RCN responds to the ‘Courage of Compassion’ report by the King’s Fund for the RCN Foundation. There are a range of different methods and tools, such as Lean, Six Sigma and the Institute for Healthcare Improvement’s Model for Improvement. NHS leaders have a vital role to play in making this happen – leadership and management practices have a significant impact on quality. Staffing vacancies are rife, there are widespread challenges in meeting financial and performance targets and demands on services continue to increase. Michael West and Suzie Bailey consider the disproportionate toll Covid-19 is taking on health and care staff from. The King’s Fund. BMJ Quality & Safety, vol 25, no 7, pp 509–17. The NHS atlas of variation in healthcare: reducing unwarranted variation to increase value and improve quality [online]. This independent report was commissioned by NHS Property Services. Available at: http://fingertips.phe.org.uk/profile/atlas-of-variation (accessed on 8 September 2017). Smith M, Saunders R, Stuckhardt L, McGinnis JM (eds) (2013). Example 1: Identifying and managing patients at risk of chronic disease exacerbation, Example 2: Acute-led development of an ambulatory care service, Example 3: Medicines optimisation and polypharmacy, Example 4: Improving safety and quality through multi-professional training, Example 5: Whole-pathway improvement involving collaboration between the primary, acute and community sectors, Comprehensive quality improvement: not ‘why should we do it?’ but ‘when will we start?’, As the Fund publishes a report on leadership for quality improvement, Matthew Kershaw encourages NHS organisations to embrace. Both quality and cost can be measured in different ways, and the impact of the relationship between the two is often spread widely across a health system and over time. The programme’s success in helping Southmead Hospital in Bristol to improve its perinatal outcomes and to reduce its litigation costs has encouraged other maternity units across the UK and around the world to implement it. The fact too that their chairman can also be the chairman of the Trust that they oversee is so wrong you cant believe it is true, but it is. 4,300 were here. ‘Optimizing patient involvement in quality improvement’. The challenge now lies in delivering the plans and making tangible improvements in NHS care as a result. Learn More public. NHS has culture of bullying, racism, discrimination and sadly has a culture of rewarding those who collude with the system than those who challenge the system or leaders. London: The Health Foundation. King's Fund annual report 1988, King Edward's Hospital Fund for London annual report 1988. The committee's report was to be the first report of its kind in South Africa. Jiang HJ, Lockee C, Bass K, Fraser I (2009). Academy of Medical Royal Colleges (2016). Does improving quality save money? This isn’t surprising as finance and operations are the areas of greatest angst and pressure in the system. Available at: www.kingsfund.org.uk/publications/tackling-variations-clinical-care (accessed on 25 August 2017). Understanding NHS financial pressures: how are they affecting patient care? We need national support and air cover for difficult tasks if we are going to have a chance of turning things around. Health care organisations must create a culture and environment that supports the delivery of high-quality, continually improving care. The 10 key lessons outlined provide a starting point for NHS leaders seeking to more firmly embed quality improvement within their local plans for improving services. London: The Health Foundation. Journal of Organizational Effectiveness, vol 1, no 3, pp 240–60. Healthcare Improvement Scotland website. NHS doesn't have leadership culture but has management culture. Current sustainability and transformation partnerships (STPs) in the NHS in England are one way to encourage this kind of joint working. Timmins N (2015). If we have less churn, the number of candidates applying for a job, who have done the same position at another organisation will be lower (or career progression slower). London: The King’s Fund. Our report draws on NHS Providers’ annual quantitative survey of leadership vacancies and on qualitative interviews and a roundtable The King’s Fund conducted with NHS trust directors and national stakeholders. Ultimately though, interviewees cautioned against placing too much focus on formal talent management or development programmes, and several noted a more effective talent pipeline alone will not reduce vacancies as long as the current operating environment and treatment of leaders is unchanged. The Joint Commission Journal on Quality and Patient Safety, vol 35, no 5, pp 286–91. Department of Health (2008). “Services are stretched to the limit. £2.3bn Our estimate of NHS trusts’ deficit at the end of 2015/16. Our report examines the approach being taken by some clinical commissioning groups (CCGs) and local systems where traditional notions of commissioning are no longer guiding their way of working. If one was asked to summarise King IV™ in one word, ‘transparency’ would come to mind. Press Release 23/09/2020. Ham C, Alderwick H (2016). We need leadership roles that are demanding but doable. NHS leadership is insular. For each example, we summarise the problem being addressed, the methods used to improve quality and some of the benefits that are being delivered (using data reported from the sites). Directors of operations and directors of finance were most likely to have been appointed in the past three years. Providing dedicated resources and project management capacity, having committed leaders capable of sparking enthusiasm, with skills in monitoring and evaluation to clearly demonstrate results, and ensuring alignment with other clinical priorities and health system changes, are all likely to help (Ling et al 2010). West M, Lyubovnikova J, Eckert R, Denis JL (2014). In the same week as The Kings Fund report, came a report from fellow think tank Reform. STPs and other local partnerships could also help NHS organisations to ‘act like a sector’, bringing together professionals from different services to agree standard procedures and processes to improve care (Dixon-Woods and Martin 2016). ‘Board engagement in quality: findings of a survey of hospital and system leaders’. In practice, this means having: Leadership is a major determinant of organisational culture (West et al 2015). ‘Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study’. London: The Stationery Office. There are a range of opportunities for NHS organisations to improve quality of care and value for money. Armstrong et al (2013) identify a number of tips for successful patient involvement in improvement projects, including (but not limited to): A range of tools and approaches can also be used to help achieve these aims, such as the Patient and family-centred care toolkit. This ‘displacement of rewards’ means that providers investing in service improvements may see their return on investment fall to another part of the system, or their income fall if they have reduced activity that they were previously paid for (Leatherman et al 2003). East Sussex County Council website. But the systematic use of quality improvement approaches within the NHS is still patchy, and many improvement efforts fail to deliver the results expected. And NHS leaders involved in developing the plans are concerned about their ability to make change happen in practice (Alderwick et al 2016). Rather, it is the process of having a systematic approach to quality improvement and applying this consistently that is important (Ross and Naylor 2017). Quality improvement: theory and practice in healthcare. Jones L, Pomeroy L, Robert G, Burnett S, Anderson JE, Fulop NJ (2017). This will help bring quality patient care further forward into the 21st century. Drawing on these studies and other evidence, researchers have created a framework that can be used to assess organisational maturity in governing for quality improvement (Jones et al 2017). And if measurement systems are poorly designed, they can create perverse incentives such as ‘gaming’, where targets are achieved but the intended changes in practice are not (Bevan and Hood 2006). Available at: www.health.org.uk/publication/how-do-you-get-clinicians-involved-quality-improvement (accessed on 18 September 2017). NHS leaders must therefore work to model and build these cultural elements. Kidney Care UK (2017). Jan 1, 2021. Ling T, Soper B, Buxton M, Hanney S, Oortwijn W, Scoggins A, Steel N (2010). shares their experiences and reflections. I am speaking of those within the SYSTEM who see our plight. NHS Improvement (2016). There needs to be a more modern approach to partnership working across the system which involves remodelling of the work being done and redone at the frontline which I would like to be part of modernising. Not there as lap dogs but continually probing and asking difficult questions. The 2nd atlas of variation in NHS diagnostic services in England: reducing unwarranted variation to improve health outcomes and value [online]. ethnic minority backgrounds and what it requires from us all to address this. Ambulatory Heart Failure Clinic: University Hospitals of North Midlands NHS Trust. By quality improvement, we mean the use of methods and tools to try to continuously improve quality of care and outcomes for patients. The King’s Fund programme, Enhancing the Healing Environment, worked with almost 30 hospitals and 35 hospices to support the design of healing environments, many with a strong focus on gardens. Since 1997, they have jointly funded a yearly award system with GlaxoSmithKline.They reward small to medium … National diabetes audit, 2015-2016. If you wish to continue receiving full reports by mail, you must let us know by selecting the Full Report option under Paper Reports here. ‘Does quality improvement improve quality?’. Available at: www.gov.uk/government/publications/closing-the-nhs-funding-gap-how-to-get-better-value-healthcare-for-patients (accessed on 8 September 2017). Only 7 per cent of very senior managers were from a black and minority ethnic background, which is far lower than representation in the NHS workforce and local communities. The current pressures on the NHS mean that, now more than ever, there needs to be a strong focus on delivering better-value care and putting quality and safety at the heart of the health policy agenda (Ham et al 2016). Organisations with the most significant performance challenges experience higher levels of leadership churn. As we have argued previously, ‘only by moving from pockets of innovation to system-wide improvement will the NHS deliver the changes that are needed to sustain and improve care at a time of unprecedented financial and service pressures’ (Ham et al 2016, p 11). In fact the merry-go-round of services with each one in turn dealing out errors, frustrations and complications from disjointed or disconnected processes, that need remedies in the form of quick fixes often conducted by the prinicpal carer of the comlex health child. It is important to recognise, however, that most errors happen as a result of the systems people work in, not the people who work in them. The task of being a leader in the NHS is not getting any easier or any less complex. In July 1993 the Institute of Directors in South Africa asked retired Supreme Court of South Africa judge Mervyn E. King to chair a committee on corporate governance. The King's Fund Library. It is also possible to encourage participation by using more formal measures – for example by including involvement in quality improvement as part of required professional development activities, or by visibly reporting data on performance between peers (Dixon-Woods et al 2012, 2011). Quality improvement in mental health. NHS Right Care (2010). Available at: www.renalreg.org/reports/2015-eighteenth-annual-report/ (accessed on 20 September 2017). Until we move away from culture of management and bring back culture of leadership and honesty and hold leaders to account patient, staff and NHS will continue to suffer. ‘Explaining Michigan: developing an ex post theory of a quality improvement program’. These include: Many NHS organisations have started to use quality improvement techniques in discrete projects. Available at: www.nao.org.uk/report/the-management-of-adult-diabetes-services-in-the-nhs-progress-review/ (accessed on 8 September 2017). Relationships and behaviours are just as important, if not more so. A smaller but growing number have developed more systematic, organisation-wide programmes to ensure that continuous improvement happens at scale (Ross and Naylor 2017). Suzie Bailey explores diversity in the NHS – and why there is still more to do. 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