We know that a lot of routine improvement development and networking activity is now on hold as staff time is focused elsewhere. Where Q is funding this, we will be flexible and supportive, exploring with you how and when you are able to proceed.
In the Q team we are also exploring how we can refocus to best support you. Can we help you to connect as you target your expertise towards tackling the huge, complex challenges of the day? Can we find time efficient and virtual ways to enable us to exchange notes on what we’re all trying, what’s working well and what’s getting stuck?
In the Q team we are also exploring how we can refocus to best support you
Over the coming weeks, we aim to share practical, quick-to-absorb insights on service changes that are accelerating as part of the NHS response. As a first offer, there will be an online event with Trish Greenhalgh next Wednesday (25 March), focused on introducing video consultations.
We’re also interested in how Q might provide a platform for a broader exchange on the role of improvement in this context. As Q member Jonathan Grellier put it last week: “As we enter an uncertain few months, what’s the role for QI? No time for QI in a crisis or no better time?”
To get a broader conversation started, here are a few reflections on how improvement methods might apply in the world we find ourselves.
Process redesign and flow: Coronavirus is generating endless practical process challenges. PDSA cycles and process redesign would seem to me to offer the sort of pragmatic, iterative style of problem solving that might be needed right now. Understanding flow and variation can help make sure we target attention at the right points.
Safety science: SBAR, huddles and other techniques can support sensitivity to ongoing and emerging risks in a rapidly changing environment. All we’ve learnt about hand-washing and insights on the role of patients in supporting safety might also be particularly relevant.
Visual management and measurement: When there’s so much happening, it can be hard to keep track and help teams know what’s most helpful. Driver diagrams could help align and clarify action in a way that can be grasped quickly. Run charts, SPC and visual management methods could help provide real-time and transparent ways to track what’s happening and adapt.
Staff engagement and morale: Integrating understanding of leadership, team dynamics and behaviours into process change is critical in a workforce likely to be stretched to the limit. How might improvers help leaders absorbed in the immediate management of crisis understand the modes of engagement that are likely to work best? What practical principles and tools might we offer as a community – from human factors and joy in work – to help manage the pressure on staff? And how might we take this beyond our own departments and organisations, using social movement and mobilisation principles to influence the culture and context within which this pandemic will play out?
Scaling and spread: The current circumstances are creating demands for established clinical pathways to change radically. Judging how and when to push ahead with scaling something that’s been tested elsewhere is going to be tricky over the months ahead. How do we make the most of the appetite for service change, while avoiding the risk of harm or backlash associated with rushing complex change?
Many individuals and organisations have been using these improvement methods, ideas and skills and others in the past few weeks. Jonathan, quoted above, gave me a great insight into how his team are redeploying their skills at pace as the NHS responds:
“Today (Wednesday) my team are split between facilitating the redesign of patient flows in our eye casualty and supporting our finance team to create visual SOPs for business-critical processes like payroll and accounts payable. We’ve created a one-page guide for rapid change and are trying to mobilise the 140 Lean Yellow belts across the Trust that we’ve trained over the past 2 years to support their teams.”
Whatever tools or methods we apply, in whatever service settings, at times like this we could do with expert friends to turn to for advice, and to help us cut through the mountains of options to find the ideas and solutions most likely to work for us. Looking out and reflecting is often deprioritised under pressure, yet surely this is also a time when it can be particularly helpful to step back and make sure we’re not wasting scarce resource tackling issues others have already solved elsewhere?
What would you find helpful as this unfolds? Do you have any practical ways you think Q can support you? Or are there any examples from your work you can share with others? Add a comment to this blog below, or email us at Q@health.org.uk