Welcome to Psychology 4 Improvement’s (P4I) first blog! This blog intends to introduce you to a few of the founding members of this Q Exchange project  and how their interest in this area, brought them together to form this piece of work.

Anna Burhouse, Director of Quality Development (South West – England)

When I look back, I realise that I have been really interested in thinking about people and culture since I was ten years old, when I was lucky enough to spend a year living in Copenhagen and became fascinated by why people did things differently. Fast forward through my life and you’ll see that I studied Social Anthropology at university to deepen my thinking about culture and then spent eight years qualifying as a Consultant Child and Adolescent Psychotherapist exploring the impact of human behaviours and people’s internal working models of the world.

Quite quickly I realised that only 20% of quality improvement is about the technical skills and knowledge needed to improve, and 80% is about people skills

I have worked in health and social care for over 30 years and remain perpetually curious about what makes people tick. In the early 2000’s I also started to get interested in how to improve the NHS and learnt how to use quality improvement tools and methods. Quite quickly I realised that only 20% of quality improvement is about the technical skills and knowledge needed to improve, and 80% is about people skills. I recognised the fundamental importance of ‘psychology’ in W. Edwards Deming’s Lens of Profound Knowledge and how few QI training resources in the UK at the time spent any time teaching the kind of skills needed to do this well. Since then I have been practising how to effectively combine the two skill sets in any quality improvement work I do and offering training and coaching in this field.

This has happily enabled me to meet a lot of like-minded and inspirational people, who also want to help other improvers build their knowledge and experience of people skills. One of these inspiring people is Kate Hilton from the IHI, who organised a ‘Psychology of Change’ development day in South London. At the end of the day, a small group of us pledged to work together to create a bid for the Q Exchange programme.

We have worked together for several months now and are delighted that the Q community voted to support this work. We hope to develop materials for the Q community, hold three engaging events and to stimulate a wider interest in this topic in the improvement arena.

My personal hope is that we can share the strong evidence base for the importance of collective compassionate leadership in improvement, think about improvement as a highly relational approach, signpost to creative ways to unleash intrinsic motivation, think about how best to share power and co-produce in healthcare and recognise the importance of individual and group reflection. I hope we can learn from others in the group, grow the number of people in our community of practice and encourage diversity of thought and share resources and thinking widely and generously with others.

Benna Waites, Joint Head of Psychology Counselling and Arts Therapies (South Wales)

I am a Consultant Clinical Psychologist and job share the role of Joint Head of Psychology, Counselling and Arts Therapies for Aneurin Bevan University Health Board. I was brought into ABCi, our organisation’s QI team, part-time, to create a leadership programme that drew on the evidence base around sustaining compassionate care. There is much of that work that has relevance to Psychology for Improvement, such as psychological safety for example. Building relationships with colleagues in the improvement team, I was struck by how challenging the work of improvers is. I noticed that much of what seems to be difficult in QI is around engagement, ownership, and beliefs about the work, as well as the oft-cited challenges of time, resource and staffing issues. I became really interested in whether we had nailed the framing of the problem and whether improvers had all the skills and understanding they needed to what essentially seems to be much more of a relational challenge rather than a technical one.

I noticed that much of what seems to be difficult in QI is around engagement, ownership, and beliefs about the work

I met Anna at the Bristol Patient Safety Conference when she presented on Psychology for Improvement in 2019 and was delighted to hear that her thinking was so aligned with our own in ABCi. She connected us up with a wider group and together we developed the Psychology for Improvement project bid.

It’s been fantastic through the process of the Q community bid to connect up with other people with similar interests both nationally and internationally and I’m looking forward to building a shared understanding of what knowledge and competencies might be helpful to add to the repertoire of existing quality improvement skills and knowledge.

Rachel Trask, ABCi Improvement lead (South Wales)

As Improvement Lead and an Improvement Advisor, I am responsible for building QI capability within our health board and supporting others to improve their services. Basically I am an ‘improver’ and have been so for the last 15 years or so. Over the years I have enjoyed working and had great conversations with, clinicians, managers, operational staff and strategic leads for QI across the country, all of whom are improvers like me. Over this time it has dawned on me that improvers had a specific set of struggles and that these weren’t about how to set up a measurement strategy, create a driver diagram or learn from a PDSA. The things people were losing sleep over were: ‘How do I create positive working relationships to engage, influence and empower others?’

It has dawned on me that improvers had a specific set of struggles and that these weren’t about how to set up a measurement strategy

Issues about ownership of change, learning from failure, being safe to raise ideas and resilience in the face of increasingly pressurised organisational conditions are what improvers are facing every day. In ABCi, for the last 2 years or so, we have been reflecting on these struggles and how to build capacity, conditions and connections to support improvers in their work. However, for me, P4I starts but does not end with, the individual.

‘The first step is transformation of the individual … the individual transformed, will perceive new meaning to his life, to events, to numbers, to interactions between people.’ Deming.

Lorraine Moutel, Patient Safety Lead (South West – England)

I am a nurse and work as a Quality Improvement, Patient Safety Lead at North Bristol Trust. Whilst working with colleagues on quality improvement projects, I have often found that it’s relationships, trust and understanding that cement the work. Colleagues wanting to carry out improvement are often seeking permission and have concerns around being allowed. We have lots of tools to support quality improvement, but perhaps not enough emphasis on relationships and understanding.

So, after I found myself stranded at Paddington train station (because of an incident) following an event by the IHI on the Psychology of Change Framework, with Anna Burhouse, who I know well from her days at our local Academic Health Science Network, and Ashley Gould from Public Health Wales, a new acquaintance that day. We started to talk about psychological safety and the human/ technical side of change. Anna asked if myself and Ashley would be interested in presenting with her at an AHSN conference in September, which I thoroughly enjoyed, and later involved us in the bid.

Charlie Jones, Specialty Lead for Clinical Psychology (Medicine Division, North Bristol NHS Trust)

I’m a Consultant Clinical Psychologist with a passion for systemic and relational approaches to supporting the wellbeing of the NHS workforce. I’m a dad with two lively twin boys, Freddie and Noah.

We need to create enabling and sustainable conditions for safe, honest conversations, with deep listening

We know from our experiences of our own family lives that to sustainably give care, we need to feel cared for and supported ourselves. Similarly in healthcare, a big predictor of safe, compassionate care is the state of mind of the care-giver; the nurse, the doctor, the carer. How is the carer feeling? What’s the quality of thinking? I’m passionate about finding a variety of ways to support the state of mind and emotions of the caregiver, and I see this as a key role for clinical psychologists within healthcare systems. We need to create enabling and sustainable conditions for safe, honest conversations, with deep listening. I think these relational and organisational conditions are at the heart of improvement: it’s about people, about the so-called ‘soft’ stuff.

I was thrilled to attend the Psychology of Change event in London and meet in person Anna Burhouse and Kate Hilton, who I’d previously been in touch with online. It was an energising event and I met so many inspiring people. There was a shared buzzing energy to invest more of our efforts in the psychological side of improvement. It was then fantastic to have backing from the Health Foundation and the Q community to take this work forwards through the Q Exchange programme.

Watch this space and expect more blog posts from P4I as this piece of work evolves. Find out more about the project on our Q Exchange project page.

If you’re interested in becoming a member of the steering group for P4I, please email Samuel Thornton.

You can also join the Psychology for Improvement Special Interest Group.