Dr Peter Chamberlain GP and Commissioner at South Sefton Clinical Commissioning Group
What do highly performing organisations have in common? From Team Sky to Salford Royal, growing evidence suggests that it’s organisations’ ability to run a slick and effective ‘learning system’, providing the mechanism to sustain continual improvement. As put by Professor Steve Spear of MIT, “today’s leading organisations outrace their competition by outlearning them.”
But before we rush to think that having a super learning system guarantees success, the system itself is only one of three factors needed to maximize improvement. Also needed is the right cultural and infrastructure ingredients, such as compassionate leadership and the integration of clinical work with informatics. Organisations then need to base these essentials on the right principles, most notably in healthcare that their work is firmly person-centred.
How organisations develop across all three areas is what’s fascinated me across my career. It’s what I’ve learnt from my time as a GP and clinical commissioner on Merseyside, as well as my time studying 15 high performing organisations as part of a fellowship at the Institute for Healthcare Improvement in Boston, Massachusetts
What I've seen time and again is how hard it can be for organisations not at the leading edge to translate what can be quite abstract concepts into reality. What specific, pragmatic initiatives can and should an organisation be doing to bring these ideas to life?
To try and help, I devised the Quality Improvement Building Blocks Framework, shown below. The aim being simply to support organisations to think through how they need to develop in order to improve. Underpinning the 3 layers and 12 building blocks are 60 specific pragmatic development areas (not shown) which organisations can focus on.
The framework draws on interviews and iterative presentations to quality experts around the globe, as well as a range of other frameworks and training programmes in quality improvement. It’s now been tested with a range of organisations in the North West, working with the Advancing Quality Alliance.
It’s not a silver bullet: it focusses on organisational development to facilitate continuous quality improvement and can’t negate the need for adequate funding, staffing, clinical training and due diligence procedures.
However, it’s striking how often struggling organisations will not have the middle layer of the framework (cultural and infrastructure essentials) in place. In such circumstances, regardless of best intentions, quality assurance processes (such as performance management and regulation) simply don’t achieve the intended results. As a consequence, commissioners, provider leads and staff at the point of care get increasingly frustrated and desperate.
It’s in situations like that where the framework can be helpful to steer an organisation’s development. Through trial and error, we’ve found three different ways for organisations to use the framework, ranging from the (relatively) quick, to the long-term:
‘Dialogic’ / jigsaw – framing the conversation in helping everyone understand what key concepts exist and how they fit together.
‘Directive’ / explanatory guidance document – unpacking core concepts of each building block with evidence and examples of application to deepen awareness of those in responsibility eager to progress.
‘Diagnostic’/ full framework – pragmatic longitudinal organisational development tool to complement coaching and a quality strategy in contributing to achieving high performing status.
In true quality improvement fashion, the framework is still undergoing testing and support information is building. Our learning is that a number of prerequisites are required for the framework to gain full impact. These include valuing of quality improvement methodology, executive support, senior leadership capacity to address development areas, and the mechanisms throughout with the organisation to facilitate readiness for change.
Many of the concepts in the framework will be new to NHS clinicians and managers for whom such aspects never made it to part of their core training. As a result we have found quality expertise and coaching helpful and in some cases essential to guide those new to the respective concepts. However, the framework also takes organisations from where they are at and can flexibly work and walk alongside the improvement journey.
We believe the framework is fit for real world organisations that experience real world pressure and hope that with further collaboration alongside regional and national bodies that it will be scalable for use across the NHS.