NHS Improvement: how can our leaders and workforce come together to make the most of the new approach?

The publication of a new single, shared improvement approach NHS Impact is an exciting milestone. It reflects recognition, at the highest level in the English NHS, that improvement principles need to be part of the mainstream approach to the challenges facing the sector.

Q has worked with NHS England (NHSE) at key points over the past year to influence the Delivery and Continuous Improvement Review that led to this new approach. We fed in insight from the community and Q members were invited to share their feedback in a dedicated roundtable last summer. 

Members were among the first to see the initial framework when the review team joined our in-person community events last autumn.

The review process has generated a well-evidenced set of principles and supporting actions. But whether it marks a turning point in how the health sector runs will depend on how they are implemented.

Two decades working at national and local level in the NHS has helped me to understand the gap that can exist between worthy policy intent and reality in frontline organisations. I can also appreciate the cynicism that may greet the latest ambitious commitments, especially when the funding situation means they don’t come with ringfenced resource. But I think there are grounds for optimism.

The new approach will need to be dynamic, owned by the service and refined through the experience gained by individual leaders, local systems and national bodies as we use it. Q, and the power we have as a community, is needed to help shape, land and embed this well.

Now is the time for the community to do what it has demonstrated so well since Q started: come together to enable learning and change at a bigger scale.

Didn’t we all join Q in part because we see the value in a more joined up approach to improving health and care, with a common language to make the most of the wide range of skills and expertise across the service?

NHSE’s expectation is that all providers and Integrated Care Systems (ICS), will embed an improvement approach and culture that includes five components:

• Building a shared purpose and vision
• Building improvement capability
• Developing leadership behaviours for improvement
• Investing in culture and people
• Embedding a quality management system

NHSE has tried to strike a balance between obligation and empowerment, opting for broad components rather than making organisations follow a set methodology. This responds well to some of the initial advice shared by Q members.

NHS Impact positions improvement as much more than ​‘QI tools’, with welcome emphasis on the leadership needed to create the conditions for effective change.

The national ambition and expectation behind the approach is high, but the level of profound change implied won’t happen overnight.

We know that NHS trusts with the strongest track record have needed five years or more to embed an improvement approach and providers will have different starting points and paths to success.

In a new long read for the Health Foundation, Bryan Jones and I call on NHSE and other national organisations to have realistic expectations, keeping the focus on the goal of deep and sustainable improvement.

Our long read describes the need to enable learning across systems and build the capacity to navigate and reconcile competing priorities. We argue that implementation needs to be handled carefully and set out key recommendations for provider, ICS and national leaders on how to do this. 

We’d love your feedback and support with promoting an effective approach to implementation in your organisation.

This is an opportunity for the community to raise the profile and credibility of improvement ideas and approaches. In England, improvement can no longer be treated as a marginal activity. And done well, the ripple effects will be felt in other nations too, with Q here to support learning across England and between nations.

Without the leadership of those with improvement understanding, there’s a real risk that the components will be applied in a narrow, top-down way without a true appreciation of what it takes to create a culture of improvement and learning. That could lead to disappointing results and cynicism, damaging our current and future efforts.

Members often tell us they value the energy boost they get from Q. We can channel this to support each other and the wider system and maintain the pace along what will continue to be a long and winding road (even if the paving is more promising in policy terms). As a central team, we’ll look to bring what you’re learning to national and local senior leaders: so please share your stories in the coming months about what’s happening, helping and hindering.

If the journey is long, we need to make sure we start from what we’ve already learned and achieved. So often, leaders think they need to start from scratch when there’s a new policy development. But many of you are doing fantastic work across the UK and Ireland. Let’s remind ourselves of this, shout about it and point people to the resources and learning we’ve already created so we can learn from our combined experience.

Q will work with NHSE and others over the coming months to support effective engagement with the approach. For example, we’re gathering insight to help understand the best ways for leaders in local systems to work with teams with different improvement approaches to support alignment. What do you think is the most effective way into this? What is less likely to work? Please get in touch on this if you have a perspective to share.

And we’re considering with NHS Providers and NHS Confederation how we can work together to share and create resources and spaces to help drive this agenda forward. With our national partners across the five nations, we’re exploring what’s involved in learning and improving across large systems, distinct from work at team and organisation level. Watch this space for more on all this soon.