Embedding continuous improvement to achieve transformational change
Dr Amar Shah is the associate medical director for quality improvement and consultant forensic psychiatrist at East London NHS Foundation Trust
Amar Shah is associate medical director for quality improvement and consultant forensic psychiatrist at East London NHS Foundation Trust.
This series of blogs chronicles the journey of East London NHS Foundation Trust in embedding continuous improvement to achieve transformational change. This blog is brought to you by BMJ Quality. For more quality improvement resources go to quality.bmj.com
Every Sunday for the past 25 years, I’ve spent my morning volunteering as part of a registered charity in London. The charity runs activities for around 500 children every Sunday morning, with the mission to develop children into well-rounded citizens and leaders of tomorrow’s society. The charity operates primarily through a network of volunteers. Working in a team of passionate volunteers, and as a board level trustee for the last decade, I’ve learnt a lot about engaging people, bringing people together in a common cause, and sustaining their motivation. In our charity, our prime asset is our people – youngsters and adults who are giving up their free time on evenings and weekends to support our goal – running activities and mentoring our children, supporting their development into leaders.
Within the NHS, our situation isn’t too dissimilar. Our staff members are hugely passionate about making a difference, driven by the desire to improve outcomes for our patients and their families. We rely on the exceptional work of all our staff to deliver the quality of care that we, and our communities, aspire to. Routinely, this involves people going far beyond what is written in their job descriptions and contracts. This discretionary effort, so precious and valuable, needs to be recognised, valued, and carefully nurtured.
One of the beautiful aspects of quality improvement is that it is all about our staff; giving everyone a voice in making things better, flattening hierarchies, giving permission, and providing the space and skills for teams to test changes. Having worked at the frontline in six different NHS providers in the past 10 years, it’s clear that we face a common challenge. The people who are closest to our patients and families have little power, access to information, skills, freedom or space to make the improvements that would make a real difference.
My work within the charitable sector has shown to me the critical need for us, as leaders within the NHS, to focus on ‘creating the conditions’ that will allow our staff to provide high quality care and continuously improve as a team. Within East London NHS Foundation Trust, we’re committed to embedding this within our philosophy, and making continuous improvement part of our day job. We’re starting the journey of flipping the way we improve quality, from large scale top-down initiatives, to supporting each team to determine what matters to them and their patients. It’s a transformation in culture that will take time, but we’re working at pace and scale while making sure that QI isn’t seen as an add-on; it must be firmly embedded into the operating structures and philosophy of our organisation.
For more information about East London’s QI programme, visit http://qi.eastlondon.nhs.uk