How did you first get involved in improvement, and what has been your journey since then?

My first exposure was during a stint at the Commission for Health Improvement. I got the opportunity to attend the Institute for Healthcare Improvement (IHI) conference in Florida where I was introduced to the concept of complex systems. Sessions by Paul Plesk and Barry Oshry had a big impact on me. I went on to manage outpatients at a large trust, attending in-house ‘Modernisation Agency’ courses on demand and capacity, and process mapping. I got a chance to implement some of this theory.

I had further opportunities to use quality improvement (QI) to make improvements when running a large breast screening service, although I didn’t know it was QI at the time.

That really cemented my passion for improvement and I knew that was what I wanted to spend more of my time on.

Having made the move into full time QI, I got the chance to study QI theory. I underpinned my practice through participating on an East of England funded postgraduate diploma in QI.

I’ve not looked back and have worked in QI ever since. I’ve delivered a number of substantial, sustained improvements, and published a few papers along the way. Now I work in an organisation who aim to have QI underpin everything we do, and I feel so lucky that I love what I do. Having a job and a team with the sole aim of making things better, well what’s to complain about?

What most inspires you professionally?

Working to improve something in partnership with clinicians and colleagues, from the most junior to the most senior within my organisation, never ceases to inspire me. I know I can’t do QI alone, and I can’t do it to teams. Seeing how even the very process of doing QI brings teams together to understand a problem, and how it changes the team dynamics for the better, reminds me why I keep doing this. My QI coaching time is definitely the favourite part of my working day.

Can you share a hard-won lesson you’ve learnt about what makes for a successful (or unsuccessful) improvement project?

If the leadership responsible aren’t open about finding the possible root causes and are adamant about why a problem is happening, there is no point starting a QI project with them. I once spent a year on a project, discovering all the drivers of their problem, many were invisible to the team. I came up with some fantastic solutions, but I couldn’t persuade them to change because they were fixated on their solution (more staff, fewer patients.) As soon as I moved off the project, the team ceased following the new processes.

I learnt that time spent on engagement up front, whilst it can be really time consuming, is time really well spent.

And if the team don’t share the vision, walk away! Work with a team who actually want your help. It doesn’t matter how good your understanding of the problem is if the team haven’t come with you on the journey.

What change could we make that would do most to embed continuous improvement in health and care?

Invest in leaders understanding the value of QI and being patient. QI takes time, and people are always itching to just do something whereas I want them to do the right thing. And NHS leaders are under so much pressure to deliver quickly that they can find that difficult to do, and struggle when they don’t get quick results. We have to get that culture change amongst NHS leaders.

Why did you join Q?

I joined quite early on. I was working as the only QI person in my organisation and although I was totally valued, I didn’t have anyone to knock things around with who really understood QI. The Q community gave me my network of other QI people, access to learning through webinars and a chance to go on some amazing Q Visits (the Visit to the Nissan factory in Sunderland was so interesting). I think of Q as the ‘Royal College of QI’!

What new connections have you made as a result of joining the Q community – and what have you learnt so far?

I’ve participated in the Randomised Coffee Trials, which have provided a little window into other people’s worlds. I’ve got to meet people on Q Visits and at the in-person yearly Q event. I’ve also participated in the health and care timebank, Hexitime both as a giver and receiver.

Can you tell us about something you’re currently working on that Q members might be able to get involved with?

Thanks for asking. Right now we’re working on a Q Exchange bid, ‘Understanding the barriers to flow and discharge’. My hospital, Whipps Cross, wants to use QI methodology to the ‘holy grail’ of flow and discharge. We want to start with an ambitious one-week observation of flow on a ward, to help us understand the particular issues at our hospital- our Pareto. There’s no doubt every hospital has all of the same issues to varying degrees, but which issues are of greatest impact? Finding this out will help us decide where to focus our QI efforts next.

It will be the most complicated observation I’ve ever organised, as we are planning to shadow all roles on a ward, and also the patients’ view, every day for a week. That needs an army of observers, a lot of data to analyse, and a lot of planning and coordination. But once we’ve worked up our data collection templates and run our observation week, we should be able to share our model with any other hospital. This will help save them reinventing the wheel. We’re also hoping to test out the usefulness of a shadowing app that a clinical colleague came across. So we’d love any input and advice from any hospital who’s already done something like this, and we’d be delighted to help others thinking about doing something similar.

Want to learn more about Debbie’s work? Get in touch.