15 July 2022
July 2022 
In this edition, we have a lot of great improvement news to share with you including (click the titles below to go directly to that section):
- Our feature article: Where can we find Value in our Quality Improvement work?
- An update on our Improvement Practicum in-person celebration event
- An update on International #WMTY2022 Day @ CNWL
- Executive QI Conversations with Hannah Witty, Chief Financial Officer & HMP High Down
In addition, we also have exciting news from the Improvement Academy including links to great opportunities that are coming up.
- Level 3: Gold QI training – Senior Leaders - Applications are now open!
- Level 1: Bronze QI training – Bitesize – Now CPD accredited! – Book now!
Each month we will be sharing great examples from across CNWL where individuals and teams are improving systems and processes to ensure that we deliver the best evidence-based service user and carer experience where ever teams are delivering care across the trust.
Image: Nick Youngson
Where can we find Value in our Quality Improvement work?
As we bring the current improvement practicum to a close and celebrate both successes and learning in all its forms with our 22 participating practicum teams, we would like to build on previous newsletters where we explored both the IHI Quadruple aim and the What matters to you? Movement.
There is increasing interest and belief in applying quality improvement (QI) to help solve our most complex challenges in healthcare, yet according to Shah & Course (2018) there is limited literature to support healthcare leaders develop business cases and evaluate return on investment (ROI) from QI. This is even more prominent in fields such as mental health and community health services. Ross & Naylor (2017) identified that ROI from applying QI at scale is not just about cost reduction as a single objective, but more about bringing new strategic capability to the organisation which can drive productivity, improving efficiency and increased revenue, while also aligning the organisation more directly with a common purpose of high quality and safe care.
Dixon-Woods & Martin (2016) found that demonstrating cause and effect within the real-life complexity of a healthcare organisation is difficult. Dixon-Woods & Martin (2016) suggest that there are often likely going to be multiple interventions within a complex system, so attributing effects to a single intervention such as QI can be difficult. Historically, it has been found that value added to the system by QI can range from the more intangible, such as revenue growth of the organisation or staff engagement, where the link between QI and the outcome is less easy to define but broadly believed to be true by those working in the system, to more concrete tangible added value, such as cost avoided or cost removed, where economic analysis is precise enough to estimate the number of pounds saved or removed due to an improvement intervention (Shah & Course, 2018). Calculating the value added requires an evaluation of costs as well as benefits.
Service User, Carer and family experience and outcomes
The primary reason for applying QI within healthcare organisations is to improve outcomes for those we serve, therefore this should be the primary benefit that is realised from our improvement work (Ross & Naylor, 2017). At the CNWL Improvement Academy, we encourage every team to consider what matters most to staff working in the team and the service users, carers and families that receive care and to support teams to use QI methodology to solve their greatest quality issues. By focusing on what matters most to those closest to the care, both receiving and delivering care, we are attempting to design our improvement work to be as personal and as meaningful as possible (Perlo,2017). Improving the experience and outcomes of the population we serve is the ultimate purpose of any healthcare provider, so this aspect of the business case for QI should align directly with the core purpose of the organisation (Dixon-Woods & Martin, 2016).
Improved staff experience
The QI approach requires devolving power to teams to identify and solve their biggest challenges and equipping them with the right tools and skills to address these systematically (Shah & Course, 2018). This should, in theory, empower staff to have more control over the system they work in, more autonomy to make changes and help staff feel more engaged in their work (Perlo, 2017). There is strong evidence that healthcare providers with happier, more engaged staff have better patient outcomes and improved financial performance (West & Dawson, 2012).
Improving efficiency and streamlining processes
One of the goals of QI is to reduce unwanted variation and remove waste from the system, through supporting teams to focus on what matters to their service users (Ross & Naylor, 2017). By removing non-value adding steps in the process, and redesigning care around what adds value to the service user, teams are likely to see improvements in productivity and efficiency. These may free up time for teams and clinicians to focus on providing care, but may not have any effect on avoiding or removing costs (Dixon-Woods & Martin, 2016).
Cost avoidance & reduction
In some areas of QI work, improving the system may mean that we are able to avoid significant costs that were previously being incurred – either staff costs, or for equipment, materials or other overheads. Improving safety and staff experience at work is likely to lead to a reduction in staff absence from work or staff turnover and in turn a reduction in agency staff usage (Perlo, 2017). This concept will also hold true where ever you may sit within the wider health and social care system as per the NHS long term plan and the implemention of Intergraded Care Systems (ICS).
Improved organisational reputation
Applying QI at scale can bring new strategic capability within an organisation, adding competitive advantage within the market (Shah & Course, 2018). This has the potential to realise the benefit of attracting new staff and potential new revenue opportunities, including through acquiring new business based on organisational reputation for quality and improvement.
In summary, when evaluating the ROI or the added value delivered through the use of QI, it is key to evaluate this at multiple levels. Undoubtedly, the primary driver is to improve outcomes and experience for those that receive care and services. However, the organisation will also reap dividend from enhanced engagement and motivation of staff, improved productivity and efficiency of teams, cost avoidance (reducing cost pressures), cost reduction and the possibility of increased revenue. All of these potential avenues for quantifying added value should be evaluated and considered as part of evaluating the impact of applying QI (Dixon-Woods & Martin, 2016).
At CNWL we have designed a framework for evaluating added value from QI (Figure 1).
If you would like to explore this framework further with a member of our team please do not hesitate to get in touch with Geetika Singh, our Head of Quality Improvement at geetika.singh@nhs.net and we will be more than happy to help you.
Additional ways of gaining support are at our QI Clinic by contacting us at cnw-tr.improvementsupport@nhs.net and other educational opportunities here.