Nurturing an improvement Culture at London Community Health Services (CHS): The Annual Visit from the Institute for Healthcare Improvement

 20th May 2022

By Carlos Santos, Improvement Advisor

What is a culture of improvement and what are some of the core ingredients needed to help this thrive? These are the questions that the London Community Health Services at ELFT have recently been asking themselves. The directorate was lucky to have some time to think this through with our friend Pedro Delgado, Vice President from the Institute for Healthcare Improvement (IHI), at their annual visit on the 12^th May.

Coming together with staff and service users, the directorate spent time thinking through three areas:

• What are the ingredients that support using Improvement in everyday work?
• What gets in the way from using Improvement into everyday work?
• What would help remove such barriers and what can be practically done to accomplish this?

Ingredients that support using Improvement in everyday work

Creating a culture of improvement is a bit like baking a cake “Different cakes have the same core ingredients, but everyone will make their own cake, with the same core ingredients”

That is to say that although the core elements might be same across different contexts, the amounts, types, way in which they measured, and the overall outcomes might look different. All improvement is therefore local. For London Community Health Services, the core ingredients were around the role of supportive leadership, having spaces for innovation and improvement, teams empowered to improve what matters most

What gets in the way of this and what would help encourage embedding improvement?

A range of different areas emerged around this with the following sticking out as key themes, complexity of working in a system, prioritising time for improvement and resistance to change generally.

Pedro suggested that teams should try to understand their own “internal locus of control”: those factors that are internal to the system and that influence their overall perceptions around their successes and shortcomings. “Looking what is inside, what is internal, before anything else” was suggested by Pedro as a great first step for the teams to embark into an improvement journey.

To help strengthen embedding improvement into everyday work, those that attended developed a range of different things that could be done differently. These included going where the energy is, simplifying ways to apply improvement, working to ensure all including staff and Service Users know how and when to use QI and sharing stories of good practice. The last of these builds on an idea from Tower Hamlets Community Health Services who have developed a simple way for people to share what improvement work they are working using a Microsoft Form. You can read more about that here.

Below you can see a force field analysis, which is a useful tool to help display restraining and enabling factors to a specific issue.

The visit provided an excellent opportunity for the directorate to reflect on their journey so far as well as celebrate some of their success.  What was clear, was this marked the beginning of an improvement journey for CHS this year. We’d invite you to come on that journey with us, so why not have a go in your own local areas at seeing what your own ingredients you think are required to enhance your culture of improvement.