If improvement is everyone’s job, how can we make it easier for all colleagues to participate in their organisation’s improvement journey?
The old model: overburdened leader, unengaged follower
Traditionally, improvement has fallen to the leaders of organisations. For better or worse, they are often expected to be responsible for identifying, implementing and driving change.
This not only sets unrealistic expectations for leaders, but encourages dependency with little opportunity for colleagues to contribute, show initiative or be engaged in meaningful improvements. When colleagues have no expectation or incentive to be involved in quality improvement, they become increasingly reliant on leaders; and with all expectations on them. Leaders continue to carry the load even as it becomes unmanageable. This can have an effect on culture, leaving leaders isolated and overburdened as their followers become passive onlookers with little motivation or positive engagement in their work.
“If you treat others as the audience for your performance, then they will applaud from time to time – or throw rotten eggs – but they are unlikely to get up on stage and help you.”Beyond the Toolkit- Binney et al, 2010
The new model: improvement for all
A significant determinant of sustainable change is whether everyone feels involved in, and part of, the change.  Continuous improvement is a philosophy, not a quick fix, and for it to be embedded in an organisation’s culture, it must feel an integral part of everyone’s daily work.
By encouraging a more collaborative work-environment, expectations shift from the old model that was dependent on leaders, to a team effort that empowers everyone to be a part of meaningful change. This will help sustain a culture of improvement by setting more realistic expectations of our leaders and creating a happier, more engaged workforce.
Happier workforce, safer patients
Frontline staff are best placed to identify the problems and come up with solutions in any healthcare setting. To learn what areas need improving and to come up with the most innovative solutions, the frontline must be engaged. A more engaged workforce leads to increased staff satisfaction, better patient outcomes and improved financial performance.
A Gallup study has shown that companies with top quartile engagement have on average: 41% better patient safety; 37% less absenteeism; 48% less safety incidents; 22% higher profitability; and 21% higher productivity.
Furthermore, it has been estimated that reduced absenteeism associated with high staff engagement could save an average trust £235,000 a year in salary costs alone (2012 Department of Health estimate).
Here are a few simple ways to begin to make improvement a part of everyone’s job:
- Make it easy for colleagues to participate – ensure everyone knows what is expected of them and how they can get involved. The ImproveWell solution allows everyone to share their ideas for improvement anytime and anywhere via an app or on the web.
- Create an environment of opportunity for improvement – promote a culture where problems are seen as improvement opportunities rather than sources of blame or criticism. The ImproveWell solution not only asks colleagues to identify problems, but also the potential solutions for improving.
- Focus on value – communicate about patients, quality, and safety to get staff buy-in, as clinicians are more likely to engage with the process if the main emphasis appears to be on improving quality rather than cost-cutting measures.  The ImproveWell solution allows leaders to designate improvement themes to focus colleagues on particular areas and ensure everyone is working toward the same objectives.
- Demonstrate early impact – measuring and sharing the demonstrable impact and results is a powerful way to help support and sustain continuous improvement efforts. Sharing ‘early wins’ across the organisation will help to motivate and inspire, while also allowing colleagues to become internal champions and ambassadors to support their work.
By empowering all colleagues to get involved in quality improvement, everyone will be better able to make the changes needed to improve staff wellbeing, enhance the patient experience and ultimately, provide safer care for patients.
 Marshall, B., Wiggins, L. and Smallwood, J., 2018. Beyond the Toolkit: Leading Quality Improvement in Health and Social Care. 1st ed. Oxfordshire: Libri Publishing.
 Creating a culture of excellence: How healthcare leaders can build and sustain continuous improvement. Link
 Sorenson, S. 2013. How Employee Engagement Drives Growth. Gallup. Link