NHS Confed and the Health Foundation share practical improvement lessons to cope with winter pressures

NHS Confederation and the Health Foundation have shared their six improvement lessons to support leaders and teams with winter pressures through a blog by Penny Pereira, Q Managing Director for the Health Foundation, and Dr Amar Shah, Consultant Forensic Psychiatrist and Chief Quality Officer at East London NHS Foundation Trust.

Here, we’ll take a look at the six lessons, focusing on digital and data where relevant.

For the first lesson, they explain how it is important to keep leadership focus on empowering and improving the frontline. Noting that ‘top-down clarity and bottom-up agency’ helped to enable innovation during the pandemic, Pereira and Shah add that “now is the time, in a fast-changing context, to support and empower people to solve problems as close to possible as when and where they occur”.

They emphasise that all organisations and local systems have people with systems thinking and improvement science skills who can support frontline teams; in order to make use of their expertise, leaders must ensure that they know where these skills are and how they are being nurtured.

The blog adds, “as a leader, you can signal you have confidence in staff to find the best available solutions: ask questions that encourage rapid and robust diagnoses of issues, and testing of solutions.”

The second lesson focuses on ‘improvement methods for rapid priority setting and problem solving’. “Done well, improvement enables problem-solving that is rapid and rigorous, and more sustainable and innovative, than top-down decision-making or traditional performance management,” the blog states. It continues that good application of improvement can help in defining priorities, which is increasingly important at times of high pressure.

The blog shares five improvement methods shown to be useful in the pandemic, including: flow charts and process maps, real-time measurement to help support the rapid decision-making; rapid cycles of testing; and tools such as system mapping, stakeholder engagement, co-production and more radical redesign approaches can help to build on short-term learning and change made during a crisis.

Lesson three, ‘capture, circulate and act on emerging learning’, the authors state that there are a range of efficient methods to build a collaborative and problem-solving culture. Examples include using huddles for quick connection between teams and following the Flow Coaching Academy’s ‘Big Room’ processes for work on complex challenges over time.

Build your response around existing innovations, is lesson four. Here, the authors underline how leaders and teams must focus their winter response on positive service changes to see longer term fixes, not short-term fixes. Work undertaken by Q Health and the Health Foundation on staff attitudes to technology shows that “behaviours can shift and organisations can see rapid innovation when circumstances force new patterns of working.” The blog states that it is important to take note of where further work is needed to “assess, adapt and embed changes introduced in crisis circumstance: don’t assume they can simply be extended.”

The blog highlights implementing new models of care, embedding virtual consultations, shifting to remote care, and to expand different models of outpatient follow up and preventative care, as some of the recommendations.

“Many of the biggest needs and opportunities are the interface between services,” they say, adding that leaders should invest in creating conditions for collaborations during crisis in order to provide a foundation for long-term service delivery and transformation.

Lesson five, ‘use safety science to manage risk positively’, notes that “times of particular operational pressure will surface many risks”. People with expertise in safety science should be encouraged to think about where attention should be focused, and the ideas and approaches particularly needed in a crisis context. “Consider where this attention should take priority over routine work,” the authors say, “but maintain data collection if you can.”

Lesson six focuses on people. “The evidence is stark,” the authors write, “those organisations that have the highest staff engagement also have better operational and financial performance.”

It is recommended that teams take a step back and adopt a systems view and problem-solving approach, providing the time to think critically, examine the situation from different perspectives, and consider change ideas.

To find out more please visit the NHS Confederation website here.

Citation: NHS Confederation (2022), Six improvement lessons to apply as winter pressures bite.