This post is from The King's Fund Blog
It’s been almost a year since the Fund called for a national quality improvement strategy for the NHS in England. We argued that there needs to be greater emphasis on developing cultures that are committed to continuous improvement and a focus on ‘reform from within’ – appealing to the intrinsic motivation of staff and providing them with the skills, knowledge and support to improve care – rather than relying on external pressures (be that regulation, national targets or market forces).
Quality improvement focuses on continuous testing and learning by frontline teams, using a systematic methodology to improve care. The use of quality improvement approaches is becoming increasingly common across the NHS, although it seems there has been relatively less adoption in mental health care. But now is the time to change this. As the recent commission on acute adult psychiatric care concluded, new approaches to quality improvement will be key to tackling the wide variation in access to high quality care.
We have seen that the momentum for the adoption of quality improvement in mental health is building. Last year I attended a workshop at East London NHS Foundation Trust (a mental health trust) to hear about its quality improvement work; what really impressed me was the strength of leadership commitment at all levels, and cultures that have developed to value and support quality improvement. Our own work with Oxleas NHS Foundation Trust in 2015 used action learning to develop a more strategic approach to quality improvement, resulting in improved staff engagement and a measureable reduction in unnecessary use of resources. Tees, Esk and Wear Valleys, East London and other mental health trusts have started improvement programmes and report seeing better outcomes for service users and staff, such as reduced average length of stay for inpatients, reduced violence on wards and improved staff wellbeing.
As part of our work on quality improvement in mental health, we recently held a seminar to explore what quality improvement means for the leadership of mental health organisations. Chief executives, nursing directors, medical directors and quality improvement champions from mental health trusts across England, Scotland and Wales came to hear from executives and directors of Tees Esk and Wear Valleys, East London, and Northumberland, Tyne and Wear NHS Foundation Trusts about how they have embedded quality improvement approaches across their organisations.
For me, the main message from the seminar was that quality improvement requires a significant cultural shift and sustained commitment from the leaders of organisations. Embracing improvement and living its values means re-thinking approaches to leadership – for example, giving frontline teams the time and space to do solve problems instead of imposing solutions from the top – using data to guide decision-making and (my favourite) paying personal attention to staff.
No one claimed that improvement happens overnight – or that they could offer solutions that were boxed up and ready to go. Improvement (and sustaining it) was described as a ‘long game’; in some places it took months to get board members’ commitment, substantial resources were required to build capability and leaders had to be faithful to their chosen methodologies for many years. Even leaders from the trusts that are seen as the furthest ahead in embedding quality improvement said that they are still working at it.
We will publish the various insights and tips emerging from the seminar along with our work on quality improvement in mental health in the spring. There are resources available to help mental health trusts with quality improvement, such as the recently launched MINDSet toolkit and the new NHS Improvement programme – presented at the seminar – that, in partnership with Northumberland, Tyne and Wear NHS Foundation Trust, will build a mental health associate network to spread best practice. Our own leadership and organisational development team can also help with quality improvement, through developing individuals’ leadership skills and working with organisations to implement tailored solutions for sustainable change.
Most of the leaders attending the seminar described themselves as taking ‘early steps’ in their quality improvement journey. And encouragingly, much of the discussion focused on the growing appetite for quality improvement. As one delegate said in their feedback about the seminar:
‘You need to do something, no matter how small – no more procrastinating, more doing.’
As we’re all well aware, there will be challenging times ahead and resources are severely stretched. There is a real need to focus on quality improvement in the mental health sector – now is the time.