill trainers so that they can teach quality improvement methods robustly.'

The Academy of Medical Royal College's report ‘Quality improvement – training for better outcomes’ recommends the normalisation of QI as part of every health professional’s job. They recommend that: ”Quality improvement should be integral to all clinical and non-clinical job descriptions and appraisal, and career recognition given for quality improvement achievements.”

The authors go on to say that learning is currently normally organised as a separate activity and can be disconnected from the daily workflow, while newer work-based learning models can exploit learning opportunities which extend beyond the ‘course and curriculum mindset’. They describe work-based learning as the best learning process for daily workflow and recommend forms of interactive learning, which encourage people to reflect on work practices and focus on ‘live projects’ and challenges. This allows healthcare professionals to approach learning as a shared and collective activity, one in which they consider problems and develop solutions.

Stephen Powis, Medical Director, Royal Free London NHS Foundation Trust, says: “In order to practise medicine in the 21st century, a core understanding of quality improvement is as important as our understanding of anatomy, physiology and biochemistry.” Powerful words, and a great reminder of the importance of training for quality improvement.

What do healthcare professionals need to learn during QI training to succeed in improvement?

QI projects have a great potential to improve the delivery of healthcare and training for QI can help professionals achieve this. And, as recommended within the ‘Training healthcare in QI’ article, there are a range of skills that healthcare professionals need to learn in order to succeed in QI.

The report states that the successful training of healthcare teams in QI ‘develops capability and resilience to put QI into action through the acquisition, assimilation and application of:  knowledge in improvement science, systems and measurement, skills in managing complexity, leading change, learning and reflection, and ensuring sustainability, training in human factors that impact capability and involvement of patients throughout the process.’

It may be useful for healthcare professionals to learn about the key tenets of QI, in order to be successful in their journeys. The Health Foundation summarises them neatly in their report, ‘The Improvement Journey‘, which highlights the key steps organisations need to take in order to plan for and deliver organisational change.

These are:
1. Assessing readiness;
2. Securing board support;
3. Securing wider organisational buy-in and creating a vision;
4. Developing improvement skills and infrastructure;
5. Aligning and coordinating activity;
6. Sustaining an organisation-wide approach.

Learning about all of these steps should be incorporated into QI training so healthcare professionals can be aware of the range of activities that are needed to build the capability, infrastructure and culture needed for successful organisation-wide improvement QI programmes.

An example given by the Academy of Medical Royal College recommends that QI be incorporated into everyday meetings that clinicians hold. For example, in the final ten minutes of a meeting about, say, diabetes, you could use this time for shared learning, to collect key metrics or the key drivers that staff feel underpin good or bad results. In addition, the authors suggest: ‘In every domain, with every educational encounter that seeks to improve patient’s wellbeing, the question should be: “Where does quality improvement fit into this, and how can we teach it?”’

What different types of learning methods are there?

There are a wide range of learning methods that you can use in your QI journey, such as shared learning, which is a highly recommended method and is recognised as a valuable tool for healthcare professionals to share expertise and experience.  

In the CQC report ‘Quality improvement in hospital trusts', the authors talk about the Shared Learning approach thus: ‘Experimentation is key to any improvement approach, which must sit alongside explicit permission to fail. Senior leaders should demonstrate humility and curiosity in seeking shared learning and partnership on the QI journey to support that experimentation approach. We have found that organisations already on a QI journey are keen to share learning, help others and support other organisations.‘

The Canadian Health Services Research Foundation asserts that teams function better when they have a ‘clear purpose and implement protocols and procedures’. They go on to promote the importance of meetings and other communication methods in order to debate suggestions, share information, and to improve performance. ‘Teamwork and collaboration are especially essential to care of patients in a decentralised health system with many levels of health workers.’

Learning from others is a great way to progress in QI – a good example for the use of this method is the East London NHS Foundation Trust (ELFT) where the QI team actively promote Shared Learning. They also use Learning Sets or Action Learning Sets, which are becoming popular in Shared Learning.

Shared Learning can sometimes need a little help, in order to break down silos of learning and move closer to colleagues. Tools such as Life QI enable you to share your learning and learn from others.

In the article ‘Training healthcare professionals in quality improvement', the authors recommend that you create a ‘repository of knowledge’ to support learning QI skills, which is where you can share what has worked and what hasn’t. Shared Learning helps make the delivery of QI easier, while a repository allows “the spread of simple lessons learnt from ‘low hanging fruit’, sowing the early seeds of improvement and supporting innovative collaboration between departments that may have either not been considered, or thought to be unfeasible.”

In summary, training is vitally important in helping healthcare professionals build their QI skills and to engage staff. In the King’s Fund report ‘Leadership in Health Care', the authors review evidence in order to define good leadership. A key point they discover is that experience is ‘the most valuable factor in enabling leaders to develop their skills, especially when they have appropriate guidance and support. Focusing on how to enhance leaders’ learning from experience should be a priority’. Wise words indeed.