It’s been hard to know where to focus our energy in this exhausting, disorientating pandemic. Just as we got our heads above water, another wave threatened to overwhelm us, pulling us back into the work of the immediate crisis response.

But it seems the tide may be turning: with the publication of the much anticipated NHS Elective Recovery Plan for England, attention is shifting in a more sustained way to service recovery and reset. Now is the time to demonstrate the breadth of contribution improvement can make to that effort. We know from Q members that for many organisations improvement has been playing an important role in the pandemic response.

Through Q we have the opportunity to highlight examples of great practice throughout the health and care sector. But we also have the ability to step back and look across the UK and Ireland. Drawing on insights from one of our regular calls with the national improvement leaders of the five nations at the end of 2021, this blog explores what’s needed to make improvement principles and methods more mainstream and widely used through recovery.

Competing and confused recovery strategies

Using the safe space Q can provide – even for those at the highly politicised ‘top of the system’ – we took stock of strategies for health sector recovery across countries. Despite everyone’s best efforts, a picture emerged of confused and often competing approaches. There’s understandably been ongoing uncertainty about when and how far to focus on the immediate emergency response versus tackling elective recovery. Waiting lists are being seen as the biggest ‘harm event’ in the health and care sector and are now top of the list of concerns in all countries. However, there are differences in how far the focus is on the headline acute waits versus taking a broader view. There’s also variation in the extent to which pre-pandemic challenges are recognised as contributing to the current situation.

But it seems the tide may be turning: with the publication of the much anticipated elective recovery plan for England, attention is shifting in a more sustained way to service recovery and reset.

There’s significant focus on the need for transformation, and acceptance that we can’t go back to delivering services as before. Yet, that co-exists with a response to waiting lists that sometimes results in pushing managers and the system harder or throwing money at short-term solutions without accompanying investment in longer term redesign. There’s acknowledgement of the pressure on staff and the need to prioritise wellbeing, yet this can be in tension with a drive to keep services running as fast as possible.

How can we get back to the sense of a clear and energising common purpose of the early peaks of the pandemic?

Improvement principles can help the system find a path to sustainable recovery and reset. Now’s the time to step into the action and show clearly why improvement approaches are relevant.

Improvement needs to run through the core of recovery

There’s a risk that in the frenetic activity focused on recovery, improvement could continue to be marginalised. Incorrectly misunderstood by too many as only about incremental change to services using a limited set of QI tools, out of touch with both the pressures of the immediate operational response and the need for transformational service redesign and innovation.

We need to help leaders nationally and locally see that improvement is an essential component of all dimensions of recovery. Improvers:

• Take a system view, to find the changes that will enable lasting change.
• Co-produce solutions with those who need, use, and deliver services. This is essential to get on the right track and for new service models to be accepted.
• Enable pragmatic and iterative measurement, diagnosis, and redesign. This is critical when so much is in flux and the only way bold aspirations and macro redesign translates to effective delivery day to day.
• Build the management system, culture, and capacity for ongoing improvement so that innovations are accompanied by the ability to adapt and embed as the context evolves.

These principles – and the tools that enable their realisation – need to run through recovery, to be confident change will meet population needs and be sustainable. This translates to a hard-edged value case for incorporating improvement approaches into recovery strategies.

Interwoven with this value case is the human case: exhaustion and cynicism could easily set in unless we can stay together through the next phase of change, in a way that helps people see and shape a future that reflects their aspirations for high quality, sustainable care. Improvement offers an approach to delivering change that inspires, revives and motivates people – giving them control in a world that’s often felt overwhelming recently. The staff wellbeing benefits of improvement are increasingly recognised and critical in the context we find ourselves. Unless we nurture the capacity of the workforce to engage with and lead the change required, the rate of recovery will falter.

Interwoven with this value case is the human case: exhaustion and cynicism could easily set in unless we can stay together through the next phase of change, in a way that helps people see and shape a future that reflects their aspirations for high quality, sustainable care.

Getting involved to make our skills felt across recovery

While there are things we can and will call on system leaders to do to make space for improvement, what’s the role of improvement leaders and practitioners locally?

The system is under immense pressure and we can’t be precious. While it’s reasonable to question strategies that offer only short-term results, we need to move with the urgency that the situation rightly demands.

Now’s the time to be out there and flexible as we bring our skills and perspectives to add value where it’s needed, not waiting to be asked before stepping into conversations and work on innovation and large-scale redesign as much as iterative process change. We need to join forces with those in other adjacent fields – not least those leading digital change given data and technology are bound to be a core feature of the future. Through Q you have ready access to examples of the rich range of methods that improvers use. There are also inspiring examples of the work people are doing – use these to help shine a light on those areas where your organisation or system is not yet using improvement. Q Exchange, Q’s participatory funding programme, is there to give a boost to collaborations bringing together the worlds and methods of improvement and digital.

How far does your experience and perspective on where we are chime with the helicopter view from across the five nations? Tell us where you’re putting your energy now and how you’re describing your contribution to others in the comments.

Making the case for the essential role of improvement can be hard work if you’re working in a place where this is not well understood. Let’s help each other out by making sense of this together and amplifying what works.