Penny: Across the UK and Ireland we’re seeing a massive impact from long waiting times and delays accessing services. Why do you think this should be a priority focus for people who have improvement skills?

Vin: I’ve been a doctor for 32 years and a Medical Director for 14 years at national, system and provider level and a proud member of Q myself. In the NHS, access to services is one of our key priorities including access to primary care, urgent and emergency care, and elective care.

In the 1990s, when I was a junior doctor, we were in a position where long waits were almost routine. But by applying improvement methodologies, we brought waiting times down, improved the quality of care and saved taxpayers money. I was part of a team that was better able to deliver the services we aspired to, and this improved patient experience, which made the work all the more enjoyable. We had opportunities for professional and personal development through our involvement in improvement work. Many of us in leadership roles learned basic operational management skills through those national improvement efforts.

The wider impact of the pandemic has led to increased pressure on services at all levels, so improvement science and methodologies are just as important in helping to solve current challenges as they were back then.

We also know that organisations that use this approach tend to be more successful in dealing with delays. For example, in England, the Trusts that participated in the Virginia Mason Institute programme have embedded improvement as their organising principle, supporting the adoption and spread of innovation practices. In Leeds for example, they tackled waiting times in the emergency department, reducing process lead times by 49% through use of improvement methodologies.

Penny: You’ve spoken about the cross sector aspects of the access challenge. What do you see as Q’s potential here, as a community of people from diverse backgrounds and different parts of the system?

Vin: I’m interested in how we bring together different improvement cultures, systems, processes, and language across integrated care systems. In my experience, there is much we can learn from each other across health, social care, local government and the voluntary sector.

There are some areas where we already know what we need, but we have to work together to do it faster and at a greater scale – taking ideas from one part of the system to another. Then there are examples where the solutions aren’t ready-made and we need to innovate. Q can help with both. For many whole-system challenges that sit behind long waits, we need to develop an integrated way of delivering improvement.

That’s not just about working across groups of staff. As a paediatrician by background, some of the best people I’ve worked with were young people and carers who got involved in improvement. Patients, service users and carers have a crucial role to play and we need to seek out ways to involve them.

Penny: How can we galvanise and inspire staff around reducing waits?

Vin: NHS staff want to do the best for their patients. When people have been through the kind of winter we’ve just had, we need to start asking as we move forward: how do we learn? And then, how do we improve? I think that is genuinely quite galvanising.

Organisations with a strong culture of quality improvement have better staff engagement scores. That’s why focusing people on improvement is more important than ever. We should be building organisational cultures that support their efforts to drive positive change. It is a way of encouraging people to do something about the challenges we’re facing, rather than feeling like they are beyond us.

Penny: For Q members putting in a Q Exchange bid, what is your advice to get the balance right between solving the most pressing access issues now, and working towards longer term interventions?

Vin: I think it’s quite right to focus on access. For example, we know the biggest driver of health inequality is lack of access to services. Access is one of our grand challenges. Though delays have been compounded by the pandemic, increased demand is also driven by the increased prevalence of multiple long-term conditions and our ageing society. That’s why we are focusing on preventing ill health as well as treating it and why the NHS and local government are working on integration and are generating social and economic value as anchor systems.

I’m excited by projects that bring fresh thinking and the opportunity to broaden the reach of ideas that are already working well in other areas. I’m looking forward to seeing how we can learn from people who are doing things differently. Ideas that we need to rapidly test, evaluate, stop when they don’t work and scale when they do. You can always do more to test fast, fail fast, learn fast, scale fast. And I think that is at the heart of Q Exchange.

In many cases, we already know the answer. For example, we know what good quality palliative care services look like. We know that patients should all have care plans. We know that they should be shared with ambulance services and that patients should have them reviewed on a weekly basis. Implementing this good practice should be part of regular business.

The real value offered by Q Exchange is in those cases where we’re still searching for answers. What we want to do is capture and spread out innovation. And to help generate new insight into difficult problems that we don’t yet know how to solve. That’s what I’m keen to see the Q community focusing on.

I know that in Q, we are a community united by values. We are people who believe in collaboration and believe in making things better through improvement, innovation, evaluation and learning for the benefit of all our patients, populations and staff.

I’d encourage Q members applying for Q Exchange and those supporting the projects to think very deliberately about what you’re trying to change. Where are the problems? What can you do to test and learn? Q Exchange is about trying something. It’s about putting the idea out there and seeing what comes through; use the community to see if it’s been tried elsewhere. Can you identify and help each other tackle some of the issues where we don’t already have a programme, policy or standard? And can you bring a new approach to how we can scale what we do know more effectively?

Q Exchange proposals are assessed by member and partner shortlisting panels and then put to the community to choose the projects to fund. Find out more about this year’s shortlisted Q Exchange projects.