Institute for Healthcare Improvement website. that remain are of the 'old guard' who's only objective is to self 'motivate' others into their way of thinking' enabling others 2 join their 'group' of 'self preservation at all costs, 'integration' is not really understood or indeed mentioned in this REPORT. All of the examples have received some funding or support from The Health Foundation. The King's Fund is an independent charity working to improve health and care in England. Improving quality and reducing costs are sometimes seen as conflicting aims. Academy of Medical Royal Colleges (2016). Healthcare Quality Improvement Partnership website. This underlines the benefit of taking a ‘whole-system’ approach to improving quality and delivering better value. Powell A, Rushmer R, Davies H (2009). Examples of overuse can be found across the NHS – including the overuse of some acute hospital services, overdiagnosis and overuse of diagnostic tests, and overprescribing of drugs. Improving quality in the English NHS: a strategy for action. Dec 28, 2020. Available at: www.health.org.uk/publication/improving-patient-flow (accessed on 8 September 2017). Armstrong et al (2013) identify a number of tips for successful patient involvement in improvement projects, including (but not limited to): A range of tools and approaches can also be used to help achieve these aims, such as the Patient and family-centred care toolkit. Available at:   http://qualitysafety.bmj.com/content/early/2017/07/07/bmjqs-2016-006433 (accessed on 27 September 2017). So too have changes in government policy on the approach to NHS improvement and reform (Ham 2015). The King’s Fund. Available at: http://fingertips.phe.org.uk/profile/atlas-of-variation (accessed on 8 September 2017). Dixon-Woods M, McNicol S, Martin G (2012). They starve either because they cannot eat or cannot absorb the nutrients from a normal diet. A framework from the Institute of Medicine defines six domains of health care quality (Institute of Medicine 2001). Available at: http://qualitysafety.bmj.com/content/25/7/509 (accessed on 8 September 2017). The NHS five year forward view (Forward View) is the national plan for improving services in the NHS in England (NHS England et al 2014). BMJ Quality & Safety, vol 23, no 2, pp 106–15. Data for 2015/16 shows that around 63.5 per cent of people with type 1 diabetes and 46.3 per cent of people with type 2 diabetes did not receive all nine care processes that could reduce complications related to their condition (NHS Digital 2017). The Institute for Healthcare Improvement has suggested that organisations aiming to improve value should distinguish between the ‘light green dollars’ (potential savings) and ‘dark green dollars’ (actual savings) that result from a quality improvement project, and understand how the former can be converted to the latter (Institute for Healthcare Improvement undated). Monitor (2013). By Suzie Bailey, Michael West - 30 April 2020, By Yvonne Coghill, Director of the WRES Implementation Team at NHS England - 14 February 2020. Public Health England website. This report is based on a survey of NHS trusts and foundation trusts carried out by NHS Providers in late 2017, qualitative interviews and a roundtable event with frontline leaders and national stakeholders. But it can be difficult to know how this should be done in practice. Our report examines the approach being taken by some clinical commissioning groups (CCGs) and local systems where traditional notions of commissioning are no longer guiding their way of working. Health care organisations must create a culture and environment that supports the delivery of high-quality, continually improving care. For each example, we summarise the problem being addressed, the methods used to improve quality and some of the benefits that are being delivered (using data reported from the sites). National Institute for Cardiovascular Outcomes Research (NICOR) (2017). Subscribe to our email newsletter and follow @TheKingsFund on Twitter to see new content as it's published, along with our other news. Getting the measure of quality: opportunities and challenges. Meanwhile, people with dementia and their carers helped to co-design the core elements of the Dementia Golden Ticket model of care (example 5). These provide a starting point for leaders seeking to embed quality improvement in their work. Kerr M, Bray B, Medcalf J, O’Donoghue DJ, Matthews B (2012). Dixon-Woods M, Pronovost P (2016). This could include refreshing directors’ portfolios at regular intervals and exploring opportunities for less experienced members of staff to participate in projects that would develop their board-level skills. There are a range of different methods and tools, such as Lean, Six Sigma and the Institute for Healthcare Improvement’s Model for Improvement. Sustained change is more likely to happen in an environment where staff across an organisation can reflect on how things are done now and think about how they could be done better in the future. Rather than searching for magic-bullet solutions, leaders should focus on developing the processes, systems and cultures to support the delivery of high-quality care on a continuous basis (Dixon-Woods and Martin 2016). The report praises the fact that entrepreneurship is “alive and well in the NHS” but it highlights the barriers innovators are facing. Another improvement may save money for one NHS organisation but shift costs elsewhere, while others may expose a new cost that was previously being met outside the health system. The NHS atlas of variation in healthcare: reducing unwarranted variation to increase value and improve quality [online]. Some NHS organisations that have adopted a systematic approach to quality improvement and invested in developing the skills and capabilities of frontline staff have demonstrated increases in staff satisfaction and retention rates and lower sickness and absence rates (Ross and Naylor 2017; Jones and Woodhead 2015). The ERF is a key policy instrument that the government has relied on since 2014 to encourage the uptake of abatement technology in Australia. The plans are broad in scope, proposing changes in all parts of the NHS by 2021 (Alderwick and Ham 2017). A case in point is the PROMPT training programme (example 4). Washington, DC: National Academies Press. Organisations with the most significant performance challenges experience higher levels of leadership churn. Available at: www.health.org.uk/publication/context-successful-quality-improvement (accessed on 8 September 2017). Available at: www.ncbi.nlm.nih.gov/pubmed/25077248 (accessed on 8 September 2017). The NHS, like all other health care systems across the world, sometimes fails to deliver high-quality care. In this honest account of the realities of leadership in today's NHS, Nick Timmins talks to 12 departing. These things do not happen by accident. James C, Savitz LA (2011). A reduced appetite for risk was mentioned as a factor in the appointment process by both applicants and decision-makers for director-level posts. The Getting It Right First Time (GIRFT) programme aims to bring about higher-quality care in hospitals, at lower cost, by reducing unwanted variations in services and practices. These are the TRUE LEADERS. King's Funds Inc Overview. We need to make these roles more attractive. Delivering and sustaining change in a few key areas, and working first with a small cohort of volunteers, can help to generate momentum and provide a platform for the roll-out of an organisation-wide programme (Jones and Woodhead 2015). Senge P, Hamilton H, Kania J (2015). Kidney Care UK website. London: The Health Foundation. Mental Health and Primary Care Networks finds that current provision of mental health support in general practice is variable and often inadequate. Overuse is bad for people receiving care because they get services that might cause them harm, or at least waste their time or cause unnecessary stress and anxiety. Tackling variations in clinical care: assessing the Getting It Right First Time (GIRFT) programme. Boards and executive teams also need to have a good understanding of how change happens in complex systems (see the subsection ‘Make quality improvement a leadership priority for boards’ above). Available at: www.nejm.org/doi/full/10.1056/NEJMp1606458 (accessed on 8 September 2017). London: Faculty of Medical Leadership and Management. High quality care for all: NHS next stage review final report. Until we move away from culture of management and bring back culture of leadership and honesty and hold leaders to account patient, staff and NHS will continue to suffer. One important lesson from organisations that have successfully built improvement capability at scale is to avoid doing too much, too quickly. improving the broader health and wellbeing of the population, giving all staff the opportunity to contribute and act on ideas for improvement, using many small-scale trials and tests as a way to learn and improve, ensuring a continuous focus on the needs and experiences of the people served by the system (, having clear goals for improving quality (and making them a top priority), regularly reviewing quality performance in meetings. ‘The model for understanding success in quality (MUSIQ): building a theory of context in healthcare quality improvement’. Enhanced health in care homes: vanguard learning guide: EHCH element 4.2: high-quality dementia care [online]. The five examples given above represent pockets of innovation in particular areas. A systematic narrative review of quality improvement models in health care. Despite differences in terminology, all of these methods draw on a similar set of tools and principles (such as rapid cycles of testing). The King’s Fund has identified a large and growing gap between capacity and demand in district nursing services, with staff reporting feeling ‘broken’, ‘exhausted’ and ‘on their knees’. National heart failure audit April 2015–March 2016 [online]. A ‘revolving door’ approach to leadership also undermines the credibility leaders have with staff in their own organisations and with external stakeholders. It is also important to understand what is likely to motivate clinicians to change their practices – critically, their intrinsic motivation to improve quality of care for their patients (rather than improving efficiency or cutting costs). In this section, we draw on relevant evidence and experience from the literature, and the examples given, to highlight 10 key lessons for NHS leaders seeking to embed quality improvement within their local systems. ‘Sustainability and transformation plans for the NHS in England: what do they say and what happens next?’. NHS England (2017b). The NHS is facing significant financial and operational pressures, with services struggling to maintain standards of care. All NHS organisations in England are required to improve the quality of the care they deliver. They face several barriers – including a lack of time and resources and a lack of knowledge and skills for quality improvement. Northumbria Healthcare NHS Foundation Trust’s care home-based medicines optimisation project, which led to reductions in the level of overprescribing and inappropriate medications, was driven by a desire to ensure that care home residents and their families were fully involved in medication decisions (example 3). Health Expectations, vol 16, no 3, pp e36–e47. Crossing the quality chasm: a new health system for the 21st century. Milbank Quarterly, vol 88, no 4, pp 500–59. In the absence of a way to de-risk this appointment of candidates with a varied backgrounds, appointing someone who is well networked in the current establishment (or has a similar background) seems the course of action for which a board will be least open to criticism. Funding Report for Week Ending 1/3/2021. Kidney Care UK (2017). Intelligent use of data is central to any efforts to improve quality. As pressures on services have increased and NHS organisations are called on to work more collaboratively, levels of leadership vacancies and leadership churn continue to pose problems. In some cases, they have done so without the explicit support or encouragement of senior leaders within their organisation, or without any meaningful resources (Bohmer 2016). Place-based systems of care: a way forward for the NHS in England. NHS England (2015). ‘Estimating the financial cost of chronic kidney disease to the NHS in England’. Developing new care models for people with multiple long-term conditions, for example, may depend on collaboration between primary and community services, acute hospitals, mental health and social services, as well as services outside the health and care system (such as housing and employment services). There was little evidence that there is a coherent national strategy for supporting the most challenged trusts, which often have the highest levels of leadership churn. Funding Reports Funding Report for Week Ending 1/10/2021. The level of exposure is higher than it's ever been and the knee-jerk response from ‘the centre’ is one of ‘decapitation’ as the first option… You’re just a quarter away from financial failure and performance failure before you get sacked. Turning to tenure, 54 per cent of substantive executive directors were appointed in the past three years (2015 to 2017) and the average (median) tenure was only two years. Leaders must also work between organisations to develop new care models and co-ordinate improvements. International Journal for Quality in Health Care, pp 1–8. London: The King’s Fund. It is important to recognise, however, that most errors happen as a result of the systems people work in, not the people who work in them. It uses national data to identify variation, shares that data with the local staff involved in running and delivering the services (including clinicians, clinical and medical directors, managers and chief executives) and monitors the changes that are implemented. Home; Headlines; Survey; NHS Performance Data; About the QMR; QMR 15 | April 2015 Share on Twitter; Share on Facebook ; Share on LinkedIn; How is the NHS performing? Available at: www.kingsfund.org.uk/publications/quality-district-nursing (accessed on 8 September 2017). the work ahead for organisations tackling deep-rooted, long-standing inequalities. Available at: http://content.healthaffairs.org/content/22/2/17.long (accessed on 8 September 2017). The views in the report are the author’s and all conclusions are the author’s own. Washington, DC: National Academies Press. These and other examples highlight the types of opportunities available in the NHS to improve quality of care and make better use of resources. Early identification of patients at risk of developing end-stage kidney disease: Heart of England NHS Foundation Trust. This content relates to the following topics: This report by The King's Fund has been co-authored with The Health Foundation. A smaller but growing number have developed more systematic, organisation-wide programmes to ensure that continuous improvement happens at scale (Ross and Naylor 2017). Future Hospital Journal, vol 3, no 3, pp 191–4. Quality improvement – the use of methods and tools to continuously improve quality of care and outcomes for patients – should be at the heart of local plans for redesigning NHS services. Leadership is all about honesty, sincerity, kindness, compassion and clear accountability and courage. The challenge now lies in delivering the plans and making tangible improvements in NHS care as a result. The King’s Fund programme, Enhancing the Healing Environment, worked with almost 30 hospitals and 35 hospices to support the design of healing environments, many with a strong focus on gardens. London: The Health Foundation. More than 700,000 nurses and midwives working in health and social care are subject to work conditions that in many cases will … Alderwick H, Ham C (2017). Jan 3, 2021. 4,300 were here. ‘Conceptualizing and assessing improvement capability: a review’. This report, commissioned by the RCN Foundation, explores the causes and consequences of poor mental health and wellbeing among nurses and midwives, and seeks to identify solutions to these issues and examples of good practice. The QMR is now published on The King’s Fund website, but old editions can be accessed in the archive below. There needs to be a more modern approach to partnership working across the system which involves remodelling of the work being done and redone at the frontline which I would like to be part of modernising. London: The King’s Fund. Kaplan HC, Provost LP, Froehle CM, Margolis PA (2012). Working as a system can also be key to spreading improvements in quality. Available at: www.rpharms.com/making-a-difference/projects-and-campaigns/pharmacists-improving-care-in-care-homes (accessed on 20 September 2017). Higher vacancy rates and shorter tenures were found in trusts experiencing the most challenged levels of performance. This will help bring quality patient care further forward into the 21st century. NHS leadership is insular. London: The Health Foundation. Royal Pharmaceutical Society website. Quality improvement – training for better outcomes [online]. Leadership vacancies in NHS trusts remain widespread with 37 per cent of all surveyed trusts having at least one vacant post for a board-level executive. One vital area not touched on which if given sufficient strong membership could be a real power house for change, is the public in the role of hospital Governors. This section uses five examples to illustrate how quality improvement approaches are being used by teams and organisations in different parts of the NHS in England to improve care and value for money. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC4292097/ (accessed on 20 September 2017). The King IV Report is dedicated to all those from the King Committee and outside it, even beyond the borders of South Africa, who so generously gave of their time and knowledge to contribute to the development of its content. However, it is important to prepare the ground carefully. 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