ISQua members don’t need telling that the task of improving healthcare is not a simple one. Evidence and experience from the work we’ve funded at the Health Foundation tells us it’s often fiendishly complex, requiring careful design, diligent execution, multiple cycles of testing and iteration, deep reserves of leadership energy and enthusiasm, and much more.
Structured Quality Improvement (QI) methods and approaches have developed in health care over recent decades to help, in parallel with research fields in improvement and implementation studies. There has been a rise in the number of expert quality improvement practitioners, with global awareness and capability bolstered through the work of organisations such as the Institute for Healthcare Improvement, and of course ISQua itself. ISQua’s outgoing CEO, Peter Lachman, was an early pioneer in the field, including undertaking a Health Foundation funded fellowship with IHI in 2005.
But improving healthcare can’t be left to a cadre of experts, important role though they certainly play. Quality Improvement needs to be everyone’s business.
To that end, the Health Foundation has recently published an updated edition of Quality Improvement Made Simple. QI Made Simple was published in 2013 and has consistently been one of our most popular publications, with over 75,000 online readers over the past eight years. It’s flown off shelves at conferences and has made an important contribution to embedding ideas about systematic approaches to improvement in health care. Updating it has prompted me to think about what’s changed in eight years, and what’s stayed the same.
One thing I noticed early is how quickly the external policy context changes. A section on commissioning, one of the great hopes of policymakers in the UK at that time for improving quality, seems outdated, and many of the specific policy initiatives mentioned then have come and gone.
Shifting norms demand other changes. A long section on the all-male pioneers of quality improvement feels out of time now. The previous version makes little mention of co-production and inequality, and no references to environmental sustainability, all now important considerations in wider society and improvement work.
The field has developed in many ways: evidence from research has deepened our appreciation of the role of local context in how well an intervention works, and the benefits of whole organisational approaches. In the UK context at least, some tools, like Six Sigma and Total Quality Management, have become less prominent, in favour of more accessible and pragmatic methods. New assets have emerged, some developed by us at the Foundation, such as the Q Community, THIS Institute, and the Improvement Analytics Unit. It’s also interesting to notice where evidence still needs development; for example, on what tools and methods are best to use for different types of problems.
Some things, however, stay much the same. The principles underlying well-led change on the ground evolve but remain similar to eight years ago: such as deeply understanding the problem you are trying to tackle, involving and engaging the users of the service and the staff who deliver it in designing ideas for what intervention you might try, and planning how you will measure the difference your intervention will make – a decent list to start with for any change effort. Something else we hope stays the same is that communicating a complicated subject in a simple and accessible way remains a valuable contribution.
I wonder if we were to update things come 2029, in another eight years, what would be different, and what would remain the same? The work of ISQua and its partners in the improvement world will have a major bearing on the answer.
Director of Improvement
The Health Foundation
Visit the below websites to learn more about Quality Improvement: