How improvement can help during times of pressure: key resources

Discover resources that show how improvement approaches can help, even during times of service and workforce pressures.

Overview of resources

The NHS is facing unprecedented pressures. Improvement approaches can help leaders and their teams solve problems at pace, in ways that maintain a focus on quality of care, staff engagement and longer-term goals.

There are many publicly available resources that focus on improvement. These are referenced in a new long read by Q members, ‘Six improvement lessons to apply as winter pressures bite’, published by NHS Confederation.

We would love to hear about further resources that you’ve found useful, so we can share these with others. Let us know by contacting qcomms@health.org.uk

Winter pressures: how improvement can help

The well-evidenced principles of systems thinking and improvement help to address immediate pressures in a way that can be sustainable.

Penny Pereira, Q Managing Director and Q member Amar Shah, Chief Quality Officer at East London NHS Foundation Trust, suggest six lessons from improvement that can be applied to current challenges, in a sustainable way.

They argue that short term fixes can store up problems down the line or create unintended consequences. They also suggest an improvement approach can drive local autonomy and enable creative thinking, which can help to prevent burnout.

The full article by Penny Pereira and Amar Shah, ‘Six improvement lessons to apply as winter pressures bite’, is published by NHS Confederation. A summary of resources that support each ‘lesson’ is below.

Lesson 1. Ensure ‘top-down clarity and bottom-up agency’
  • Q community insight on the role of improvement during COVID-19, describes the distinct ways in which improvement was used in ‘crisis conditions’. This distinguishes between the maturity of improvement approaches in different organisations. It also outlines some of the leadership characteristics that those leading improvement found helpful. Read time: 20-30 minutes
  • NHS Providers has a range of events and insight briefings aimed at trust boards. For example, their insight briefings and guides webpage include a board member’s guide to trust-wide improvement and an insight briefing on leading for improvement. Read time: 20-30 minutes
  • The BMJ Quality & Safety article describes the key skills required by front-line staff to deliver improvement and discusses how they can be successfully deployed. Read time: 20-30 minutes
  • The article, ‘Putting improvement in everyone’s hands’, describes ways in which improvement can be made accessible through simplifying language and focusing on core purpose. Read time: 5 minutes 
Lesson 2. Use improvement methods for rapid priority setting and problem solving
  • The ‘Quality improvement at times of crisis’ article in the BMJ provides an overview of five ways in which improvement helped during the crisis of the early pandemic peaks. It includes practical examples and an assessment of the implications for how organisations approach and lead improvement. Read time: 8 minutes
  • ‘Quality Improvement made simple’ provides an accessible overview of the underlying principles of improvement, together with a summary of the most popular approaches. Read time: 20 minutes
  • NHS England’s ‘Making data count’ resources explain how to make better use of data to understand and track the performance of processes over time, in ways that guide appropriate responses to variation and support improvement. Read time: 30+ minutes
  • The BMJ’s Quality Improvement series includes education articles on the use of key improvement approaches and methods. It also includes essays and analysis that explore major issues such as improvement leadership, the role of culture and the co-production of improvement with patients. Read time: 1+ hour 
Lesson 3. Capture, circulate and act on emerging learning
Lesson 4. Build your response around positive innovations in care
Lesson 5. Make the most of safety science when managing risk
  • The BMJ Quality & Safety article summarises the findings of a large study of culture and behaviour in the English NHS.  This includes the role of leadership in creating a positive culture. Read time: 8 minutes
  • The online book is free to access and provides a view of safety that looks at risk across whole pathways of care, including from the patient perspective. It provides practical strategies for safety when considering new models of care. Read time: 120+ minutes
  • Human factors are the environmental, organisational and job factors, and human and individual characteristics that influence behaviour at work in a way which can affect health and safety. Ensuring staff understand this helps make sure you address the real system issues that lead to things going wrong, rather than resorting to blaming individuals. Q’s ‘Human Factors Guide’ developed by colleagues in Ireland, provides an overview. Read time: 30+ minutes 
Lesson 6. Recognise staff engagement, morale and wellbeing as the critical foundation

The above is a selective reading list. Please let us know about any other key resources that may help others, including those new to improvement, by contacting qcomms@health.org.uk