How to build capacity and capability for improvement

The content in this section has been developed by the National Clinical Director for Improvement, Dr Amar Shah, in an aim to support those who may be embedding a Quality Improvement (QI) approach.

There is no set sequence in which to plan your capability building.

Starting with the board is almost inevitable though, as without board engagement, understanding and support, the rest is unlikely to be possible.

Creating internal experts has a significant lead time (usually a year) – so start this early and continue to build a pipeline that deepens this essential level of skill within the organisation until it reaches the desired level.

Creating a programme for those involved in improvement efforts is critical, as this will not only enable people to learn improvement skills, but also deliver results. This programme is wrapped around real projects, and so is an important place to begin.

As the scale of improvement grows, build in a way to create a deeper infrastructure of improvement support for teams – e.g. through developing improvement coaches.

Design an introductory course for all staff to undertake, which can enable large numbers to complete each year.

Add in other offerings – such as bespoke programmes for patients, service users and carers, students, trainees, etc.

Capability building

Group Role Skills needed Options Numbers and frequency
All staff Applying improvement method and tools to daily work. Participating in improvement projects. Awareness of the chosen improvement method. Familiarity with basic aspects of method, and use of common improvement tools. Design an internal programme that reaches all new starters and can cover 20% of the organisation in a year. Likely one day needed. All staff in the organisation. Co-design a one-day training and provide at a pace that would reach 10% of staff each year.
Those involved in improvement efforts and all leaders. Leading improvement projects. Identifying the right opportunities for improvement. Knowledge and skill of how to apply the method and tools to work through a complex problem. Design or commission a programme that enables teams to learn and apply the method to solve a real issue. Likely multiple days over several months. Ideally aligned with the planning and delivery cycle – perhaps once or twice a year. Enabling projects to be designed and delivered in support of the strategic plan.
Improvement support for teams Providing close, skilled support and coaching for teams who are applying improvement. Either full-time or part-time roles. Deeper knowledge of the method, and skill in working with teams to help them apply this in daily work. Commission or purchase places on programmes (e.g. improvement coaching) that can build an infrastructure of support to cover every team in the organisation. Likely multiple days over several months. Needs to create sufficient support for every project and team in the organisation, and able to replenish this pool each year due to turnover.

Likely one programme a year, with 25-30 participants.
Internal experts Guiding the organisation and leaders on building an improvement system. Designing and delivering large-scale improvement. Building an infrastructure at scale. Likely full time roles. Technical experts in the method. Internal consultants on deployment of the method. Skill in design for large-scale improvement and building an infrastructure for scale. Create a central team. Develop individuals to expert level (e.g. improvement advisor, advanced process improvement training, black belt etc) – likely need to purchase places. Likely one year programme. Depending on organisation size, will likely require one person for each division/directorate – acting as guide and supervising the local improvement support for teams. For example, an organisation of size 5000 will likely require 8-12 experts.
Executive team Creating the conditions for improvement. Sponsoring large-scale efforts. Coaching leaders to apply the method, role-modelling of behaviours. Knowledge and skill in how to apply the method and tools to work through a complex problem. Leadership for improvement behaviours. Learn alongside teams who are learning & applying the method. Leadership for improvement programme. Identify the executive lead for improvement, and skill up to expert level. Likely to be regular, short, team-based discussions. Aim for all executives to have completed the learning relevant to project delivery & leaders, within 2 years. All new executives to complete this within first year in post. Strategic guidance session for executive team every 2-3 months.
Board Setting direction. Commissioning large-scale improvement. Investing to build the improvement system. Awareness of the chosen improvement method. Familiarity with basic aspects of method, and use of common improvement tools, particularly analysis of variation. Develop or commission a board development programme, which will need to be customised to the current progress and maturity of the organisation. Likely to need regular board development time. Will depend on level of improvement maturity of the organisation. Multiple sessions likely at start of journey, followed by a development session once or two a year to reflect on progress and plan / prioritise.

 

Resources

The case studies and resources on our NHS IMPACT web pages have been curated by National Clinical Director for Improvement, Dr Amar Shah, in an aim to inspire those who may be considering adopting a QI approach.

Building capacity and capability for quality improvement: developing an organisational approach – British Journal of Healthcare Management
There has been an increase in the adoption of quality improvement methods to tackle complex problems in healthcare. One of the key requisites for sustainable quality improvement is ensuring that organisations have the capacity and capability to make these changes effectively. This article uses a case study methodology to describe the learning from 9 years of developing, delivering and evaluating quality improvement learning programmes at East London NHS Foundation Trust.

Building the foundations for Improvement – The Health Foundation
How five UK trusts built quality improvement capability at scale within their organisations

Building improvement capability in frontline staff: a UK perspective – National Library of Medicine
This paper gives a narrative account of how the Oxford Healthcare Improvement Centre has embedded continuous quality improvement (CQI) across both mental health and community services in Oxford, UK.

Conceptualizing and assessing improvement capability: a review – International Journal for Quality in Health Care
The study identifies and analyses 70 instruments and frameworks for assessing or measuring improvement capability.

Building improvement capacity in mental health services – Cambridge University Press
Organisations can build improvement capacity and skills by developing permanent multidisciplinary centres to provide sustained inspiration, research, training and practical support for implementation and innovation.

Building Quality Improvement Capacity in Primary Care: Supports and Resources – Agency for Healthcare Research and Quality
In this paper, the Agency for Healthcare Research and Quality (AHRQ) describe the approaches and supports that an external infrastructure could provide to build improvement capacity in practices and a strong QI orientation in primary care.

How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis – BMC Health Services Research
The aim of this research was to explore the factors that lead to successful implementation of a program of quality improvement projects and a capacity and capability building program that facilitates or support these.

Building Improvement Capacity and Capability – Institute for Healthcare Improvement
A “dosing” approach guides and targets organisation-wide learning to building improvement capability and capacity.