Skimming through today’s newspaper, a headline caught my eye : “Seven in 10 hospital trusts failing to meet safety standards.” (1)

Most members of the public would have found this rather alerting. But to yours truly, an NHS clinician of modest experience and a regular reader of CQC reports, it seemed a bit like stating the obvious. One doesn’t need postgraduate studies in health economics to appreciate that a service expected to meet increasing demands would require increased funding. And if the increase in funding is significantly less than the increase in demand, the service will soon become unable to meet said demand.

But my intention is not to discuss the major challenges currently faced by NHS organisations. This has been done time and time again, and by authors far more distinguished than myself. (2)

My intention is to demystify something that has been touted as the magic bullet for those challenges : quality improvement !

Before I go any further, please allow me to make a confession. I didn’t use to think much of quality improvement. It seemed like a nebulous concept, a buzz word, utilised by elusive service managers rather than hard-working clinicians like myself.

I was, of course, aware that robust quality improvement programmes had allowed healthcare providers across the country (as well as across the world) to dramatically improve the care they provided to their local populations. I was also aware of the fairly enthusiastic recent CQC publication on quality improvement. (3)

When my current employer, Southern Health NHS Foundation Trust, began implementing a major transformation programme, clinicians were encouraged to train in the “Lean” quality improvement methodology. (4), (5)

I went along, to see what all the hype was about. I did not, however, believe that the training would make a lot of sense, and I certainly did not think it would change any aspect of my practice. I can now categorically say that I was wrong.

Quality improvement principles, once you have moved beyond the jargon, are nothing but a structured way to bring improvement through the application of common sense. Allow me to illustrate this point through an example.

One of the core principles of Lean is the elimination of waste activity. There’s nothing new or contentious about this. If you aim to complete a task, you want every single bit of effort you put into it to move the task closer to completion.

But I suspect that most people would be surprised by the amount of waste activity going on around them. And they would be even more surprised by the amount of waste activity they themselves undertake on a daily basis.

Lean methodology identifies seven types of waste activity, one of which is movement. Have you ever asked yourself “Why do I need to attend this meeting in person, when I could join through videoconferencing software ?”. I have, and it resulted in me saving two hours of driving that I could then utilise for clinical work.

It is well within the gift of individual clinicians to make small-scale changes like this to their practice. And small-scale changes made by numerous individuals within an organisation have been shown to have a cumulative positive effect on the entire organisation.

There are, of course, examples which require larger-scale change to be implemented. But clinicians can still rely on quality improvement methodology to guide them.

Quality improvement is, of course, not a panacea. But with no real solution to the NHS funding crisis forthcoming, it’s clear to me that NHS organisations have no choice but to make the most out of the resources they have access to. And I have no doubt that quality improvement methodologies can provide the best framework for this.


  3. Quality improvement in hospital trusts Sharing learning from trusts on a journey of QI. CQC September 2018