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Last week, Q’s country partners, leaders of the national improvement teams across the UK and Ireland, came together on a call to exchange notes on how they are responding to coronavirus (COVID-19). So, what’s pre-occupying and energising those with a helicopter view of improvement efforts right now? This blog summarises what I took away from our conversation and four themes that emerged across countries.

I was inspired to hear how they were “living and breathing continuous improvement”

The work of national teams has changed dramatically in recent weeks, with planned programmes hibernated, staff redeployed and offices re-purposed as call centres. Yet, I heard that collaborative change approaches feel as relevant as ever. I was inspired to hear how they were “living and breathing continuous improvement” as they set up large-scale testing programmes and continued to roll out remote consultations across hundreds of providers in a matter of weeks.

Four themes struck me from the conversation:

  1. Health inequalities and meeting the needs of vulnerable groups

There is a strong focus on groups that might be particularly vulnerable or heavily impacted in all countries: those with mental health needs and learning disabilities, homeless, Roma / travelling communities and asylum seeker communities were specifically highlighted.

There’s concern that people are being left behind as the system innovates at pace. The digital inclusion agenda is becoming ever more relevant with the shift to remote health care delivery and work is accelerating to expand access to IT facilities.

2.   Staff wellbeing and system resilience

Watching the incredible efforts of staff from all levels and backgrounds brings with it concerns amongst leaders about the risk of burn out and compassion fatigue, as health and care services seek to both respond to the unique challenges for COVID-19 and maintain quality in routine care. At the Health Foundation we’re currently working with the Point of Care Foundation to explore a new online intervention supporting reflective practice called ‘Team Time’, adapting the Schwartz rounds approach for the current context.

While the focus remains on what needs to be done now, leaders were keen to look ahead to recovery

While the focus remains on what needs to be done now, leaders were keen to look ahead to recovery. They recognised that creating space to look forward was important for maintaining morale and focus over the months ahead.

3.   Space and support to learn

We talked about how creating pragmatic ways to capture and share the learning that’s emerging from the changes being introduced feels urgent. This is partly to inform decisions being made each week as the pandemic unfolds, for example with other parts of the UK keen to learn from London where things have progressed faster to date.

This is also about the imperative to build on and continue to improve the service innovations being introduced during this period. Making sure for example that the shift to remote working during this period becomes a platform for ongoing positive improvement and sustainable high quality care rather than slipping back once the pandemic passes.

The Q team will make this a key focus during the pandemic: supporting community members and others to capture the rapid innovation and learning that’s all around us.

4.   Collaborative improvement alive and strong

There is much to learn and share. While the call was serious as the context demands, this was also an opportunity to take stock and celebrate the innovation that’s shining through from how we’re responding as a system: both in terms of specific service changes and ways of working.

barriers are being shattered, teams are linking and working well as they haven’t done before

Leaders reflected that “barriers are being shattered, teams are linking and working well as they haven’t done before”. They are observing “fewer complications as territorial battles have receded and many constraints have been removed”. “Things are being done differently and decisions made very quickly. Huddles are being done by people who didn’t know what they were before, discovering this is the only way to get things done quickly”.

I was inspired by the role that collaborative improvement is playing as the health system responds in every part of the UK and Ireland.

Does this snapshot of the focus of national improvement leaders resonate with you and your world? Please do share your stories and reflections with the community as we travel this bumpy road together.


  1. These 4 themes resonate with my experience with AQuA members in the North West and as a secondee to an acute NHS Trust. Part of my work involves capturing the stories of change and innovation, both clinical and no-clinical, to inform the recovery process. It would be really helpful to hear how other Qs are approaching this in terms of listening, collating and embedding Covid-practice into the 'new normal'. Thanks

  2. Hi Elizabeth, that's great to hear.

    I'm inspired to see the widespread recognition that capturing and sharing learning is a critical part of what's needed.  That strikes me as a shift from previous situations, (not that there's anything quite comparable).

    It would be fantastic to hear more and to use Q to share both what we're learning and how we're going about capturing and sharing it.  We hope to be able to say more this week on what Q will be doing in this space.

    I've been impressed by what I've seen from AQUA during the pandemic: great work!  Networks and improvement support critical at the moment, even while capacity to engage is tighter than ever.


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