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Weeknote, 29 May: Identifying enablers for change and leading collectively

What's happening across improvement this week? Our summary of what is being shared from improvers across the UK and Ireland

What’s happening across improvement this week? 

Our weeknotes are a summary of what we’re hearing from improvers across the UK and Ireland, members and partners, and colleagues at the Health Foundation.

We try and do these weekly and keep them relatively short. Let us know if you find them helpful or have suggestions for improvements.

What’s going on in improvement?

I have a sense of hope and positivity at the end of this week, and to be honest I wouldn’t have said that on Monday for a whole host of reasons. Our thoughts and feelings fluctuate regularly during this pandemic.

There is clear energy for improvement right now. This isn’t just a set of tools or methods that are put down and picked up. While specific improvement programmes might have been hibernated, improvement itself hasn’t been. Q members and others are using their skills in a variety of ways to support urgent work during this time. The challenge is it may not always be recognised as improvement.

The more we can do to shine a light on this, the better. And we need to work together on that by sharing, learning and leading.

I’ve been watching a new Special Interest Group set up to give people a space to share tips, ideas and questions about delivering virtual QI training quickly grow. To find out more, join the group. It is a great example of the energy for sharing and learning (and stealing with pride) within and outside of the Q community. Improvers are leading this together, supporting others to build their confidence, enquiring, and conveying the power of the collective. This, in itself, builds much needed resilience and support.

I also attended a community of practice this week with people from across the five nations this week, focused on collective leadership. We discussed how we can understand the motivations and enablers to behaving differently during this pandemic. Is it the agreed sense of purpose and one common goal, a refocus on mapping services around patients, or that staff feel looked after, supported and trusted to make change happen?

We share some of what we’ve seen and heard on these themes below.

Rapid learning and improvement

In conversations with colleagues, with Q members and partners, and from what we’re seeing out in the world, we all seem to be coalescing around a single question: How do we hold on to what has facilitated positive, rapid innovation at this time? But there is caution in those conversations. We also don’t want to lose sight of some of the things we might have missed or failed to do in implementing service changes so quickly.

My colleague Penny’s blog explores the shifts in mindsets that our partners – leaders from the national improvement teams across the UK and Ireland – feel are enabling innovation.

And Helen Bevan sparked conversation on Twitter by considering whether we should be asking ‘what are the innovations?’ or ‘what has enabled us to innovate so rapidly?’ or both.

Health Systems Innovation Lab’s recent report explores this on an individual level through a survey of NHS staff. What has changed about ways of working that has helped people work in a higher performing health system? What do people want to keep? Respondents shared frustrations and challenges – things not to repeat – but it is interesting to see so much positivity coming from frontline workers who’ve valued more joined-up way of working, more autonomy, present leadership and the chance to use 21st century tools. Lots more to read in the full write up.

Keep an eye out for more on this topic by following #RapidQI where we’ll be sharing lots of conversation from a workshop we’re running today.

Video consultations

Talking 21st century tools, we know that so many across the country have been involved in the roll out of video consultations. This report in BMJ Open Quality on the rapid implementation of virtual clinics at the Royal National Orthopaedic Hospital makes for interesting reading.

It shows how valuable QI methodology has been for them, specifically repeated PDSA cycles. But also reinforced for me that we shouldn’t underestimate the work needed to make this happen, or the ongoing resource, commitment and space we will need to keep innovating in such a time of change:

“The rapid implementation of [virtual clinics] required a dedicated multidisciplinary team, expertise in operational management, QI, clinical care and data analysis. It required whole systems support from the RNOH Senior Leadership Team, information technology team, information governance team, administrative teams and clinical staff. […] A structured and planned approach using QI methodology will be required to facilitate a return to [face-to-face] clinics as the COVID-19 situation allows.”

Virtual working

The more we’re reading and talking about remote ways of working, whether video consultations or just our day-to-day meetings, the less it’s focusing on the tech. It’ll be interesting to see how this plays out in the coming months as we all settle into ‘socially distanced’ working over the longer term. In the meantime, a few things we spotted stood out to us this week.

To go back to the virtual QI training Special Interest group that I mentioned: the first article shared there, from Modern Workplace Learning on employers’ support for online learning, highlights the many different ways we can encourage learning. While online training plays a part, this is as much about giving people the permission to be self-sufficient, learn incrementally, and take time to do this.

Reminders that tech in and of itself isn’t going to solve everything also appeared on the Twitter feeds of those sharing about the Proud2bOps event, attended by 30+ operations and QI leaders earlier in the week. This simple but effective image shared by Emma Challens resonates for me:

Change (and rapid change at that) can be messy and complicated, but it can be so vibrant when we get it right!

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