But more could be done to extend these leadership and development offers to the other professional roles experiencing high churn and where there are concerns about the pipeline of future leaders. More and better mental health support is needed in GP surgeries in the wake of Covid-19, according to a report published today by The King’s Fund and Centre for Mental Health. Available at: http://content.healthaffairs.org/content/22/2/17.long (accessed on 8 September 2017). But the most common suggestion for improving the development of future leaders focused on the need for better regional talent management, similar to that previously provided by strategic health authorities. So too have changes in government policy on the approach to NHS improvement and reform (Ham 2015). The NHS is facing significant financial and operational pressures, with services struggling to maintain standards of care. Available at: http://fingertips.phe.org.uk/profile/atlas-of-variation (accessed on 8 September 2017). Available at: http://fingertips.phe.org.uk/profile/atlas-of-variation (accessed on 8 September 2017). Local NHS trusts should also invest in seeking out and developing future leaders. Sutton Clinical Commissioning Group website. Available at:   http://qualitysafety.bmj.com/content/early/2017/07/07/bmjqs-2016-006433 (accessed on 27 September 2017). Funding Report for December 2020. Read more → 53% of trust finance directors said that quality of care in their local area has worsened in the past year. Crossing the quality chasm: a new health system for the 21st century. It is also possible to encourage participation by using more formal measures – for example by including involvement in quality improvement as part of required professional development activities, or by visibly reporting data on performance between peers (Dixon-Woods et al 2012, 2011). The 2nd atlas of variation in NHS diagnostic services in England: reducing unwarranted variation to improve health outcomes and value [online]. Available at: http://webarchive.nationalarchives.gov.uk/20150317164830/http://www.nhsiq.nhs.uk/resource-search/publications/quality-improvement-theory-and-practice-in-healthcare.aspx (accessed on 18 September 2017). Numerous studies have found an association between board commitment to quality improvement and quality of care within their organisations (Jones et al 2017; Tsai et al 2015; Jha and Epstein 2010; Jiang et al 2009, 2008). NHS England (2017a). NHS leaders – and boards in particular – have a vital role to play in creating a supportive environment for quality improvement within their organisation – for example by providing a clear vision and objectives for improving quality and putting in place the capabilities and support needed for staff to improve services. These are the TRUE LEADERS. Available at: www.ncbi.nlm.nih.gov/pubmed/22815543 (accessed on 20 September 2017). Jiang HJ, Lockee C, Bass K, Fraser I (2009). Learn More public. Available at: www.health.org.uk/publication/building-foundations-improvement (accessed on 8 September 2017). Journal of Geriatric Cardiology, vol 11, no 4, pp 329–37. Share responsibility for quality improvement with leaders at all levels. To tackle high leadership churn, national programmes should target professional roles where concerns over the pipeline of future leaders is greatest. Understanding NHS financial pressures: how are they affecting patient care? The report praises the fact that entrepreneurship is “alive and well in the NHS” but it highlights the barriers innovators are facing. The potential benefit is even greater if quality improvement techniques are applied consistently and systematically across organisations and systems. Effective quality improvement requires much more than just the technical use of tools and models such as those listed in the subsection ‘Have a consistent and coherent approach to quality improvement’. Develop the skills and capabilities for improvement. There are many examples across the NHS showing that even relatively small-scale quality improvement initiatives can lead to significant benefits for patients and staff, while also delivering better value. Frontline staff engaged in quality improvement need to be given the skills required to identify quality problems, carry out tests of change, measure their impact and act on the results. The challenge and potential of whole system flow. The term ‘quality improvement’ refers to the systematic use of methods and tools to try to continuously improve quality of care and outcomes for patients. Tackling variations in clinical care: assessing the Getting It Right First Time (GIRFT) programme. It is no use a challenged Trust looking for an "experienced" COO/Director of Finance as there is little incentive for a high-performing COO/DoF to leave a stable Trust to take over at a smaller / challenged Trust. We need national support and air cover for difficult tasks if we are going to have a chance of turning things around. A review of the literature on healthcare professionals’ views on quality improvement initiatives. There is acute shortage of doctors and nurses and rota gap is huge. Leadership for improvement must be distributed within organisations. Effective networks for improvement: developing and managing effective networks to support quality improvement. Improving quality of care is complex and takes time to achieve. While there are many different approaches to quality improvement, there are some key principles that are common to all. Skip to main content. NHS has management culture of bullying, intimidation and target driven culture NHS leadership is dominated by Nurses or Finance Directors and it has become more and more finance focused and target focused. The task of being a leader in the NHS is not getting any easier or any less complex. ‘Board engagement in quality: findings of a survey of hospital and system leaders’. Does improving quality save money? A summary of the King IV Report on Corporate Governance™ for South Africa, 2016 Overview. Quality and finance are closely related through the many opportunities that exist to deliver better outcomes at lower cost (improving value). Health Expectations, vol 16, no 3, pp e36–e47. However, making this happen is not simple, and many quality improvement initiatives fail to deliver positive results. Providing dedicated resources and project management capacity, having committed leaders capable of sparking enthusiasm, with skills in monitoring and evaluation to clearly demonstrate results, and ensuring alignment with other clinical priorities and health system changes, are all likely to help (Ling et al 2010). Huge embezzlements in the zakat funds have come to known by the Zakat and Ushr Department’s report on Tuesday saying city hospitals were doled out massive funds in the name of medical procedures for charity. Available at: www.rpharms.com/making-a-difference/projects-and-campaigns/pharmacists-improving-care-in-care-homes (accessed on 20 September 2017). Interviewees noted that changing this culture would require national bodies to better model the behaviours they expect of local leaders, a clearer articulation of ‘what good looks like’, and for NHS leaders to be treated more humanely. In practice, this means having: Leadership is a major determinant of organisational culture (West et al 2015). ‘Collective leadership for cultures of high quality health care’. London: The Health Foundation. Available at: www.gov.uk/government/publications/closing-the-nhs-funding-gap-how-to-get-better-value-healthcare-for-patients (accessed on 8 September 2017). It is the job of good leaders to hold bad bullying leaders to account and NHS is also works in silos and there are many middle men and women who make lot of money out of NHS like head hunters, private investigators, private consultancy firms, agency and many other staff. All health and care systems should be seeking to improve these aspects of care for people using their services, on a continuous basis. Available at: www.ncbi.nlm.nih.gov/pubmed/25057539 (accessed on 11 September 2017). Available at: www.kidneycareuk.org/about-kidney-health/order-or-download-booklets/ (accessed on 20 September 2017). 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 challenge now lies in delivering the plans and making tangible improvements in NHS care as a result. Example 1: Identifying and managing patients at risk of chronic disease exacerbation, Example 2: Acute-led development of an ambulatory care service, Example 3: Medicines optimisation and polypharmacy, Example 4: Improving safety and quality through multi-professional training, Example 5: Whole-pathway improvement involving collaboration between the primary, acute and community sectors, Comprehensive quality improvement: not ‘why should we do it?’ but ‘when will we start?’, As the Fund publishes a report on leadership for quality improvement, Matthew Kershaw encourages NHS organisations to embrace. Available at: http://fingertips.phe.org.uk/profile/atlas-of-variation (accessed on 8 September 2017). 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. This content relates to the following topics: In 2014, work by The King’s Fund assessed the level of leadership vacancies in NHS provider organisations. ‘The dawn of system leadership’. Royal Pharmaceutical Society England (2016). But it can be difficult to know how this should be done in practice. This briefing makes the case for quality improvement to be at the heart of local plans for redesigning NHS services. Available at: http://qualitysafety.bmj.com/content/25/7/509 (accessed on 8 September 2017). 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. A systematic narrative review of quality improvement models in health care. The committee's report was to be the first report of its kind in South Africa. One example is the overprescribing of antibiotics for people with coughs, colds and sore throats. CQC test for Fit and proper person is not fit for the purpose for which it was introduced. ‘Quality improvement savings tracker worksheet’. London: The King’s Fund. There was some evidence that leaders were taking more action to pursue greater equality and diversity. British Medical Journal, vol 356, j1541. ‘Explaining Michigan: developing an ex post theory of a quality improvement program’. British Heart Foundation website. Available at: www.hqip.org.uk/resources/national-heart-failure-audit-april-2015-march-2016/ (accessed on 29 September 2017). Available at: http://content.healthaffairs.org/content/34/8/1304.long (accessed on 8 September 2017). Ambulatory Heart Failure Clinic: University Hospitals of North Midlands NHS Trust. International Journal for Quality in Health Care, pp 1–8. Estimates suggest that there are around 50 million prescribing errors in the community, 45,000 prescribing errors in an average acute hospital (NHS England 2015) and 2,500 potentially preventable deaths in hospitals in England related to medication each year (NHS England 2015; Hogan et al 2012). The recent launch of a national support programme for aspiring directors of operations is a welcome step and could be built on with similar offers for directors of strategy, for example. The Health Foundation (2014). These infographics illustrate some of the key statistics when it comes to leadership in today's NHS. They demonstrate that even relatively small-scale quality improvement initiatives can lead to significant benefits for patients, staff and health system costs. There is no clear evidence that one approach is superior to others. That can’t be good for bringing new ideas to the table when you are facing new challenges. A recent review of approaches to improving quality in the NHS found that, while improving quality remains a stated priority, implementation is weak (Molloy et al 2016). NHS England, Health Education England, Public Health England, Monitor, Care Quality Commission, NHS Trust Development Authority (2014). Ham C, Alderwick H, Dunn P, McKenna H (2017). Happy staff - happy patients. The Kings Fund report, commissioned by the Academic Health Science Networks (AHSN), charted the journeys of eight innovations from creation to widespread use. The five examples given above represent pockets of innovation in particular areas. Our report draws on NHS Providers’ annual quantitative survey of leadership vacancies and on qualitative interviews and a roundtable The King’s Fund conducted with NHS trust directors and national stakeholders. Robertson R, Wenzel L, Thompson J, Charles A (2017). Powell A, Rushmer R, Davies H (2009). Royal Pharmaceutical Society website. The Kings Fund has published a new report, The courage of compassion: supporting nurses and midwives to deliver high-quality care. Available at: www.health.org.uk/publication/context-successful-quality-improvement (accessed on 8 September 2017). 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. These variations are too wide to be explained by differences in people’s health needs and patients’ preferences. Together, they make up around 1 in 10 of the total workforce in England. WRES Implementation Team at NHS England, looks at race equality progress over time. The churn of leaders can stall organisational progress, which can be especially costly as trusts try to work collaboratively in local health and care systems to develop more integrated models of care. History. Learn More public. There is generally widespread support and enthusiasm for involving patients, service users and their carers in quality improvement efforts and ensuring that change is ‘co-produced’. Jiang HJ, Lockee C, Bass K, Fraser I (2008). London: The Health Foundation. Working as a system can also be key to spreading improvements in quality. Øvretveit J (2009). But the systematic use of quality improvement approaches within the NHS is still patchy, and many improvement efforts fail to deliver the results expected. Raleigh V, Foot C (2010). Gardens and health 8 The case for gardens should not be reduced solely to ‘the business case’. Available at: www.kingsfund.org.uk/publications/reforming-nhs-within (accessed on 8 September 2017). There are already effective national programmes that support aspiring chief executives. 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). If we have less churn, the number of candidates applying for a job, who have done the same position at another organisation will be lower (or career progression slower). A smaller but growing number have developed more systematic, organisation-wide programmes to ensure that continuous improvement happens at scale (Ross and Naylor 2017). GOV.UK website. having board members with experience and training in quality improvement. Our report explores the factors that have helped NHS organisations launch and sustain a quality improvement strategy. Armstrong N, Herbert G, Aveling EL, Dixon-Woods M, Martin G (2013). Nephrology Dialysis Transplantation, vol 27, suppl 3, pp iii73–80. New England Journal of Medicine, vol 375, pp 709–11. Available at: www.health.org.uk/publication/are-clinicians-engaged-quality-improvement (accessed on 8 September 2017). Suzie Bailey explores diversity in the NHS – and why there is still more to do. 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’. 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. Now, more than ever, local and national NHS leaders need to focus on improving quality and delivering better-value care. West M, Armit K, Loewenthal L, Eckert R, West T, Lee A (2015). Available at: www.eastsussex.gov.uk/socialcare/providers/dementia-care/ (accessed on 20 September 2017). Available at: www.ncbi.nlm.nih.gov/pubmed/25077248 (accessed on 8 September 2017). Improving quality and reducing costs are sometimes seen as conflicting aims. By quality improvement, we mean the use of methods and tools to try to continuously improve quality of care and outcomes for patients. National Audit Office website. Improving patient flow. The King’s Fund. Whilst the depth of quality has been hinted at, I would like to go further and deepen some of the core aspects of improvement and transformation that have been seen in other private and public sectors, as well as in the NHS recently. Public Health England website. The Sussex integrated dementia and end of life care guidance [online]. Available at: www.health.org.uk/publication/challenge-and-potential-whole-system-flow (accessed on 8 September 2017). ‘Coproduction of healthcare service’. Programmes to support you at all stages of your leadership journey, Addressing race inequalities in the NHS needs engagement, commitment and a plan, As the Fund prepares to publish its report on workforce race inequalities and inclusion, Richard Murray reflects on. Healthcare Quality Improvement Partnership website. Leadership is all about honesty, sincerity, kindness, compassion and clear accountability and courage. This risk aversion manifests as a desire to appoint people who have ‘done the job before’, and less willingness to find candidates from outside the NHS or from elsewhere in the health and care system. Enhanced health in care homes: vanguard learning guide: EHCH element 4.2: high-quality dementia care [online]. Maybin R, Charles A, Honeyman M (2016). Available at: www.nao.org.uk/report/the-management-of-adult-diabetes-services-in-the-nhs-progress-review/ (accessed on 8 September 2017). The 10 key lessons outlined provide a starting point for NHS leaders seeking to more firmly embed quality improvement within their local plans for improving services. A challenging mix of pressures facing NHS organisations, coupled with a culture of blaming individuals for system-wide problems, mean NHS trusts are facing significant difficulties in recruiting and retaining senior leaders, according to a new report from The King's Fund and NHS Providers. Data should be used to identify quality problems, define indicators for improvement and track the impact of different interventions on quality of care. Public Health England website. Ultimately though, interviewees cautioned against placing too much focus on formal talent management or development programmes, and several noted a more effective talent pipeline alone will not reduce vacancies as long as the current operating environment and treatment of leaders is unchanged. NHS leadership is insular and turn over is high. As we have argued previously, ‘only by moving from pockets of innovation to system-wide improvement will the NHS deliver the changes that are needed to sustain and improve care at a time of unprecedented financial and service pressures’ (Ham et al 2016, p 11). Health Affairs, vol 30, no 6, pp 1185–91. However, as we will demonstrate in this briefing, there are numerous examples showing that this does not necessarily need to be the case. Sustainability and transformation plans in the NHS: how are they being developed in practice? Bevan G, Hood C (2006). One important lesson from organisations that have successfully built improvement capability at scale is to avoid doing too much, too quickly. Evidence tells us that there are a range of opportunities to improve value in the NHS (Alderwick et al 2015). Our report draws on NHS Providers’ annual quantitative survey of leadership vacancies and on qualitative interviews and a roundtable The King’s Fund conducted with NHS trust directors and national stakeholders. The fact too that their chairman can also be the chairman of the Trust that they oversee is so wrong you cant believe it is true, but it is. Have a consistent and coherent approach to quality improvement. I work at this front line however the patient/carer role is often percieved as problematic and difficult and not functioning in ‘partnership’ . Local context is crucial in understanding the success of different quality improvement programmes (Fulop and Robert 2015; Bate et al 2014; Kaplan et al 2010). More than 700,000 nurses and midwives working in health and social care are subject to work conditions that in many cases will … Available at: www.kingsfund.org.uk/publications/stps-in-the-nhs (accessed on 8 September 2017). But the support of senior leaders in the organisations involved is important in getting a project off the ground and creating time for staff to design and test new ways of working, as shown in example 5 on dementia care in Sussex. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC4292097/ (accessed on 20 September 2017). Bate P, Robert G, Fulop N, Øvretveit J, Dixon-Woods M (2014). The King’s Fund website. Leatherman S, Berwick D, Iles D, Lewin LS, Davidoff F, Nolan T, Bisognano M (2003). The importance of having access to robust, real-time data is highlighted in example 1, which focuses on the surveillance system developed by the Heart of England NHS Foundation Trust to help renal teams identify people at risk of end-stage kidney disease. Practical Obstetric Multi-Professional Training (PROMPT): North Bristol NHS Trust. Conventional management wisdom also often says that improving quality can save money. This is no surprise: patients have a unique role to play in identifying quality problems (such as duplication and waste), coming up with solutions to address them and ensuring that any change genuinely delivers the outcomes that matter to them (Batalden et al 2015; Fulop and Robert 2015). For this reason, The King’s Fund has worked with NHS Providers to review the current level of vacancies and tenure of executive directors in NHS provider trusts. NHS Right Care (2017). Institute for Healthcare Improvement (undated). Available at: www.improvementacademy.org/patient-safety/medicines-safety.html (accessed on 18 September 2017). Studies have shown that board commitment to quality improvement is linked to higher-quality care, underlining the leadership role of boards in this area. All NHS organisations should be focused on continually improving quality of care for people using their services. If you wish to continue receiving full reports by mail, you must let us know by selecting the Full Report option under Paper Reports here. The examples given above illustrate how leadership for improvement comes from all parts of an organisation (or multiple organisations), as well as from patients and service users. News Desk-January 20, 2021. You can explore these documents on this website, download them for your own use and embed them on your own website. National Audit Office (2015). Quality improvement – training for better outcomes [online]. Available at: https://digital.nhs.uk/catalogue/PUB23241 (accessed on 8 September 2017). A case in point is the PROMPT training programme (example 4). More attention should be given to addressing the environment NHS leaders operate in. Future Hospital Journal, vol 3, no 3, pp 191–4. Leis J, Shojania K (2017). 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. NHS Digital (2017). A culture of blaming individuals for failure is making leadership roles less attractive. To err is human: building a safer health system. STPs and other local partnerships could also help NHS organisations to ‘act like a sector’, bringing together professionals from different services to agree standard procedures and processes to improve care (Dixon-Woods and Martin 2016). Subscribe to our email newsletter and follow @TheKingsFund on Twitter to see new content as it's published, along with our other news. 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. We need more diverse leadership. 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. Place-based systems of care: a way forward for the NHS in England. The increasing personalisation of organisational performance by national bodies was making director roles less attractive. An evaluation of the Health Foundation’s Engaging with Quality Initiative. ‘Hospital board and management practices are strongly related to hospital performance on clinical quality metrics’. Rather than being seen as the business of managers, it is important for there to be an understanding that quality improvement approaches can help frontline teams to deliver better and more effective services for their patients. The King’s Fund. 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). ‘Management of chronic heart failure in the older population’. But evidence showing that providers have been able to act on these opportunities is much harder to come by. The evidence on whether quality improvements save money for health care providers was reviewed for The Health Foundation (Øvretveit 2009). 15. Drawing on these studies and other evidence, researchers have created a framework that can be used to assess organisational maturity in governing for quality improvement (Jones et al 2017). National data painted a sobering picture of how ethnically diverse NHS leaders are. ‘The hard work of health care transformation’. This means that NHS leaders must make a long-term, overarching commitment to improving quality within their own organisation, and set realistic goals for improvement. Total Net Investment since Last Week: $6,640,541. A clear, unifying vision for improving quality should be enacted at multiple levels, with co-ordination and alignment between teams, departments and individuals (Bohmer 2016; Dixon-Woods et al 2014). 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. Improving quality in the English NHS: a strategy for action. These things do not happen by accident. These included ensuring recruitment panels have black and minority ethnic representation and developing in-house mentoring and reverse-mentoring programmes. In my opinion, this feeds into the ongoing diversity issues (and under-representation of non-white people) at senior levels in the NHS. Equally, any effort to highlight variation needs to go hand in hand with practical support to help teams and organisations to close the gap with their peers. ‘Ten challenges in improving quality in healthcare: lessons from The Health Foundation’s programme evaluations and relevant literature’. Home; Headlines; Survey; NHS Performance Data; About the QMR; QMR 18 | February 2016 Share on Twitter; Share on Facebook; Share on LinkedIn; How is the NHS performing? Available at: www.health.org.uk/publication/improving-patient-flow (accessed on 8 September 2017). While some interventions (often on a small scale) resulted in quality improvements and reduced costs for providers, others (particularly on a large scale) failed to do so. A shared determination to make a difference, together with an ability to carve out time to focus on improvement work, have been critical to their success. McCannon C¬, Perla R (2009). 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