It’s time to put on hold our improvement efforts. Money is too tight. We should protect services today rather than getting distracted by tomorrow. Improvement is a great idea, don’t get me wrong, but now’s not the time.
Fortunately, the 40 of us gathered in a packed room in Harrogate didn’t think this. We were all there because we saw improvement methodologies and approaches as a necessity, not a nice-to have, in how the NHS responds to the most prolonged period of financial constraint it has ever faced. When future generations look back on this time, how can we ensure that improvement is a key part of that story? The Harrogate 40 were here to help us design a programme of work for the UK Improvement Alliance of work on improvement in an age of austerity. What should we focus on? How should we go about it?
Three clear themes of agreement emerged.
First, the importance of improving how we evaluate and measure improvement interventions was clear. If we want improvement teams, projects, resource to be protected and indeed increased, we need to be able to show results both in terms of quality and finance.
Second, conversation turned to who wasn’t in the room. Where were those working in finance, or members of the Board? (They may reply, where were you when we were getting together?) How can we have conversations which cut across these boundaries?
Third, how can we sell what we do in improvement better? If others have the perception outlined in the first paragraph above, is that their fault – or ours’? It was striking that, over six years after NHS budgets first felt serious squeeze, no-one was able to share stories of having achieved great success in making the improvement case.
But we also disagreed. One strand of thought focused on how we share information about projects; a new database needed, or existing databases made better, or streamlined, or a hub created, or a repository of everything people need to know.
Absolutely not said a range of others; we’ve tried this, it doesn’t help (they exist already, but here we still are). Yes, we need sharing, but not of words on a website. The sharing we need is of people, connections, experiences; how do we do this?
There’s not a single right answer as to what we should do. But through 75 minutes of frenetic discussion, an idea has emerged.
What if we were to make our primary weapon the power of the personal connection. Not scatter-gun, not random, but laser targeted linking up of people to help co-design solutions which will work in their circumstance.
This could be within organisations – prioritising ways to bridge boundaries between improvement and finance. How to do this? In line with the spirit of the conference, let’s take a positive deviance approach and find an organisation where joint conversations have been brokered, and learn from how this happened. While we’re at it, let’s find ways for organisations to get round having separate teams for improvement and efficiency (call it ‘better patient care’ as one participant suggested).
But also let’s prioritise the personal connection between organisations. This is the focus of our work in the UKIA, and also the outstanding Q network. What would be new with regards to improvement in austerity? One option is to look at staff who regularly move between different trusts (junior doctors as a starting point?), and support and empower them to act as sharers-in-chief, highlighting and brokering conversations with regards to how different organisations eliminate waste, promote efficiency, and prioritise improvement.
This is not – and could never be – the whole answer. This brings us to the last part of this plan. Any plan operated by the UKIA, or even the whole improvement community, in isolation will fail – the problem’s too big. So how do we build alliances with others: networks, charities, providers, patient groups, to make sure what we do complements and mutually supports each other. This is not easy – but essential. So. What do you think?