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What’s going on in improvement?

As individuals, as a team and across the Q community, we have been reflecting on the murder of George Floyd and the subsequent #BlackLivesMatter protests in the US and beyond. Our role as individuals to act as allies, learn and reflect, amplify BAME voices, and speak up is essential. So too is our responsibility to explore how we listen and act collectively within our work. Here you can read the Health Foundation’s statement on what this means for our organisation.

The disturbing events in America have, for me, illustrated how a fatal brutality is all we’re left with when power and domination have pushed aside the humane potential for equal voice, partnership and shared power. Shared power is just as important in health and care improvement.

The need for equal voice was starkly illustrated by the Public Health England report ‘Disparities in the risk and outcomes of COVID-19’ – and its disproportionate impact on BAME communities. This Twitter thread from NHS Chief People Officer, Prerana Issar, also succinctly sets out the need for all of us to contribute to real, lasting change for our health and care workforce.

While not the big leaps of change that we know we need, close to home – amongst improvers – there are some small ways in which I think our methods and approaches can be used to make equal voice a norm not a novelty, and to challenge structural inequities in the systems and services we work to improve.

I’ve shared some brief links to some of these below. And recognising that this is incomplete and does not involve a full range of voices, I’m keen to learn from others so please do comment or get in touch.

Improvement approaches and fostering equal voice

The rapidly-spreading use of Liberating Structures provides helpful practices for getting work done that involve every voice in the room (or – these days – in the Zoom). the current UK public Liberating Structures immersion trainings, with 100+ participants, have seen most of their places taken up by NHS staff, including dozens of Q improvers.

Few are aware that Liberating Structures first emerged partly as methods to battle more effectively against MRSA, so offer lessons for our current pandemic, as their co-developer Keith McCandless explained in ‘Tiny Changes Making A Huge Difference: Responding to COVID-19’.

“We started to liberate the creative adaptability of a vast array of people playing different roles (e.g., nurses, cleaners, clerks, doctors, family members, infection control professionals, chaplains, transporters).”

For many working remotely right now, rich advice for fostering inclusion in our online meetings is shared in ‘Power Dynamics and Inclusion in Virtual Meetings’.

It was good to see Karen Turner sharing The Royal Free’s tools for next week’s What Matters to You Day, and is happy for others to use these. Genuine listening and reflecting on diverse patient voices next week will be important.

Finally, the resonance between networked approaches to change, such as ‘Network weaving’, and black liberation is explored in ‘Decentralized Networks and the Black Radical Tradition – Part 1’. Gaining the skills for working with such ‘system-shifting networks’ is something we believe is relevant for Q members’ improvement work too, particularly as the NHS transforms into cross-boundary Integrated Care Systems (ICS) structures. Q will be offering members training in such ‘Network Weaving’ skills for improvers, later in the year.

Next week, at the intersection between race inequality and the Coronavirus pandemic, ‘Building Back Better’ webinar (11 June) will bring together a diverse panel to look at how “we move beyond COVID-19 in a way that addresses the impact of racism, xenophobia and discrimination on health”. We’ll be joining to hear more about this topic.

Rapid learning and improvement

Rapid learning and improvement are going to be necessary for a long time to come, as the recent discussion paper, Here to stay? How the NHS will have to learn to live with coronavirus, from Nigel Edwards at the Nuffield Trust highlights. His thread on Twitter points to major challenges and tensions:


We know that many Q members and others are deep into learning and thinking on rapid change. Our regular call with Q’s partner organisations across the UK and Ireland gave me insights into developments. Levette Lamb, for example, talked about the work in Northern Ireland to create a learning system for COVID-19 across the network – as well as novel practices such as using SenseMaker software to collect and learn from nurses’ stories.

Philip Crowley (National Director, Quality Improvement Team, Health Services Executive) spoke for many when he said: “We don’t want to put the machine back together as before”.

We heard much more from many of you in our recent online workshop on this topic. You can now read the write up from this session.

A range of examples of innovation across services in response to COVID are shared by CQC in ‘Innovation and inspiration: examples of how providers are responding to coronavirus (COVID-19)’ (available as a webpage, or filterable spreadsheet).

And while it may be ‘uncomfortable’, the needs and methods of innovators need to be accommodated by the NHS, Dr Alan Wilson (Senior Research Officer, Life Sciences Hub Wales) explains in his recent blog on ‘The habit of innovation’.

Video consultations

It’s interesting to see the signs of the ‘new normal’ embedding into clinical specialisms. The Royal College of Speech and Language Therapists, for example, has new telehealth guidance during COVID-19. The resources cover everything from consent, information governance, platform selection and empowering users, to roll-outs like Rotherham’s ‘Attend Anywhere’.

In the Q team, we’ve been analysing the latest learning logs from people currently implementing video consultations. This week’s logs particularly focus on access and inequalities. Keep an eye on our website – we’ll be sharing a blog on this next week.

Staff health and wellbeing

Global events, stress and increased workloads mean many of our colleagues are feeling drained and tired. Staff health and wellbeing, and open conversations about our responses to experiences at work and beyond, feel like an essential focus right now.

With support from the Health Foundation, the Point of Care Foundation has launched virtual ‘Schwarz Rounds’ called ‘Team Time’. These 45-minute online reflective sessions offer an opportunity for people emotional and social responses to experiences at work.


If you’re looking to spend some time thinking about this topic, here are a few upcoming events from Q’s special interest groups:

  • The convenors of three of Q SIGs – Simon Gill, Hilda Campbell and Julia Wood – have come together to offer a Zoom call on ‘Wellbeing during COVID: what have we learned?’, taking place 16 June.
  • The story of a pioneering organisational Mindfulness project with the Royal Orthopaedic Hospital will be shared on 26 June.

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