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My Improvement Journey: Dr Helen Tucker

Dr Helen Tucker shares her improvement journey in Community Hospitals, and the key lessons she has learned about the involvement of people in their health and care services.

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Q member Helen Tucker shares her QI journey and invites you to follow the progress of the Community Hospitals Q Exchange 2020 project.

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

I was first inspired by improvement when I became manager of a Community Hospital. I became part of an already-established highly integrated multidisciplinary and multi-agency team who put patients first. My previous experience of working in an acute hospital was a contrast to this, and I was impressed with the degree of co-operation and respect between professionals and across health and care agencies within this small local GP hospital. I was also impressed by the way that patients and families were an integral part of the decision-making, and that the community and League of Friends were part of the way the hospital functioned. I was prompted by the experience to research how other Community Hospitals functioned, so undertook a survey that was funded and published by the King’s Fund. This experience very early in my career sparked my passion for Community Hospitals, community-based services integration, locality planning, co-production and research.

What most inspires you professionally?

One of my earlier lessons was about not making assumptions about what is important to those who use health and care services.

I have been inspired by many people, and one of those was the late Dr Meryck Emrys-Roberts, who taught me so much. He was a GP and had wisdom, humility and compassion. I met Meryck when I joined the Community Hospitals Association (CHA) in the mid-1980s. The CHA has a role in promoting Community Hospitals and sharing innovation and best practice as part of continual learning and improvement. I have been a member ever since and am now the President. I inherited Meryck’s much-loved and highly valued library on Community Hospitals, which I retain on behalf of the CHA.

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

One of my earlier lessons was about not making assumptions about what is important to those who use health and care services. I was part of a very enthusiastic, dedicated and driven team that was charged with helping people with learning disabilities who were living in hospital to move into their own homes. An inspection by the National Development Team provided a new insight into the priorities and aspirations of those individuals, which were modest and concerned with small but important details of daily living. The independent team drew out new insights and views, and prompted a redesign of the process that embedded the continual involvement of the individuals concerned with an increase of support for them to do so. These were often individuals without family or friends, who were not used to expressing views or having their voices heard. The value of continually talking and listening to those who use the service and adjust the service accordingly was a strong lesson.

More recently, I have enjoyed working as part of a research team with the University of Birmingham, studying the value of Community Hospitals. Interviews with patients, carers and staff about their experiences gave us new knowledge and evidence on the value of the service. The evidence was overwhelmingly positive and showed that there is a place in small-scale local hospital services for a range of clinics, diagnostics, treatments and bed-based care, and that these are highly valued by their communities.

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

Actively listen to those who use the service, supporting them to express views and preferences.

Actively listen to those who use the service, supporting them to express views and preferences. Have a service that is flexible and responsive enough to act on expressed views on experiences and outcomes. Recognise and measure quality in services, celebrate good practice, and share learning.

I learnt much from designing a QI framework for a community organisation that was required to demonstrate improvement following a CQC report. Working with all concerned to embed this into systems and culture was rewarding, with measurable improvements in the quality and safety of care.

Why did you join Q?

I have been impressed with the ethos of Q and the way that the network has developed. Colleagues recommended Q to me, and the more I explored the resources, events and sharing the more impressed I became. I signed up for the RCTs (Randomised Coffee Trials) and enjoyed very rich and fruitful discussions with Q members. I look forward to becoming more involved in the future.

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

The CHA and Community Hospitals as well as communities and patients will benefit from Q Exchange funding to study the contribution of Community Hospitals during COVID-19. We hope you will follow our progress and that there will be considerable learning from this, as well as an appreciation of the diverse contribution small hospitals bring to the health and social care system.

Join the Community Hospitals Special Interest Group to find out more and join the conversation.

Interested in finding out more about Community Hospitals? Join us for the upcoming event.


  1. Thanks Helen, peoples stories and journeys are always fascinating

    1. Thanks Evelyn. The journey continues!

  2. Thank you Helen for this blog and your report (1987) published by the King's Fund.

    I had never heard of General Practitioner Hospitals before.

    If you were to write the report today how would it differ?  What research would you recommend today?

    Can you provide an editable version of the report?  I would like to refer to some of your findings.

    I am surprised that 'better patient care' - right care, in the right place, at the right time by the right person - would not reduce GP patient time.

    With the rationalisation of District General Hospitals there is an increasing need for 'community hospitals, in urban as well as rural area.  This would increase the average number of beds especially if provision was made for step-up and carer breaks (respite).  There seems to be an increasing commissioning of hospice for step-up/prevention beds.  What do you see as the distinction between these types of beds and CH beds?

    Will the Integrated Care System be a suitable arena for recognising the value of Community Hospitals in improving patient/carer outcomes, encouraging the return and recruitment of staff, and providing a truly integrated service of tertiary/secondary, primary and community services?

    The patient and public definition of an operation (and operating theatre) and the current definition within the hospital setting is not the same.  We would call many activities deemed as 'operations' by the hospital as 'procedures' (e.g. removal of basal cancers, guided injections).

    How do use envisage Population Health Management deriving the Community hospital of the future and supporting the Primary Care Networks?

    Rehabilitation services are extremely limited due to the shortage of physiotherapists.  Do you believe that community hospitals are an effective way of using these limited resources?

    I would like to promote best practice in the area of community hospital commissioning and delivery.

    Kindest regards,

    Kevin Minier

    1. Hello Kevin. I am delighted that you are promoting best practice in community hospital commissioning and delivery.  There is a concern that not enough is known about the service offering and its impact.  You have asked some very fundamental and deep questions and I am not sure I can do justice to them in a short reply. Hopefully we can arrange to talk, and then we can share the outcome. Thank you. Helen

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