We believe that transforming our health and social care system so it is fit for the 21st century will require a focus on both system redesign and continuous improvement.
Supporting teams to become more effective and efficient won’t help if fundamentally the system needs redesigning. However, it is not enough to redesign a system if we don’t then provide those delivering care with the skills to continuously improve it. So our approach is to focus on both:
- Supporting the work to redesign systems, services and processes which enable people to receive the right support and care, in the right place, at the right time while also reducing harm, waste, duplication, fragmentation and inappropriate variation.
- Supporting the development of cultures of continuous quality improvement so that every person working in health and social care is engaged in the work of improving their day to day practice.
We combine a person-centred, evidence and data informed approach with the systematic application of design methodologies, quality improvement methodologies and relational change management (improving outcomes through relationships). We are currently looking at how we might better integrate behavioural science into our core approach to ensure we are using the latest evidence about what enables key changes in individual behaviour.
Further, we recognise the vital role of artificial intelligence and automation in the work of transformation and hence are committed to close partnership working with national digital organisations such as NHS National Services Scotland, NHS 24 and the Scottish Centre for Telehealth and Telecare. An example of how this has worked in practice can be found in our case study on overnight support.
Our work focuses on:
- Supporting services and systems to understand their high impact opportunities for improvement.
- Assisting in the design of processes, care models and systems which will improve outcomes.
- Providing practical support to enable organisations to implement changes that will lead to improvement.
- Supporting services and systems to evaluate the impact of their changes, embed successful change and spread the learning about what has and hasn’t worked.
Our core offerings are delivered through a combination of:
- Bespoke support – this is largely focused on our work around system redesign and our work with governance. Practical examples include our work in Orkney and our work with Health and Social Care Partnerships (HSCPs) leaders.
- National improvement programmes
- Prototyping programmes – these are programmes where we are working with a defined number of local organisations to develop and test practical solutions for common improvement challenges across Scotland. For example, see our current work with five HSCPs to develop tools and approaches to reducing pressure ulcers in care homes.
- Scale-up programmes – these are programmes where we are providing support to scale-up known improvements across the wider Current examples include our work around the SPSP and our Living Well in Communities programme.
- National learning networks – In 2017-18 we facilitated 17 national learning networks. Some of these are embedded within our national improvement programmes, while others sit separately.
- Grants and allocations – to enable improvement work to happen locally. In 2017-18, £2.95 million of the ihub budget was allocated to health and social care organisations to enable them to fund staff to do the work of improvement.
We work at every level in the health and social care system, though the majority of our work is with the teams that deliver health and care services in the recognition that this is where much of the meaningful improvement work happens. However, over the last year we have increased the focus of our work with the management and governance tiers for two reasons:
- System redesign work, by its nature, requires an organisational approach.
- Continuous quality improvement within our health and social care delivery teams requires an enabling organisational infrastructure and culture, which in turn requires an enabling national context.
Healthcare Improvement Scotland’s Improvement Hub (ihub) is enabling health and social care improvement, by: