When he first entered the field 15 years ago, improvement was a nascent field in the NHS. Now, as Amar Shah, the National Director for Improvement, reflects on the journey so far, he shares a new sense of hope and purpose. In this post, Amar offers his personal take on the rapid evaluation of NHS IMPACT, a report by Professor Nicola Burgess and Nick Downham. He explains how the findings have not only reinforced his belief in the growing movement for improvement, but also highlighted the key challenges the NHS must overcome to truly embed improvement into its culture and solve today’s most pressing problems. You can access the full report by clicking here.
When I first dipped my toe into the field of improvement, 15 years ago, there was little to identify it within the NHS. I could find only a handful of enthusiasts, no obvious convening or support from national bodies, few ways to learn, connect and share. As I learnt my way into developing an approach to improvement at East London NHS FT, it has felt like forging a career path in a newly establishing field. Every job description I wrote for the growing team, or indeed for myself, was the first of its type that I could find.
I’m so heartened by how this field has changed over the last 15 years. From being a pursuit of a handful of enlightened organisations then, we are in a position where pretty much every healthcare provider in England is somewhere along the journey of learning how to adopt an improvement approach, and we are beginning to support and enable improvement across systems and regions within England.
I am really grateful to Professor Nicola Burgess and Nick Downham for the evaluation that they have skilfully conducted, two years on from the launch of NHS IMPACT. The evaluation is a really accessible read, and I’d encourage you to take a look if you haven’t already. The findings reinforce some of what I think we’ve sensed across England recently – a growing movement for improvement, appreciation for professional leadership in this field, the importance of regular spaces to learn and connect with peers.
The big issues at the moment in the NHS relate to access, money and public satisfaction. If NHS IMPACT, and improvement more broadly, is going to remain relevant and a credible problem-solving approach that our senior leaders and politicians have belief in, we will need to demonstrate that it can help us with solving these complex challenges. There are brilliant examples of this in places across the NHS, but we will need to build on this rapidly.
The challenges that the evaluation of NHS IMPACT invites us to consider, are undoubtedly challenges also for the wider field of improvement. Constancy of purpose was W. Edwards Deming’s first point for management. We know from the examples within the NHS where improvement really delivers, that the approach has sustained beyond a single person or executive team. There is a very real question about how we can maintain belief in improvement at national level and the infrastructure to support it properly, with such frequent change in leadership and proximity to politics.
Frameworks come and go, of course. However, the principles of NHS IMPACT that have resonated with people and allowed them to find meaning and connection to their own work are the key learning that we need to hold on to.
There is no single way to do improvement – there are a plurality of methods. The evidence tells us that no method is more effective than another – the key is to pick one and stick with it. Adopting a method-inclusive approach through NHS IMPACT is not only evidence-based, but allows us to build a broad community that accepts all – modelling how good improvement is done.
Building our improvement muscle, learning how to apply the rigour of improvement to solving real complex problems that face the health and care system today, is only possible if we enable people to learn from each other in safe spaces. It has been a key personal focus of mine to build stronger improvement communities and learning spaces across England. There is now such richness of improvement work across England – one of our biggest opportunities is to find better ways to curate the learning, share and adopt.
With a health system as large as England’s NHS, it remains a curiosity that we don’t really have a wealth of expertise somewhere centrally to support the design and delivery of large-scale national programmes, to support the continuing professional development of the improvement field, to give voice to improvement in national conversations, to curate learning and systematically support scale and adoption, and to do things once in order to bring greater value. The upcoming NHS IMPACT operational improvement training, and the Board and executive development programme, are two examples of what might be achieved with a small, agile central agency with true expertise. It has been a feature of the first two years of NHS IMPACT that we have been highly reliant on the generosity of people in supporting our progress with improvement. My sense is that we are reaching a tipping point soon, with the growth of improvement knowledge, skill and application in England, where we will need to make a choice about whether we’re willing to invest to take this to the next level.
My final, and most profound, reflection is one of gratitude. It has warmed my heart to read the quotes within the evaluation, describing the support and meaning that people have found through the NHS IMPACT work over the last two years. The work ahead of us is two-fold – to continue to nurture and strengthen the community of improvement professionals in service of making people’s experience and outcomes from healthcare better, and also to ensure that improvement is valued, practised and held dear by everyone who works in, or comes into contact with the NHS.
You can read other blogs about the impact of NHS IMPACT here: