Sustaining improvement: the stories of four NHS trusts

Chief Inspector of Hospitals, Professor Ted Baker, introduces the latest in our ‘Driving improvement’ series, in which we speak to four NHS trusts which have sustained their improvements

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Prof Ted Baker, Chief Inspector of Hospitals

Over the past few years, our Driving improvement report series has shone a light on a selection of NHS acute and mental health trusts that have achieved significant improvements in their ratings.

Through sharing their experiences and good practice, we hope that other providers have picked up practical tips to take to their own services and support their own improvement.

But what next?

We revisited four trusts to find out from staff and leaders how they have managed to sustain their improvements and, in some cases, been able to improve further.

  • Cambridge University Hospitals NHS Foundation Trust has maintained a ‘good’ overall rating, but improved from ‘good’ to ‘outstanding’ in well-led
  • East Lancashire Hospitals NHS Trust has maintained a ‘good’ rating across the board
  • North Staffordshire Combined Healthcare NHS Trust has improved further to achieve an ‘outstanding’ overall rating
  • Lincolnshire Partnership NHS Foundation Trust has maintained its ‘good’ rating and improved in two key questions from ‘requires improvement’ to ‘good’.

While all have individual stories to tell, there are common themes arising from their experiences, which other providers may find useful to reflect upon.

All four of the trusts had formal QI programmes in place, either of their own design or through signing up to formal programmes such as Vital Signs. In addition, they recognised the importance of encouraging staff to get involved in improvement work and allowing them to develop ideas to improve care based on their experience of providing care.

These are at the heart of continuous improvement. Some trusts have introduced their own ward accreditation schemes and developed metrics that are audited regularly. All four trusts now use statistical process control (SPC), which in some cases have replaced traditional RAG ratings. SPC is an analytical technique that plots data over time allowing trusts to see trends, understand variation, and determine the most appropriate action.

We know that a common feature of good and outstanding trusts is leaders who are accessible and approachable to staff. In all four trusts, stability in leadership has helped sustain improvement, and robust succession planning has helped continue the approach to improvement where there have been changes to the leadership team. More generally, recruitment is linked to the trust’s values and behaviour.

Training is seen as a high priority, and trusts have implemented leadership programmes and other training to give staff the skills they need to step up to leadership roles.

Successful engagement is key to sustaining and continuing improvement. Staff need to be engaged and supported by leaders if they are to make a telling and ongoing contribution to the continued success of an organisation. Where staff are involved in developing the trust’s vision and values, we see a positive impact on culture: staff feel able to contribute ideas and voice concerns that are listened to and acted upon.

The trusts we spoke to also engaged with and involved people using services, their families and representatives in ensuring services are designed around people’s needs.

Sustaining improvement depends on having the right number of the right staff available at the right time. This might mean thinking creatively about recruitment and retention, deploying staff in new ways, and ensuring existing staff have the training and opportunities to progress within the trust. We heard examples of initiatives to make the trust a good place to work leading to better staff retention, such as programme that support physical and mental wellbeing.

The importance of being an active partner in the local system was clear. All four trusts take a leadership role in their local systems, and work on joint initiatives such as system-wide workforce and mental health plans. They see the importance of working in partnership with primary, community and social care, and have taken steps to involve local voluntary sector organisations that may not be part of formal system arrangements.

I would like to congratulate the four trusts we’ve spoken to on their continued success and thank them for taking the time to share their experiences. Improvement is no mean feat, let alone under the continued pressure faced by many providers, and I commend those who undertake this regardless for the benefit of their organisations, staff, and people using services.

I would encourage you to look at the case studies and consider how you might adopt some of the practices in your own organisation. You may also want to revisit the other reports in the series for further support in your continued efforts to learn and improve.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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