Become Improvers and Innovators

“Effective improvement and innovation is all about people.” Staff need to feel involved in improving parts of the system they know best. When setting priorities for improvement you need to have quality planning and understand needs and assets from the customer’s perspective. Always engage with patients, their families and staff when making improvements to healthcare delivery. [The Scottish Government. Personalising Realistic Medicine: Chief Medical Officer for Scotland’s Annual Report 2017-18. Published 2019. https://www.gov.scot/publications/personalising-realistic-medicine-chief-medical-officer-scotland-annual-report-2017-2018/pages/7/]

Research has continued throughout the pandemic, with world leading COVID-19 research being conducted collaboratively across the UK. Research has encompassed drug and vaccine trials, the testing of new diagnostics, and clinical & observational studies. We must build on this momentum for change, continue to innovate and invest in research to advance our knowledge and practices. 

Near me, a video consulting service, has allowed delivery of care when face to face consultations weren’t possible. It has supported physical distancing by reducing the number of people attending services in person. It has supported personalised care by allowing patients to attend appointments at home and have someone join the video call with them. Near me also reduces the amount of time off work or study and cuts the amount of travelling resulting in greener healthcare. Overall,  people's experience of Near Me has been very positive as it offers choice in how they access services. Choosing Wisely BRAN questions (Benefits, Risks, Alternatives, Nothing) have been embedded into the Near Me virtual waiting room. By encouraging people to ask the BRAN questions they can become active partners in decisions about their care, and support them to make an informed choice.  [The Scottish Government. The Chief Medical Officer for Scotland’s Annual Report 2020-21: Recover, Restore, Renew. Published 2021. https://www.gov.scot/publications/cmo-annual-report-2020-21/ ]

Healthcare Improvement Scotland. iHub https://ihub.scot/ (accessed 08/10/2019)

 NHS Education for Scotland. Quality Improvement Zone TURAS Learn https://learn.nes.nhs.scot/741/quality-improvement-zone (accessed 08/10/2019)

Institute for Healthcare Improvement. IHI http://www.ihi.org/ (accessed 08/10/2019)

LAL, M.M., 2020. Innovative Nurse-Led Initiatives Improve Population Health. Journal of Nursing Administration, 50(2), pp. 59-60.
The evolving healthcare environment has put a new emphasis on population health. Healthcare organizations, and the nurses who work in them, are in a unique position to reach beyond hospital walls to address unmet needs and improve the health and lives of the community they serve. This month's Magnet Perspectives column examines nurses' growing impact on population health through the lens of the 2019 Magnet Prize winner, OSF HealthCare Saint Francis Medical Center. Learn how OSF Saint Francis nurses developed an innovative program to address food insecurity among their community's most vulnerable residents and improve health outcomes. The column also explores how American Nurses Credentialing Center Magnet-recognized organizations promote strong external partnerships that extend nurses' influence from the traditional one-patient-at-a-time approach to broader, population-based outreach.

LOCOCK, L., et al, 2020. Understanding how front-line staff use patient experience data for service improvement : an exploratory case study evaluation. Health Services and Delivery Research, 8(13), pp. (Marh 2020).
The NHS collects a large number of data on patient experience, but there are concerns that it does not use this information to improve care. This study explored whether or not and how front-line staff use patient experience data for service improvement. The most commonly cited barrier to using patient experience data was a lack of staff time to examine the data (75%), followed by cost (35%), lack of staff interest/support (21%) and too many data (21%). Before-and-after surveys of patient experience showed little statistically significant change. Staff were engaged in a process of sense-making from a range of formal and informal sources of intelligence. Survey data remain the most commonly recognised and used form of data. 'Soft' intelligence, such as patient stories, informal comments and daily ward experiences of staff, patients and family, also fed into staff's improvement plans, but they and the wider organisation may not recognise these as 'data'. Staff may lack confidence in using them for improvement. Staff could not always point to a specific source of patient experience 'data' that led to a particular project, and sometimes reported acting on what they felt they already knew needed changing. Some sites focused on staff motivation and experience on the assumption that this would improve patient experience through indirect cultural and attitudinal change, and by making staff feel empowered and supported. Staff participants identified several potential interlinked mechanisms: (1) motivated staff provide better care, (2) staff who feel taken seriously are more likely to be motivated, (3) involvement in quality improvement is itself motivating and (4) improving patient experience can directly improve staff experience. We propose 'team-based capital' in NHS settings as a key mechanism between the contexts in our case studies and observed outcomes. 'Capital' is the extent to which staff command varied practical, organisational and social resources that enable them to set agendas, drive process and implement change. These include not just material or economic resources, but also status, time, space, relational networks and influence. Teams involving a range of clinical and non-clinical staff from multiple disciplines and levels of seniority could assemble a greater range of capital; progress was generally greater when the team included individuals from the patient experience office. An online guide for NHS staff was produced in collaboration with The Point of Care Foundation.

NINEROLA A., et al, 2020. Quality improvement in healthcare: Six Sigma systematic review. Health Policy, 124(4), pp. 438-445.
Six Sigma has been widely used in the healthcare sector as a management tool to improve patient quality and safety. The objective of this study is to identify opportunities for its implementation through literature analysis. A literature review has been carried out since the first publication of Six Sigma in the sector appeared until 2017, 20 years in all. To this end, it has been used three databases: MEDLINE, Web of Science (Core Collection) and Scopus. Accordance with the 196 articles of our database, it is found that: (1) Six Sigma publications in healthcare sector have been carried out mostly in the USA, (2) multiple specialities and services have used this tool, among them, we can emphasize the operating room and radiology service, (3) the case study has been the most used methodology and, (4) the objectives are focused mainly on achieving reductions of time, costs and errors, for the improvement of the quality and the satisfaction of the patients. This review seeks to serve healthcare professionals to know the benefits that Six Sigma can generate in processes that take place in a health center, hospital or other organizations in the sector.

KNUDSEN, S.V., et al, 2019. Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Services Research, 19(1), pp. 683.
Of the 120 QI projects included, almost all reported improvement (98%). However, only 32 (27%) described a specific, quantitative aim and reached it. A total of 72 projects (60%) documented PDSA cycles sufficiently for inclusion in a full analysis of key features. Of these only three (4%) adhered to all four key methodological features. CONCLUSION: Even though a majority of the QI projects reported improvements, the widespread challenges with low adherence to key methodological features in the individual projects pose a challenge for the legitimacy of PDSA-based QI. This review indicates that there is a continued need for improvement in quality improvement methodology.

SALAMA J.S., et al, 2019. Innovating in healthcare delivery: A systematic review and a preference-based framework of patient and provider needs. BMJ Innovations, epub ahead of print
We conducted two systematic literature reviews to identify the needs of these stakeholders throughout healthcare delivery and developed a conceptual framework for innovating in healthcare. Our results reveal tension between patients' and providers' preferences across three major categories-treatment and outcomes, process of care and structure of care. Therefore, innovating in healthcare may be better understood as addressing the unmet needs of each stakeholder by easing or eliminating tensions between stakeholders. This conceptual framework may serve as a useful instrument for health policymakers, payers and innovators to alike make better decisions as they invest in healthcare innovations.