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

I originally trained in ecology and did a PhD studying swallows. After eight years of working in conservation, I fancied a change and got a job with NHS Highland. This is where I first got involved in Quality Improvement as part of the National Unscheduled Care Collaborative Programme in 2005. The aim was to reduce waiting times in emergency departments and was based on Plan-Do-Study-Act cycles, process mapping, and Rapid Process Improvement projects. It also involved collecting and analysing data to dispel myths, monitor progress and focus improvement efforts.

From here I went onto work on other collaborative programmes before taking up a post as Head of Public Relations and Engagement. This coincided with the health board seeking to embed Quality Improvement and included partnering with Virginia Mason. The article published in Management on Healthcare in 2017 describes a bit more about that work.

I am currently working with the Scottish Government Technology Enabled Care Team to embed the option of health and care appointments being offered by a video called Near Me. It was originally co-designed and tested in the Highlands and then rolled out nationally also based on Quality Improvement approaches.

Currently, I have just completed a co-edited book, International Examples of Lean in Healthcare, due to be published in December 2022.

In many ways, a research background was helpful not least because of being curious. Also data always trumped anecdote – which I wish I could say was true in health and care.

What most inspires you professionally?

Most of all I would say working across all parts of health and care, professionals, politicians, government, partners and communities and making the connections to unlock problems rather than working in silos and hierarchies.

Strategic Adviser at NHS Horizon, Helen Bevan created this Distributed Leadership model which resonates with me.

While hierarchies are invertible and sometimes helpful, it is a weakness to overly rely on them and worse, hide behind them.

When I joined the NHS, I was struck by how hierarchical it was both in terms of positions and professions. Moreover few people were interested in the whole system even though how it functions can have a profound impact on their own area of service.

Leandro Herrero, CEO of The Chalfont Project says: “people who are highly connected have twice as much power to influence change”. This is also true when co-producing service change with staff and communities. The power to influence change can be seen from differing perspectives with plenty of examples where well-connected people can block change for good or ill.

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

There are so many hard-won lessons it is hard to pick out just one! But I think getting the scope right, and tied into this, actively involving (and wanting to involve) all the relevant stakeholders. It sounds easy but getting a shared understanding of the ‘problem’ and co-designing any improvements is remarkably hard.

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

That is such a tough question!

While tools and techniques have their place there needs to be greater attention to the importance of context, culture, and history.

It needs experienced leadership to create the conditions and coaching, encouragement, and support to demonstrate continuous improvement can be effective. Colleagues spend so much time firefighting it is not easy for them to pause and think of doing things differently. So often familiarity rules.

Why did you join Q?

I took a career break in 2019 but wanted to stay up to date on Quality Improvement and wider health and care policy. I was familiar with the work of the Q community as they had funded some work in Highland through the Q Exchange programme, Co-designing the use of NHS Near Me at home.

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

I have joined various Special Interest Groups including Sustainable Healthcare, and Video consultations, I try to contribute regularly. Through my connections with Q the Technology Enabled Care Team got invited to the Q workshop Community Space: exploring co-design in digital change projects and colleagues participated in the event which was positive.

One of the things I have been struck by is how the use of digital options in health and care is put under far more scrutiny than the accessibility (or lack off) of face-to-face or telephone appointments.

Concerns around digital exclusion are quite rightly put under the spotlight. It is often argued with great ferocity, especially by professionals, that video appointments will not work for everyone or in all situations. Notably, however, surely the same is true for other appointment types. The work in Scotland is backed up by an Equalities Impact Assessment, national public engagement, and independent evaluation exploring the benefits and barriers of video. I am not aware of this being in place for telephone and face-to-face appointments and yet there appears to be no scrutiny or challenge around this.

You should expect to meet some obstacles on your improvement journey, but who should give way and why?

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

In Scotland, some of the biggest resistance to having digital approaches as a choice has not been from citizens but some professionals. I would be extremely interested to know of any examples of professional resistance and the arguments for not offering video as a choice.

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