Beyond scented candles and quick fixes

Source: NHE Jan/Feb 18

Joni Jabbal, researcher at The King’s Fund, asks why quality improvements and innovations are failing to be adopted by the NHS.

There is now good evidence that embedding a quality improvement approach – where you systematically empower frontline staff to continually test iterative change – has considerable benefits for organisations. If this approach is so effective, why is it not happening widely in the NHS?

The first problem is that quality improvement has an image problem. It is all too often seen as being about “unicorns and scented candles” rather than being a genuine vehicle for performance improvement which, unsurprisingly, can be off-putting for leaders who are focused on results.

The second problem is that, contrary to its image, implementing quality improvement is hard to do, and requires tough choices and leaders who are prepared to hold their nerve. It also represents a fundamental challenge to many people’s concept of what being a leader is, both within organisations and at national level.

This is because embedding quality improvement into the fabric of the NHS requires a fundamental shift in the role of leadership at all levels. At organisational level, this means leaders moving from being ‘problem-solvers,’ a role they often feel comfortable with, to enablers of change. Rather than imposing improvement programmes from the top of the organisation, leaders need to learn to empower staff to develop solutions that they are able to own and feel proud of.

Giving staff the freedom to test solutions

It means giving permission, space, skills, and trust to staff. It requires a mutual exchange of ‘gives and gets’ (roles and responsibilities of staff and the organisation), which amount to a formal ‘compact’ between an organisation and its staff. This includes giving staff and teams the permission to try and test solutions to problems, having a clear and agreed vision for the organisation to achieve high-quality care, and ensuring staff have adequate time to dedicate to quality and safety activities.

The personal energy and effort leaders need to put into building capacity and capabilities for quality improvement should not be underestimated. If you are not used to leading in this way, then change can be personally tough.

A new compact is just as important at national level. Too often, external performance management creates a culture of compliance and risk aversion in NHS organisations and, at its worst, this disempowers those working in organisations and creates an overreliance on central guidance. This is the opposite of what is needed for quality improvement.

Instead, providers need to be adequately supported by the national bodies to focus on their improvement journey. Again, this means agreeing mutual roles and responsibilities, including a shared realism about what quality improvement approaches can deliver in the face of funding pressures and workforce shortages.

Above all, it means a joint commitment to a 10- to 15-year journey and the determination not to be blown off course by the next month’s performance numbers. As one NHS trust CEO we spoke to put it, the role of national bodies “may be to remove barriers to improvement, not to be the organisation that comes in with top-down solutions and tells you how to deliver care.”

If all this sounds very difficult, then that’s because it is. So you can understand why for every chief executive put off by the ‘unicorns and scented candles’ image, there is another who can see the benefit of quality improvement but puts it in the ‘too difficult’ box.

But while quality improvement is not an easy option or a quick fix, it is the right thing to do. Organisations that provide the training, time and support to allow those at the frontline to flourish will, in turn, see their long-term organisational performance flourish as a result. Above all, introducing and sustaining a quality improvement approach can unlock more efficient and high-quality services, but this requires both bravery and commitment from senior leaders at organisation and national levels.


Top image © Peopleimages



There are no comments. Why not be the first?

Add your comment


national health executive tv

more videos >

latest healthcare news

Councillors fear identity crisis following CCG merger

22/06/2018Councillors fear identity crisis following CCG merger

Members of one of Kent’s leading councils have voiced their concerns against an upcoming merger between CCGs in the area. Cllr Wendy P... more >
Top NHS England boss to leave the organisation

22/06/2018Top NHS England boss to leave the organisation

NHS England’s chief financial officer will leave the post after 11 years. Paul Baumann CBE, who joined NHS London in 2007, and took up... more >
Most urgent primary care services ‘good’ or ‘outstanding’

22/06/2018Most urgent primary care services ‘good’ or ‘outstanding’

Over eight in 10 primary care services are providing good care, despite mounting work force and commissioning pressures, the CQC has said. A... more >
681 149x260 NHE Subscribe button

the scalpel's daily blog

The impact of NICE on cardiovascular disease prevention

06/06/2018The impact of NICE on cardiovascular disease prevention

Professor Gillian Leng, deputy chief executive and director Health and Social Care at NICE, looks into what can be done to decrease cardiovascular disease nationally and how to prevent missed opportunities in the future. Cardiovascular disease (CVD) accounts for just over a quarter of deaths and affects around 7 million people in the UK. Risk factors for CVD include smoking, obesity, mental illness, physical inactivity, and long-term fa... more >
read more blog posts from 'the scalpel' >


Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >
Tackling infection prevention locally

04/10/2017Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a boar... more >
Scan4Safety: benefits across the whole supply chain

02/10/2017Scan4Safety: benefits across the whole supply chain

NHE interviews Gillian Fox, head of eProcurement (Scan4Safety) programme at NHS Supply Chain. How has the Scan4Safety initiative evolved sin... more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... more > more last word articles >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

health service focus

Isosec launches first Virtual Smartcard to revolutionise NHS authentication

12/02/2018Isosec launches first Virtual Smartcard to revolutionise NHS authentication

ADVERTISEMENT FEATURE A new virtual smartc... more >
Health creation is here to stay

09/02/2018Health creation is here to stay

NHE’s Sacha Rowlands speaks to Michael ... more >