Introducing Improving Quality Together

Purpose Improving Quality Together aims to support a change in mindset in NHS Wales, where each individual demonstrates a belief that:  They have one job and two roles: to do and improve.  Small step changes can make a big impact. To do this, we need one common language of improvement and a consistent approach to its delivery.

Structure 3 levels of development. Supported by local Improvement Coaches. Complemented by Board level development. Learning outcomes developed for each level. Suggested delivery model for each level.

Context Quality Delivery Plan 2012 ACTION 2: 1000 Lives Plus will continue to be the core NHS improvement programme, ensuring a common and consistent language and approach to improvement. ACTION 4: Health boards and trusts will agree a plan to train 25 per cent of their directly employed and contractor workforce in quality improvement methodology (at basic, expert or leadership level) by the end of March 2014, supported by 1000 Lives Plus.

“I think Improving Quality Together is excellent. It gives our frontline staff the skill-base to go into their own departments and say: ‘I can make this improvement’.” Neil Windsor Quality Improvement Manager

Improving Quality Together Levels Silver: Able to apply quality improvement approach with support. Bronze: Awareness of quality improvement approach. Gold: Able to apply quality improvement approach independently and support others. Board: Able to lead system -wide quality improvement and assurance.

Bronze audience Bronze: All NHS staff including the contractor workforce across all services.

Bronze learning outcomes Benefits of a person-driven approach. Principles of quality improvement. Benefits of quality improvement. Their role and responsibility in improving services. Importance of measurement to quality improvement and service delivery. Model for Improvement approach to small step change.

Bronze e-learning Hosted on Wales. Modular approach with assessments. Health board/trust nominated leads can then track organisational coverage. Links will be made to OLM.

Bronze delivery Extraction from e-Modules can be included in induction programmes. As part of microsystem approach, teams can demonstrate understanding, whilst lead completes Silver level. Incorporated into other national improvement programmes – Transforming Care/ Theatres/ Maternity Services.

“I’ve got a greater knowledge and understanding of quality improvement methods. We’ve learned tools and methods we can apply in everyday work.” Sara Roberts

Silver audience Silver: All individuals across all services who lead teams within the organisation (micro system approach).

Silver learning outcomes In addition to Bronze, focuses on delivery of a quality improvement: Identify an area for improvement. Involve others in quality improvements. Use the Model for Improvement in their workplace: –Understanding data and variation. –Understanding small steps of change. –Evaluating sustainability and spread. Reflect on the quality improvement.

Silver content Uses the Model for Improvement as a framework for delivering a quality improvement. Focusing on understanding your system and testing small steps of change. Supported by elements of teamwork, communication and reflection.

The Model for Improvement The model is based on three questions.... And on the application of a structured improvement approach known as the PDSA cycle. 3.2, 6.2 Associates in Process Improvement, 1996

Silver Delivery: Proposed

“Improving Quality Together is patient-driven. It’s also staff-driven. By improving quality, we can take away some of the stress and strains on staff.” Chris Rowland

Gold audience Gold: Individuals who have a detailed understanding of quality improvement and who have experience in managing a number of quality improvement projects

Gold learning outcomes In addition to Silver: Be able to support others in implementing quality improvements. For Gold Improvement Coaches: Be able to use a learner-led delivery style approach to cascading Improving Quality Together.

Gold network approach Gold network: Development of Gold learning objectives and development material. Advice and support for Improvement Coaches. Improvement Coaches to develop Silver materials further. Further learning and development of all members.

Board Board: All Board members (including non-executive members) and other senior leaders as identified by organisations

Think in terms of the organisation as a system & understand fundamentals of improvement methodology Aim Competencies Board leadership of the ‘triple aim’: (Continuous improvement in patient experience* and population health at reduced cost). Give focus and direction through clear, patient-centred values and goals Build a learning organisation which understands patterns of avoidable harm & analyses causes to drive improvement. Provide visible leadership & build engagement, based on understanding of motivation, culture & teamwork. Be accountable and hold others to account * “Experience” includes all aspects of quality: safety, effectiveness, dignity, respect and timeliness Board leadership

Delivery - Potential routes for delivering development support Input to general induction for new Board members. Access to online IQT resources at Bronze and Silver levels. Support for assessment of competency development needs. ‘Whole Board’ development sessions. Quality and safety committee development sessions. Learning sessions for Board members with specialist roles (e.g. Q&S committee chairs; AMDs for Q&S). Individual coaching.

Potential support resources National Learning Sets and lectures. National collaboratives – e.g. Mortality and harm measurement. Guidance – e.g. WalkRounds/patient conversations/culture surveys. Facilitated peer group support – e.g. AMDs for Q&S. White papers – e.g. Achieving High Reliability/ Assurance and improvement. Facilitated study visits – e.g. Jonkoping; Bolton NHSFT. Case studies – e.g. Using patient stories in Board meetings.

Recognition of prior learning Team approach to improvement – Bronze fast-track Delivered one QI as an individual through a formal programme – Silver fast-track Delivered three QI as an individual – Gold fast-track In addition to Gold, has accredited delivery skills – Gold (Improvement Coach) fast-track

Contact Every organisation has their own lead for Improving Quality Together. These are available online at If you have any queries, please