The Orthopaedic Quality Improvement (inc.Clinical Audit) Network (OQICAN), hosted by the National Orthopaedic Alliance (NOA) aims to bring NOA members together to benchmark and improve their services. John Bateson, Deputy Director of Strategy at the Royal National Orthopaedic Hospital NHS Foundation Trust (RNOH), leads the Quality Improvement (QI) strand of this work. He reflects below on QI work at RNOH and explores how a network approach might help.
Most healthcare organisations already have a strategy for QI. My organisation, the RNOH, sees QI as key to helping us make changes that improve experience and outcomes for our patients and colleagues. There are a few different methods to approach QI, but they all involve the same basic structured approach to identifying issues, setting up measures, making changes, and judging their impact.
This usually consists of iterative testing rather than sweeping changes and so lends itself to exploring difficult-to-solve issues like those we face in healthcare. At best, QI engages a team of healthcare workers and patients to work together towards better patient experience and outcomes, better system performance and better staff engagement. We use the Improvement Method across the RNOH which means we have a common language for talking about improvement, and this certainly seems to help.
For me, the mark of success for the RNOH strategy will be wide engagement in improvement across our organisation. Improvement should not be the preserve of a central team but rather should be led by the people treating and supporting the patients (administrators, nurses, AHPs, doctors), and by patients themselves. And so at the RNOH we offer training programmes, coaching and good practice sharing alongside the centrally-driven trust-wide programmes of improvement work (we have a number of these, with the three biggest looking at non-admitted patients, peri-operative and post-operative pathways).
Our Chair and Chief Executive have established a slot at all our Public Boards for an improvement story, and recently we’ve been able to give a platform to improvement work that has had limited input from the central improvement team. Last month it was an excellent piece of work by our AHP team that reduced post-sacrectomy recovery time and length of stay using a tilt table.
We’re relatively early in our work and there’s a long way to go before we are an organisation where everyone feels that they can identify improvement opportunities, be listened to, and have the skills and support to make improvement happen. There are signs that we are getting there though; in this year’s NHS staff survey we had the best results in the country for staff engagement.
A recent BMJ open quality article we wrote reflects on our experience of using a rapid improvement model for virtual clinic implementation; because it was rapid, it was a pragmatic mix of improvement action and reflection underpinned by some additional project resource. It was a priority because Covid-19 made us stop doing face to face consultations. It’s not always so easy to understand the right thing to work on, however.
Using evidence to agree priorities and ensure that we’re working on the right thing is just one of the areas that we’re working on here at the RNOH. We’re also trying to get better at engaging collaboratively with patients and sustaining our improvements. These are just some of the areas where we think OQICAN can help us improve our quality improvement.
OQICAN is currently working on ideas for sharing improvement work and developing some QI teaching sessions. We’re looking for colleagues who want to offer their ideas and/or their expertise. Any contribution whether it’s a couple of lines in an email or joining the planning and delivery group, would be much appreciated so please get in touch with me directly on firstname.lastname@example.org or via the NOA team on email@example.com
John Bateson is Deputy Director of Strategy at the Royal National Orthopaedic Hospital NHS Foundation Trust (RNOH). He is proud to be leading the improvement team at the RNOH having worked in the NHS for over two decades, both in operations and improvement in a variety of London hospitals, and in national roles developing improvement strategy.
John leads on the QI strand of the Orthopaedic Quality Improvement (inc.Clinical Audit) Network hosted by the National Orthopaedic Alliance.