The role of improvement during the response to COVID-19

The COVID-19 pandemic placed unprecedented pressure on the health and care system. Improvement, which offers systematic approaches that can help adapt to change, would be expected to be a useful asset in the response to the pandemic.

However, from the start of the pandemic, competing narratives emerged about the role of improvement in the changes made. Some suggested it was improvement’s moment to come to the fore whereas others reflected that core elements of improvement were being bypassed.[ref] Scott J, Hill M. Frontline insights on the rapid implementation of video consultations: what’s needed now? Q, The Health Foundation; 2020.[/ref][ref]Lewis R, Pereira P, Thorlby R, Warburton W. Understanding and sustaining the health care service shifts accelerated by COVID-19. The Health Foundation; 2020[/ref][ref]Shah A, Pereira P, Tuma P. Quality improvement at times of crisis. BMJ 2021; 373[/ref]  

We sought to understand the role of improvement in the pandemic response in more detail and ensure that the community can learn helpful lessons for the future. 

In 2020, through a Q survey, more than 200 Q members shared their experiences of the role of improvement tools, methods, approaches and mindsets in supporting change during COVID-19.

We then explored individual experiences and the emerging findings in more detail through semi-structured interviews with 12 of the survey respondents. 

• Improvement played an important role for respondents during COVID-19. Most extensively for rapid review and change to process and for engaging staff in changes. 

• Improvement took a distinct form in response to the crisis context, providing a profound opportunity to learn for the future. Short term goals and flexible use of methods were reported, with concerns around sustainability. 
• Improvement played a more important, valuable, and strategic role during COVID-19 in mature improvement organisations. More rigorous and intentional improvement was possible in settings with better developed improvement set-ups.

• Build on the positive momentum from the pandemic and ensure that improvement plays a central role in the recovery. In particular, the power of improvement to engage a wide range of staff perspectives, to enable collaboration and to ensure buy-in for change will be critical.
• Reflect on which ways of working and specific solutions developed during the pandemic should continue. Balancing the benefits of agility seen in the crisis with the need for rigour. 
• Embed improvement in core ongoing work in ways that are relevant and accessible to those on the front line. By simplifying language, intentionally adapting approaches to fit current constraints and galvanising around shared system priorities. 

Explore the findings and recommendations in full in the report.