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How do you feel when you hear the word recovery these days? The prospect of emerging from the worst of the pandemic should bring joy and relief. Yet, for those of you leading and delivering health services, it might also raise anxiety. The prospect of further pressure for an exhausted workforce as attention turns to both the backlog in care and the emerging opportunities to work differently could feel daunting.

There’s great need – and so much potential – for both iterative improvement and more radical innovation and redesign. But we shouldn’t be surprised if it feels increasingly hard to lift ourselves and colleagues to this next phase of the challenge when energy has been stretched to the limit for many for so long.

This blog explores the interconnections and challenges we face as we recover services, build on the opportunities to work differently, and look after staff – including ourselves – all at the same time.

Staff and service recovery and rebuilding must go hand in hand

Finding strategies that enable both staff and service recovery is a challenge for all of us in the coming months, whether working nationally or on the frontline. It was the topic the national leads for improvement in each of the five countries of the UK and Ireland chose to tackle in March, when we brought them together through Q, as we have done throughout the pandemic.

We now need to chart a realistic path for recovery and reset, that puts people – both those receiving and those delivering care – at the centre.

Across the UK and Ireland, we’re facing massive backlogs in planned care. Whether you’re a clinician, manager, commissioner or policymaker the urgent need to get services back up and running is deeply felt. Yet, recovering services at the expense of staff recovery is not an option.

The NHS staff survey shows those in services bearing the brunt of the COVID-19 response report high rates of stress-related illness. As well as the immediate impact on individuals and teams, there’s a risk the pressures of the last year could tip many into leaving the health sector, further eroding delivery capacity and morale.

So, how can we climb the next mountain, while looking after the health sector’s most precious resource – its workforce?

Improvement can fuel staff and service recovery

Improvement approaches can play a central role in helping us through this challenge. Improvement offers practical, flexible tools and approaches to understand and redesign care. It gives staff a much-needed sense of being able to do something about the challenges they’re facing.

Q’s analysis of the role of improvement during COVID-19 showed improvement approaches have come into their own for many, not just through providing time-efficient ways to solve practical problems rapidly, but by building engagement and ownership amongst staff.

Whether you’re a clinician, manager, commissioner or policymaker the urgent need to get services back up and running is deeply felt. Yet, recovering services at the expense of staff recovery is not an option.

But improvement also needs sufficient time and support

A career amongst improvers tells me that optimism and commitment to make things better is rarely in short supply. Yet, we are also the ones who know through hard evidence and experience that change efforts fail to deliver long-term benefits unless staff come on the journey, and that relies on sufficient leadership, time and support. Now is the time for us to bring both this optimism and realism to help set the right pace and ambition for the months ahead and make it clear what will be needed to sustain and build on the innovation seen during COVID-19.

The pandemic response showed us that NHS staff can lead radical service change quickly and effectively, but this relied on being empowered and freed up to innovate, with service change happening in part because routine services were paused and resources and attention focused on a pressing, shared imperative. And while the pandemic sparked incredible innovation, such as with the shift to virtual models of care, both staff and patients are saying that much of this needs further refinement and embedding to provide a sustainable route to high-quality care.

Over the months ahead, we will need health and care leaders to listen to staff and understand the reality of recovery and redesign, prioritising effectively and managing expectations of the public and policymakers about the time this will take.

We, as improvers, also need to help the leaders around us understand that the long-term, complex work ahead will need sustained energy and commitment of staff throughout the workforce. Specialists, such as Q members, can both guide organisations to what’s needed and then help both create the right conditions for, and lead, this change.

Look after the improvers and improvement will follow

Many Q members are being called on to jump from supporting the pandemic response to delivering urgent and ambitious changes as part of the recovery. Yet before we jump to the next pressing imperative, let’s remember we and our fellow improvers may well need time to recover too. After being re-deployed for many months or delivering short-term rapid change, many may need time to re-orientate and in some cases retrain for a world and portfolio that has moved on.

Improvement approaches can play a central role in helping us through this challenge. Improvement offers practical, flexible tools and approaches to understand and redesign care.

While it can be hard to prioritise ourselves in the face of such pressing patient need, investing in our own resilience is critical. We’ll need all our resources, creativity, and energy to meet the demands of the next phase, not least because this is a critical point to revisit how we approach making services better.

Take this opportunity to reset how we improve

Bringing together insight from 200 Q members with perspectives from national improvement leaders across the UK and Ireland, I see three priorities for refining how we work to make sure we’re equal to the challenges ahead:

  • Ensuring we focus resources on the real issues. By weaving back in meaningful patient and public involvement and resetting how we measure to ensure a better balance between accountability and improvement and to embed staff wellbeing and equity long term.
  • Developing how we do improvement to meet the scale of change needed. Simplifying language and consolidating methods to make improvement more accessible to all, keeping pace with and effectively integrating digital innovation, and building our collaborative learning and change skills to maintain the silo-busting spirit of the pandemic.
  • Delivering improvement differently to meet big system challenges. Rather than just re-starting topic-focused programmes that have been hibernated, exploring the adaptive, holistic support needed to create the right conditions for service recovery and exploring fresh approaches to enable radical service transformation and redesign, recognising incremental improvement is unlikely to be sufficient.

How are you and your organisation planning to evolve your improvement work? How much time have you had to learn and reflect over recent months to support this? And have you had a chance to explore how you can bring together the dual needs of both staff and service recovery in your work?

COVID-19 showed big variation in how improvement has been used during the pandemic: now’s a good time to reach out to look at what others are doing as you decide your next steps. Time taken to learn from others at this critical juncture is a good investment in both your work and personal resilience.

Charting a sustainable route to recovery and reset together

I’ve swung many times over the last year from huge optimism about the pace of innovation and change, to deep despondency about the scale of the challenge and inevitability of reverting to old patterns. We now need to chart a realistic path for recovery and reset, that puts people – both those receiving and those delivering care – at the centre.

With our skills and networks, Q members can play a critical role in supporting the wider workforce through the challenges ahead, but only if we in turn take the time and support we need.

When thinking about how to enable both staff and service recovery we used a Liberating Structure, designed to find both / and solutions. Check out the ‘integrated autonomy’ structure and think about joining Q’s Liberating Structures special interest group.

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