The reality of change in the NHS: making the most of improvement approaches

As the Secretary of State for Health and Social Care acknowledges, there’s long-standing consensus about the big shifts needed in health care, but successive governments have failed to deliver. In his report, Lord Darzi confronted the dizzying range and depth of change needed to get the health service truly fit for the future. There’s a lot riding on the eagerly awaited 10-Year Health Plan. 

Yet, as we explored in the Health Foundation’s webinar, it’s the approach to implementation that will make or break the impact of the plan and the new government’s ability to fix the NHS. There’s a need and opportunity to set clearer priorities and reform targets, payment systems and regulation, but this will make limited difference without also supporting the NHS’s capacity to improve in response. Given the distributed nature of health care, it is particularly critical to enable local leaders to shape implementation and effectively engage staff, equipping them to lead change. 

Improvement approaches offer practical, inclusive ways to involve people in the process of change. As the evidence shows, where used well, these approaches can boost staff morale and teamwork while also improving processes and outcomes for organisations. Nearly 6,000 people from all parts of health and care have now joined the Health Foundation’s Q community to collaborate around service improvement. The breadth of success had with improvement methods shows their broad relevance. Yet many organisations still only use them in the margins, on a small scale. 

The government’s health mission needs thousands of teams in hundreds of organisations to have the licence and means to do things differently. The Health Foundation, Q, THIS Institute, the BMJ and others have supported and documented many examples of the critical role improvement can play. We now know what’s needed to bring these methods to the mainstream of how organisations and systems deliver. Here, we outline the action needed in four areas to realise the potential of improvement methods at scale. 

Improvement approaches should be central to delivering the strategic shifts needed to sustainably improve care quality for all. Take, for example, the shift from analogue to digital. Improvement science offers proven ways to understand existing services and redesign roles and processes to embed new technology. As research has shown, staff and patient trust and confidence can be a barrier to how much people use new technology. Improvement approaches can address both the delivery process and human elements of any technological innovation, making changes more likely to be secured, supported and sustained. 

As those who work in the health sector know, shifts that sound simple in a headline can in reality require redesigning dozens of interconnecting clinical and supporting processes. Staff need to see changes introduced thoughtfully, in ways that maintain care quality. There’s now plentiful evidence of improvement approaches improving the reliability of care processes and pathways. Improvement provides mechanisms to safely and sustainably target scarce resources to reduce waits and evolve care models within the financial constraints facing the sector. The transformation challenge is to not just deliver the big shifts but to do so in a way that provides better value for the taxpayer, systematically stopping what’s not working to release resources. Improvement approaches help with making difficult choices and optimising productivity in ways staff will support. 

While improvement uses the expertise of front-line teams to inform change, there are limits to what can be expected of them without support. Organisations and systems must become capable of enabling the scale of transformation to come. NHS England’s move to introduce NHS IMPACT reflects a broader shift in the improvement world from isolated projects to embedding improvement as part of an approach to overall organisational delivery. 

Strengthening the ability of organisations to deliver ​‘reform from within’ is critical if staff are to see their efforts to improve flourish at scale. This can also help rebalance a sector Darzi noted has come to rely disproportionately on external regulation and assurance. Q provides a range of resources for those on this journey, collating the evidence and examples needed. NHS Providers has supported organisations to develop trust-wide approaches to improvement and, in partnership with Q, is testing development support for boards.

Securing improved performance one organisation at a time is necessary but not sufficient. Moving from care to prevention and from treatment to health will require effective collaboration by people across the NHS, local government and communities. A partnership between the Health Foundation, Q community and NHS Confederation has developed an approach to enable effective transformation across whole systems. We are supporting peer learning and spotlighting improvement done well through our Leading Improvement in Health and Care podcast. The latest episode explores how to mobilise change in the light of the 10-year plan. 

Health secretary Wes Streeting is calling for the public, staff and experts to be ​‘at the centre of reimagining the NHS’. Improvement approaches provide the means to move beyond imagination to reality. 

This piece was first published on The Health Foundation’s’ website.