Some have lost the jobs but many have been re-circulated including CEOs who were removed for culture of bullying in the organisation. NHS Digital (2017). They face several barriers – including a lack of time and resources and a lack of knowledge and skills for quality improvement. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC4292097/ (accessed on 20 September 2017). This is likely to be different from data collected for overall performance assessment and management (Raleigh and Foot 2010). Available at: www.renalreg.org/reports/2015-eighteenth-annual-report/ (accessed on 20 September 2017). Intelligent use of data is central to any efforts to improve quality. Bate P, Robert G, Fulop N, Øvretveit J, Dixon-Woods M (2014). Jha A, Epstein A (2010). But the systematic use of quality improvement approaches within the NHS is still patchy, and many improvement efforts fail to deliver the results expected. This, again, highlights the key role of senior leaders and boards, described in the subsections ‘Make quality improvement a leadership priority for boards’ and ‘Share responsibility for quality improvement with leaders at all levels’. The Ambulatory Heart Failure Clinic at the University Hospitals of North Midlands NHS Trust was a response, in part, to local heart failure patients’ wishes for a service that allowed them to remain in their own home (example 2). Milbank Quarterly, vol 89, no 2, pp 167–205. Available at: www.health.org.uk/publication/does-improving-quality-save-money (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. ‘Collective leadership for cultures of high quality health care’. London: The Health Foundation. 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. Funding Report for Week Ending 1/3/2021. 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’. Enhanced health in care homes: vanguard learning guide: EHCH element 4.2: high-quality dementia care [online]. But evidence showing that providers have been able to act on these opportunities is much harder to come by. Available at: www.health.org.uk/publication/perspectives-context (accessed on 8 September 2017). Make quality improvement a leadership priority for boards. The programme began with orthopaedics and is now being rolled out to 32 different surgical and medical specialisms across the NHS in England. Available at: www.bhf.org.uk/publications/healthcare-and-innovations/an-integrated-approach-to-managing-heart-failure-in-the-community (accessed on 20 September 2017). Does improving quality save money? This is easier said than done. The expert panel provided its final report to the government on 14 February 2020 (the King Review). One example of underuse is care for people with diabetes. Early identification of patients at risk of developing end-stage kidney disease: Heart of England NHS Foundation Trust. 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. All NHS organisations in England are required to improve the quality of the care they deliver. Improving quality in the English NHS: a strategy for action. The survey showed that leadership vacancies are widespread, with director of operations, finance and strategy roles having particularly high vacancy rate and short tenures. Since 1997, they have jointly funded a yearly award system with GlaxoSmithKline.They reward small to medium … Jones B, Woodhead T (2015). London: The King’s Fund. This independent report was commissioned by NHS Property Services. In my opinion, this feeds into the ongoing diversity issues (and under-representation of non-white people) at senior levels in the NHS. Not there as lap dogs but continually probing and asking difficult questions. How do you get clinicians involved in quality improvement? 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). Available at: www.health.org.uk/publication/clear-road-ahead (accessed on 8 September 2017). Senior leaders, and boards in particular, play a vital role in setting the strategic direction of NHS organisations and creating a supportive culture and environment for quality improvement. 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). Robertson R, Wenzel L, Thompson J, Charles A (2017). Multidisciplinary review of medication in nursing homes: Northumbria Healthcare NHS Foundation Trust. A national framework to guide action on improvement capability building and leadership development in NHS services in England has also been launched (NHS Improvement 2016). These and other examples highlight the types of opportunities available in the NHS to improve quality of care and make better use of resources. 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. Working as a system can also be key to spreading improvements in quality. 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. They starve either because they cannot eat or cannot absorb the nutrients from a normal diet. 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). Available at: www.kingsfund.org.uk/publications/practice-system-leadership (accessed on 1 August 2017). Mandating participation in quality improvement training, without first making the case for it, runs the risk that it will be perceived as simply ‘another thing to do’ or a further ‘box to tick’ (Academy of Medical Royal Colleges 2016). National diabetes audit, 2015-2016. Sustainability and transformation plans in the NHS: how are they being developed in practice? NHS Right Care (2011). The Kings Fund has published a new report, The courage of compassion: supporting nurses and midwives to deliver high-quality care. This can lead to poor outcomes for patients and wasted resources for the NHS. Leadership and management practices are strongly related to performance on quality, and there is a well-established relationship between board commitment to quality improvement and quality of care within their organisations (Jones et al 2017; Jones and Woodhead 2015; Tsai et al 2015). While this is sometimes the case, as demonstrated by the significant savings being identified through the GIRFT programme, the relationship between quality and cost in health care is complex and poorly understood (Hussey et al 2013; Smith et al 2013; James and Savitz 2011). It is important to recognise, however, that most errors happen as a result of the systems people work in, not the people who work in them. Senge P, Hamilton H, Kania J (2015). Available at: www.nejm.org/doi/full/10.1056/NEJMp1606458 (accessed on 8 September 2017). The Health Foundation (2014). Crossing the quality chasm: a new health system for the 21st century. Building the foundations for improvement. The Kings Fund report, commissioned by the Academic Health Science Networks (AHSN), charted the journeys of eight innovations from creation to widespread use. It describes the potential benefits from investing in quality improvement – including for patients, staff and the financial sustainability of the system. Understanding NHS financial pressures: how are they affecting patient care? While driving better value is important, quality improvement has a fundamental role in improving all aspects of quality – including the safety, effectiveness and experience of care. The NHS five year forward view (Forward View) is the national plan for improving services in the NHS in England (NHS England et al 2014). Available at: www.aomrc.org.uk/publications/reports-guidance/quality-improvement-training-better-outcomes/ (accessed on 8 September 2017). 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. The trouble is that they often are, don't and fail themselves and us. Leadership for improvement must be distributed within organisations. New England Journal of Medicine, vol 375, pp 709–11. Develop the skills and capabilities for improvement. ‘Patient safety and the problem of many hands’. We need the autonomy, not regulatory control, to do them. Department of Health (2008). British Heart Foundation (2015). Only 7 per cent of very senior managers were from a black and minority ethnic background, which is far lower than representation in the NHS workforce and local communities. NHS Right Care (2010). 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). The King’s Fund is an independent charity working to improve health and care in England. Health Affairs, vol 34, no 8, pp 1304–11. Institute of Medicine (2001). By Michael West et al - 23 September 2020 Data visualisation NHS workforce . There was some evidence that leaders were taking more action to pursue greater equality and diversity. National Institute for Cardiovascular Outcomes Research (NICOR) (2017). Directors of operations and directors of finance were most likely to have been appointed in the past three years. London: The Health Foundation. This report by The King's Fund has been co-authored with The Health Foundation. 14. Quality improvement in mental health. News Desk-January 20, 2021. Kaplan HC, Provost LP, Froehle CM, Margolis PA (2012). Are clinicians engaged in quality improvement? London: The Health Foundation. They also call for major improvements in NHS efficiency – typically at well above the rate of improvement achieved in the recent past. Public Health England website. Report 1: care processes and treatment targets [online]. The quarterly monitoring report (QMR) reveals the views of NHS trust finance directors and clinical commissioning group finance leads on the productivity challenges they face, and examines some key performance data for the NHS in England. These variations are too wide to be explained by differences in people’s health needs and patients’ preferences. However, it is important to prepare the ground carefully. Involve patients, service users and carers. The right medicine: improving care in care homes [online]. Public Health England website. Despite differences in terminology, all of these methods draw on a similar set of tools and principles (such as rapid cycles of testing). ‘Hospital board and management practices are strongly related to hospital performance on clinical quality metrics’. Future Hospital Journal, vol 3, no 3, pp 191–4. Leaders must also work between organisations to develop new care models and co-ordinate improvements. 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. 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. Bohmer RMJ (2016). The level of exposure is higher than it's ever been and the knee-jerk response from ‘the centre’ is one of ‘decapitation’ as the first option… You’re just a quarter away from financial failure and performance failure before you get sacked. 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. ‘The hard work of health care transformation’. In January 2016, 71 of the 142 orthopaedic units in England identified combined savings of between £20 million and £30 million after an initial GIRFT visit, with an additional £15 million to £20 million forecast for the next 12 months (Timmins 2017). ‘Board engagement in quality: findings of a survey of hospital and system leaders’. ’We’re here and you’re there’: lived experiences of ethnic minority staff in the NHS, Shilpa Ross explores some common experiences from our research into what it means to be an ethnic minority. The NHS, like all other health care systems across the world, sometimes fails to deliver high-quality care. Early evidence suggests that the programme is identifying significant opportunities to improve value, through changes to procurement practices, productivity and quality. In July 1993 the Institute of Directors in South Africa asked retired Supreme Court of South Africa judge Mervyn E. King to chair a committee on corporate governance. ‘How do hospital boards govern for quality improvement? The nature of the challenges facing leaders of NHS trusts has also changed, with greater emphasis placed on working collaboratively as part of more integrated health and care systems. Healthcare Quality Improvement Partnership website. The King’s Fund has been calling for transformational change to respond to the growing pressures and demands in the health and care system. Available at: www.kingsfund.org.uk/publications/better-value-nhs (accessed on 8 September 2017). National data painted a sobering picture of how ethnically diverse NHS leaders are. Alderwick H, Dunn P, McKenna H, Walsh N, Ham C (2016). This report is authored by Lord Warner, a former Labour health minister. Ambulatory Heart Failure Clinic: University Hospitals of North Midlands NHS Trust. The review confirmed that there are significant opportunities to improve quality and reduce costs in health care – mainly because of the high cost of poor-quality care to patients and the health system. Available at: http://fingertips.phe.org.uk/profile/atlas-of-variation (accessed on 8 September 2017). Available at: www.bmj.com/content/356/bmj.j1541 (accessed on 8 September 2017). GOV.UK website. Molloy A, Martin S, Gardner T, Leatherman S (2016). We also provide links to further resources and information about the work. Health Expectations, vol 16, no 3, pp e36–e47. A mixed methods study of 15 organisations in England’. 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’. To help ensure these roles are attractive in future, national bodies should better model the behaviours they expect in local leaders, the expectations of ‘what good looks like’ should be more clearly articulated, and NHS leaders themselves should be treated more humanely. This ‘displacement of rewards’ means that providers investing in service improvements may see their return on investment fall to another part of the system, or their income fall if they have reduced activity that they were previously paid for (Leatherman et al 2003). 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.