Having come into the NHS from a background in finance, my professional training to that point had rarely encouraged me to question or challenge established rules and techniques. Since moving into operations and through to chief executive level, I've recognised that by turning away from rigid thinking and adopting an improvement mindset at all levels, we can allow room for innovation while maintaining quality delivery and patient care standards. By embedding this mindset wherever we can, we make it possible to work within the boundaries of existing structures while continuously challenging their legitimacy and effectiveness. With this approach, we can explore new ways of working, safely and consistently.
Improvement is a science and an art, and it should be everyone's business.
Chief Executive
Improvement is a science and an art, and it should be everyone's business. In my view, there is a danger in delegating ownership of improvement to specialised teams. It takes the responsibility away from those who are doing the work daily, and with it the excitement and intellectual challenge of innovation. If we do this, we can inadvertently disempower our teams and foster complacency. Instead, I encourage fellow board members to think about how they actively support this work themselves, and how they might make use of improvement methods and principles in their own tasks, and to continue to do so on an ongoing basis.
It's crucial that we recognise that improvement is a job that is never finished. To use a football analogy, even the very best players have great coaches, and if this shows us anything it's that we can always be improving. Healthcare is a landscape that is constantly changing – demand, patient needs, workforce aspirations, there is always something shifting, and in order to keep up with the pace we need to be constantly reflecting and implementing change accordingly.
An important element of this work comes from truly knowing and understanding the reality of the situation on the ground level. First, we need to listen. In my organisations, when we as leaders visit wards and meet staff, we aim to prioritise listening over telling. Throughout my years in the NHS, I've seen that people do notice what leaders pay attention to and where we focus our time, so we need to ensure that we're demonstrating that we care about our patients, the quality of the service and the views of our staff.
When it comes to regulated healthcare, we need to be careful that adhering to the expectations of compliance doesn't prevent us from making improvements or creating an environment where people feel able to innovate.
Chief Executive
Acting on what we hear and implementing change safely requires that we find a balance between protocol and innovation. Consistency often goes alongside quality in textbook definitions, and it can be difficult to navigate the line between traditional approaches to the Care Quality Commission, which can involve working to a set of rigid outcomes and processes, while taking measures to act on the knowledge that we could be doing things better.
When it comes to regulated healthcare, we need to be careful that adhering to the expectations of compliance doesn't prevent us from making improvements or creating an environment where people feel able to innovate. It's crucial that we have a strategy – that we're able to demonstrate that we're exploring in a safe and controlled way and give assurance that we're analysing appropriately and spotting when things aren't quite right. But we also need to be open about our improvement mindset, and open about the fact that we're encouraging this throughout the organisation, and now across our wider partnerships in systems.
If you're not making mistakes, you're not pushing the boundaries of improvement.
Chief Executive
Part of a permissive mindset is to be able to see failure as the biggest opportunity for learning, and we need to make sure we're not afraid to take measured risks in order to move forward. If you're not making mistakes, you're not pushing the boundaries of improvement. There are many ways to solve problems, there is never only one solution, and by listening to the diverse range of experiences of our peers throughout the NHS and fostering a culture which encourages the sharing of ideas, we can create solutions that work for everyone, and most importantly, for our patients.
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