Are Improvement Programmes Working in the NHS?

The NHS is no stranger to turnaround and improvement. It has gone through numerous large-scale structural reforms with the impact on services changing little.

The issue is how to make improvement lasting and meaningful. Building a culture of continuous improvement must be at the top of the agenda. So, what does this culture look like and how do we improve it?

Medical Transformation

Transforming culture in large employers like NHS trusts

To talk about culture is to talk about how people go about their work, how people think and how they behave. When we talk about an ‘improvement culture’, the aim is to create a culture in the NHS which celebrates and encourages success and innovation. Furthermore, a culture which recognises success and sees past mistakes as learnings.

When I think about fostering healthy culture, the top five priorities that come to mind are:

  1. Creating shared vision and values
  2. Communicating clear goals and priorities
  3. Encouraging learning and innovation
  4. Promoting effective and supportive teamwork
  5. Demonstrating collaborative leadership

Tackling these priorities is an approach applicable to any industry sector and organisation. Without a clear vision, goals and priorities, employees often fall into poor behaviours. I am sure we have all seen how others’ negative actions, such as a blame culture, accepting inefficiencies, and doing the minimum, can impact your own motivation in your day-to-day job.

Changing cultures like these is necessary if we really want improvements to last.

A longer-term strategy for change

Change can’t be led solely by line managers. Real change takes ownership across the organisation. Looking at culture from an NHS perspective, we need to ensure all staff are engaged with their organisation’s vision and values. The patient should be at the heart of every decision, with everyone contributing to a supportive environment that fosters learning and innovation.

To embed new ways of working and thinking, employers have to nurture an environment that allows cultural change to happen. This means making mistakes along the way – then learning from them.

This is a long-term strategy, which moves away from the quick financial wins that the NHS is sometimes seen to rely on.

How successful are improvement plans that don’t have a clear strategic intent, vision or direction?

There are many examples of trusts who have had turnaround director after turnaround director, and I wonder if their legacy is a culture of continuous improvement? Has the shorter-term financial imperative of balancing the books taken priority over driving the longer-term requirement for driving quality transformation?

This is a topic I looked at in more detail in my previous blog, ‘Has QIPP Become Another Cost Improvement Programme?’

A Culture of Improvement

As I meet with my NHS clients, there is no doubt that morale has taken a hit from financial pressures, service pressures and the impact of large-scale structural change.

However, this is also the perfect time for the NHS to focus on a culture of continuous improvement. With the move to a single leadership team, the NHS should look for new ways of working and thinking. All members of staff should be engaged in capability building. The result? A positive working environment and a culture of improvement.

As ever, I’m interested in your thoughts.What is your experience in your organisation? What do you see as the blockers to improvement within the NHS? How do you think we make Improvement within the NHS lasting and meaningful?

Do you think culture is key in fostering continuous improvement?

Our upcoming NHS leaders event, on Friday 29 November, looks at smarter strategies for sustainable improvement. Our speakers will showcase a success story in NHS improvement and give you the opportunity to network with your peers. Register your place if you're interested in attending.

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