Engaging and empowering staff is key to driving improvement in hospital care

The Care Quality Commission (CQC) has  published a report that explores how eight NHS trusts have been able to make significant improvements in the quality of care and improve their CQC rating.

‘Driving improvement: case studies from eight NHS trusts,’ reveals the journey of improvement travelled by eight trusts from the perspective of staff, patients and organisations that represent them, and highlights how engaging and empowering staff has been critical in driving up quality.

The report – based on interviews with staff, patients and local patient group representatives – shows that one of the first steps to improvement for trusts was to review the culture of the organisation and look to address any disconnect between clinicians and managers, between medical and nursing teams or between different hospitals in the same trust. The priority for leaders was to bring all the elements of the trust together by engaging with staff and allowing open and honest conversations about what needed to happen to improve.

Professor Sir Mike Richards, CQC’s Chief Inspector of Hospitals, said: “Since introducing our comprehensive inspection programme in 2014, I have been encouraged by the number of NHS trusts that have made significant improvements in quality. We know from our inspections that strong leadership and a positive open culture are important drivers of change.

 “This report set out to build on that knowledge by exploring how leadership can drive improvement and identify what action has been taken to successfully deliver transformational change.

“Each trust had its own approach to change, but there were themes common to all and numerous examples quality initiatives, collaborative working, and programmes of engagement that have helped to drive forward improvement. 

“Real change does not happen overnight – the improvements made by each trust are a testament to the time, effort and determination of staff and local partners. I hope their stories will encourage and inspire others in their own improvement journey.”

Trusts placed emphasis on the visibility of leaders: chief executives and senior staff spent time on the ‘shop floor’, meeting staff and setting up regular channels of communication. They worked with staff to produce a set of shared values that would underpin positive cultural change and understood that staff needed to have ownership of those values if they were to be meaningful. For some this involved recognising the need to tackle equality and diversity issues relating to staff and patients and in the wider community.

The trusts also took action to change their approach to quality improvement and the report highlights a number of different initiatives. For example, Leeds Teaching Hospitals NHS Trust and Barking Havering and Redbridge University Hospitals NHS Trust are two of five trusts chosen to work with the Virginia Mason Institute as part of a programme led by NHS Improvement to help improve patient pathways.

As well as corporate initiatives, trusts set up their own local initiatives. At East Lancashire Hospitals NHS Trust, they embarked on a major staff engagement programme featuring ‘Big Conversations’.  These were focussed on improving quality and safety and ensured staff commitment to their vision – to be recognised for providing safe, personal and effective care.

The feedback received from trusts also shows that inspection helps improvement. As well as identifying problems and helping trusts develop improvement plans, CQC reports can give a rigour and discipline to improvement work and provide clinicians and managers the boost to make changes.