The pandemic has provided a critical test of improvement’s role in supporting positive change in health and care. As improvers take the opportunity to reflect on the last twelve months, we’re sharing the lessons from our insight work with the Q community during this period of change. Today we published The role of improvement during the response to COVID-19, drawing on our survey of Q members and in-depth interviews.

Here are some key learnings and recommendations that we think will ensure improvement tools, methods, approaches, and mindsets are fully utilised during the recovery period and beyond.

Organisations with a well-developed approach to improvement pre-pandemic were better placed to use it strategically

Respondents to our survey told us that improvement’s role had generally increased at the individual, team and organisational levels during the crisis. It was used most for rapidly reviewing and improving processes and for engaging staff in change work. This finding resonates with examples we’ve seen elsewhere – such as the North West Ambulance Service running 200 PDSAs in six weeks to implement a new ‘safe check system’ or efforts to involve all staff as improvement agents in an organisational learning system at London’s Nightingale. We must maintain this positive momentum throughout the recovery period where harnessing improvement’s power to support collaboration and ensure stakeholder buy-in will be crucial.

Perhaps most significantly, we also found that improvement played a more important role in organisations that had a well-developed approach to improvement pre-pandemic. This reinforces the case that organisational and system leaders need to provide an enabling context for improvement through empowering leadership, resources and a commitment to building capabilities and positive cultures for the long term.

Improvement took a distinct form in the crisis so we need to learn the right lessons

Our analysis shows that improvement during COVID-19 was often organised around short-term goals, with methods used flexibly and sometimes in a partial way. Indeed, respondents generally found it more valuable to draw on their broader improvement mindsets rather than specific technical improvement methods. While this approach undoubtedly allowed improvers to work responsively to achieve goals at pace, some respondents raised concerns about the longer-term effectiveness of the changes made.

Future efforts will need to balance the benefits of the more accessible and flexible approaches that were often appropriate in the crisis context with the need for sufficient rigour to support sustainability. In particular, we heard of the many challenges improvers faced in applying systematic measurement and engaging patients during COVID-19. We believe that both areas should be prioritised in improvement work during the recovery.

Improvement needs to be embedded into core ongoing work to achieve system priorities

We heard many examples of improvement being applied in ways that were relevant and accessible to front line teams. Yet, this was far from universal and responses suggest the need to simplify language, consolidate methods, and ensure that improvement methods are more intentionally adapted to organisational context and constraints.

Future efforts will need to balance the benefits of the more accessible and flexible approaches that were often appropriate in the crisis context with the need for sufficient rigour to support sustainability.

At the same time, and echoing what we heard previously about implementing video consultations, respondents in this insight work stressed the importance of a wider shared purpose in driving positive change during COVID-19. The Q team are committed to more deliberately focusing our work around system priorities and have already begun conversations with the wider community around some of the priorities identified by respondents. We look forward to sharing more about this with members as our plans develop over the coming months.

What next?

As the health and care system enters a new phase in the pandemic response, it is paramount that improvers, and those who support them, reflect on what the last year has taught us about our work. A huge thank you to all members who shared their experience – especially those who joined our insight team as peer interviewers.

You can read more about what we heard from Q members in the full report and please share your thoughts in the comments below.

Download the report