Updated: Nov 7
If you are new to the Primary Care Network Digital and Transformation Lead role and new to Primary Care, this blog is for you.
This resource is also for anyone leading a change.
In this blog, you will find:
The NHS toolkit for leading large-scale change. This resource introduces you to a host of quality improvement tools which will aid you in your role.
A robust risk assessment template which is available to download, to support you in proactively considering and documenting what could derail your project.
9 (more) top tips to support you to be successful in your role.
4 podcasts that provide practical advice on how to manage change using quality improvement.
The purpose of this blog is to give you an introduction to quality improvement, what it is and why it is important, and to provide you with a range of resources, tools, and ideas to underpin your own quality improvement initiatives.
Before we jump in, you might want to check out our previous blog on creating a plan to support your first 90 days in post. This is just an example to get you started, and the blog can be found here (skip to section 9). Also, there is a lot in this blog, so hopefully, this is a resource you will come back to time and time again.
Why use Quality Improvement (QI)?
Quality Improvement is all about helping you to identify problems, explore solutions, and implement change cycles to see what does and doesn’t work. The QI approach stops us from jumping feet first into finding a solution, particularly when we may not have a firm enough grasp or understanding of the reasons for the issue.
When used pragmatically, I believe that the application of QI tools can create consistency, as well as saving you time and money, because changes are rolled out across your PCN, instead of everyone making it up as they go along, without any clear or agreed frameworks in place.
Quality Improvement Training
Below are two key training programmes which I have found to be hugely beneficial in my career:
1. Participating in the NHS England and Improvement General Practice Improvement Leaders Programme and joining the faculty as a Time for Care Quality Improvement Facilitator.
One particular project which stands out to me was working with a PCN to increase the uptake of childhood immunisations within a Jewish community.
This project encompassed the importance of four key Principles to aid change.
🎯 Identifying the problem by using data and process mapping the current state of activities before applying changes.
🎯Working collaboratively with others to ensure that not only key PCN people were involved and engaged but that other key stakeholders (and people of influence) within the wider community were consulted and able to contribute.
🎯 Taking the time to create a plan which took into consideration key dates in the diary and enabled the setting of realistic project milestones and goals.
2. Before my time in healthcare, I worked in insurance and undertook training in the Basics of Lean Six Sigma.
This course taught me how to use and apply Lean principles and tools to reduce waste and speed up processes, and I used these skills to manage the digitisation of physical insurance documents.
This was a huge project which required us to set up an office in Delhi where some of the insurance documents could now be processed.
This project gave me valuable insight into:
The deconstruction of a process
Procurement of workflow technology
The creation of standard operating procedures
Management of a huge range of stakeholders which included The Lloyds of London insurance brokers as external stakeholders (as there was direct impact on existing working processes for them ). Redundancies were also a factor, alongside the selection of UK members of staff who would be required to relocate to India.
Another memorable project which used the skills of Lean Six Sigma involved me writing a proposal to build a stem cell laboratory which also involved an extremely robust risk analysis that covered the following.
Project Intelligence Risk
The risk that the quality of initial intelligence will impact on the likelihood of unforeseen problems occurring
The risk that the project cannot be financially sustainable
The risk that there will be an undermining of customer’s/media’s perception of the organisation’s ability to fulfil its business requirements operational problem
The risk that the service is not fit for purpose
The risk that the design cannot deliver the services to the required quality standards
The risk that the implementation of a project fails to adhere to the terms of the planning permission, or that detailed planning cannot be obtained; or, if obtained, can only be implemented
at costs greater than in the original budget
The risk that the construction of physical assets is not completed on time, to budget and to specification
The risk that the nature of the project has a major impact on its adjacent area and there is a strong likelihood of objection from the general public
The risk that can arise from the contractual arrangements between two parties – for example, the capabilities of the contractor if/when a dispute occurs
The risk that operating costs vary from budget and that performance standards slip or that a service cannot be provided
Availability and Performance Risk
The risk that the quantum of service provided is less than that required under the contract
The risk that the demand for a service does not match the levels planned, projected or assumed
The risk that actual usage of the service varies from the levels forecast
The risk that the costs of keeping the assets in good condition vary from budget.
The risk that changes in technology result in services being provided using sub-optimal technical solutions
The risk that the availability of funding leads to delays and reductions in scope as a result of reduced monies
Residual Value Risk
The risk relating to the uncertainty of the values of physical assets at the end of the contract period
External Environmental Risks
The risks faced by society as a whole
The risk that project outcomes are sensitive to economic influences
The risk that legislative change increases costs. This can be divided into secondary legislative risk (for example, changes to corporate taxes) and primary legislative risk (for example, specific changes which affect a particular project)
The risk of changes in policy direction leading to unforeseen change
Please feel free to adapt the above table to use in your network. Click here to download the Microsoft Word version.
9 (more) top tips to increase the chances of success in your role
In order to maximise your chances of success, there are a few key things you can do.
Take the time to educate yourself on the QI tools available. Application of these will increase your chances of success.
In particular, set aside time each week to familiarise yourself with the NHS toolkit for leading large-scale change. To take this one step further; you could set up an action learning set to help you brainstorm (and make sense of the tools) and learn from others.
Clearly define the problem you are trying to solve and the goals and objectives of the transformation initiative from the outset. This will help to ensure that everyone is on the same page and working towards the same goal. Keep revisiting this. This may take some time and will require the analysis of data.
Where possible, try to lead with data and not use assumptions and tacit knowledge. Once you have identified the problem, you can then create a vision / goal for the future.
Make a solid plan for implementation. This plan should be realistic, achievable and should take into account any potential risks or challenges that could arise. Don’t rush this, as this could result in a direct hit when it comes to reputational risk.
Ensure that you have buy-in from all stakeholders; from staff to patients and other relevant parties. Without buy-in from all stakeholders, it will make it significantly more difficult to implement transformation.This step is vital, and you will need to use your soft and interpersonal skills to build rapport; so they grow to know, like, and trust you.
Communicate regularly with all stakeholders throughout the implementation process and use a variety of communication methods to keep everyone informed. Do not just rely on email. Actually....don’t just communicate regularly, OVER COMMUNICATE and be fully prepared for members of your network to still claim they have no idea what’s going on.
Be prepared to adapt your plan as necessary. Things will inevitably go wrong during any change initiative. The key is to be flexible and adaptable, so that you can quickly address any issues that arise.
Consider the risks and how you can minimise these.
Investing time in making sure these key elements are in place will help you to set the optimum conditions for change. For a real-life case study of change in action (and how best to approach it), why not check out our recent podcast episode featuring Ankish Patel, Head of PCN Workforce at Nottingham City General Practice Alliance.
For more guidance on all things digital and transformation, and quality improvement, please check out:
Creating your Primary Care Network Digital Transformation Lead Job Description and 90-day objectives
Whilst we share a lot of information in our blogs, there is so much more, and for those of you who are looking to invest in your professional development and the performance of your network, our programmes are full of tools and templates and master classes.
Click here for further information on our upcoming course - An Introduction to the Digital and Transformation Lead.
Lastly, we lead and manage PCNs too. We are in the thick of it and experience the good and those days when you think 😫!