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/]

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)

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 per cent), followed by cost (35%), lack of staff interest/support (21 per cent) and too many data (21 per cent). 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.

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.