To support improved care quality and performance in healthcare, the Health Foundation have repeatedly called for increased focus on the development of improvement capability. It has also been argued that this development needs to be from ‘within’ healthcare provider organisations and systems. In addition, a national framework which proposes actions for the building of improvement capability has recently been published in England. But what do we really mean by improvement capability? How can we assess it? And what changes can we make to develop it?
Our ongoing research suggests that there are different conceptualisations of improvement capability
Our ongoing research suggests that there are different conceptualisations of improvement capability. One perspective suggests improvement capability comprises the improvement skills and abilities of individuals within organisations. This perspective implies that improvement capability is a set of technical skills which can be taught through training sessions with certification, ‘belts’, and even ISO accreditation. It suggests that the development and measurement of improvement capability is then relatively simple; counting how many participants have been on a training course or have met the requirements for different levels of competency for a specific group of improvement approaches. It also facilitates individuals to make judgements of their own personal development needs based on their perceptions about their own improvement capability. However, this viewpoint seems to us to take little or no account of the wider organisational context for improvement.
An alternative perspective suggests that improvement capability consists of organisational-wide processes and practices of innovation. That is, rather than being limited to individual skills and abilities, improvement capability is something that incorporates many aspects from across an organisation, including dimensions such as leadership, employee engagement, patient perspectives and other contextual factors as well as individual skills for improvement approaches. This means that organisations may develop improvement capability through their operating procedures, rituals, culture and behaviours and that the presence of improvement capability is less dependent on specific individuals within organisations. This type of perspective, informed by the wider research literature of organisational performance, suggests that improvement capability may take time and investment to develop and may also decay or atrophy over time if it is not continuously exercised and updated.
If we accept that there are plural conceptualisations of improvement capability, then there is no ‘one’ right way for its assessment, and its development
However, the wider organisational perspective on improvement capability leads to some challenges in development and assessment. Our research identified seventy frameworks and instruments that have been used to assess improvement capability, from a range of industries, yet they are diverse and contain many different assessment approaches with little overall consistency in assessment content. We found four groups, each taking a slightly different conceptualisation: improvement models, maturity models, change models and governance models. Different approaches to assessment are also taken, with some using surveys, some interviews and others in-depth case studies of organisations informed by self-assessment. Further, not one instrument or framework seems to dominate across sectors or geographies and few have been validated.
So, what does all this mean? If we accept that there are plural conceptualisations of improvement capability, then there is no ‘one’ right way for its assessment, and its development. But that makes it more difficult for improvement leaders to ensure that they are accomplishing their aims of developing improvement capability. Therefore pragmatically, when considering how to develop improvement capability, the choice of assessment instrument needs to be contingent on organisational context and patient requirements as well as instrument accuracy. This will clarify the strengths, risks and blind spots and highlight priorities for development depending on the conceptualisation chosen. Regulatory agencies for example, may find it useful to compare organisations using an instrument based on a governance model, whereas healthcare provider organisations may find one based on a maturity model more valuable.
In conclusion, to support the development of improvement capability, we need to be clear about what it means and why it is important for improvement capability to be developed. Further, given the diversity in the perceptions of improvement capability, it is also important to think through whether there is a shared understanding of improvement capability across an organisation or health system, and with stakeholders including patients. This will inform assessment approaches and associated development strategies. What do you mean by improvement capability?
Joy Furnival is a Health Foundation PhD Award holder, Generation Q Fellow and Q Community member. She has worked as Chartered engineer and manager within industry and the NHS. She is currently completing her PhD at Alliance Manchester Business School, supervised by Professor Kieran Walshe and Professor Ruth Boaden.