Service improvement - Healthcare

Background and context

In the previous chapter we looked at the importance of developing your leadership skills from the beginning of your career. In this chapter we are going to examine how service improvement experience can help you to develop both essential and desirable employability skills. During this chapter we will explore these skills so that you can recognise for yourself how your service improvement experience can help you to get the career or job you really want. As this is an area where your emerging leadership skills can be further developed and honed, we will come full circle at the end of the chapter by summarising how service improvement is integral to healthcare leadership.
As a healthcare professional there are many things that you can do to market yourself to potential employers. First and foremost, in order to secure work it is essential that you are able to demonstrate that your personal profile fits the specifications of the job description. In other words, you must be able to show that you are fit for purpose. However, in the current highly competitive job market it is likely that you will be part of a large pool of appropriately qualified healthcare professionals, all keen to demonstrate their potential value. With this in mind one, of the most useful pieces of advice I was given as a new graduate was to carefully consider what added value I could bring to potential employers. Whilst there will undoubtedly be many ways that you can show how you offer something unique, certain types of activity and experience lend themselves particularly well to this purpose. Service improvement is a great example of an area where knowledge and experience can provide you with a wealth of transferrable employability skills and, therefore, the opportunity to clearly demonstrate to employers how you will be an asset to the team in the future.

It is important to point out at this stage that a propensity for improvement and managing change is actually a fundamental requirement for modern healthcare professionals that will undoubtedly be written into all job specifications. Yet, despite this fact, relatively few healthcare graduates really grasp the value of fully engaging with service improvement. When you analyse the many transferrable skills that can be evidenced by demonstrable service improvement experience, even at a very basic level, hopefully you will begin to see that this is your opportunity to show potential employers how you can make a real difference to their organisation.

So is it feasible for students and new graduates to be realistically expected to be improvers when they are still coming to terms with the basics of service delivery? The answer to this is emphatically ‘yes’. The reason for this is that service improvement methodology is logical and objective. It generally starts with a picture of what is happening currently, in order to help everyone to visualise where improvements need to be made. To do this does not require you to be an expert. Instead it requires you to be able to build up an accurate picture of what is currently happening by consulting widely with all of the stakeholders involved. One effective way of doing this is by using a simple tool such as a ‘Process Map’ (NHSI, 2007), which is essentially a flow chart of the work process that acts as a visual representation of what is actually happening in practice. As well as being beneficial for actually being able to picture all of the critical stages within the process, the act of producing the map requires you to discuss what is happening with team members. The finished process map then acts as evidence for the team to brainstorm to find ways of improving the service. In this way, the application of common sense and objectivity is just as valuable as experience. In fact, when it comes to thinking innovatively or creatively about how to do things differently, a fresh pair of eyes can be a distinct advantage (Adair, 2012).

Although a fresh pair of eyes is very valuable when looking for new ways of working, it is essential that everyone involved in the work process is consulted during the service improvement process. In fact, when analysing services it is absolutely vital that all of the team members are able to contribute, ideally in the same room at the same time. This will ensure that the outcome accurately reflects what is happening in reality and not just what certain people think is happening. Importantly, working through this mapping process together promotes a sense of collective ownership and involvement in the improvement; this will increase the chances that any proposed change will be successful. Indeed, it is through this process that ideas for improvement normally begin to flow and can be actively encouraged from all members of the team.

However, before we get too carried away, it is very important to recognise that analysing services and suggesting areas for improvement is the relatively simple part. Making sure that the improvements suggested are meaningful and can be implemented in practice is a much harder job. Ensuring that the improvements ‘stick’ in the long term, that is they are sustainable over time, is even harder. Much of this depends on the ability of the whole team to work together to collectively own the improvement and to methodically work through progressive cycles of change to iron out the many problems that present themselves in practice. Based on original work by Walter Shewhart, American change guru W. Edwards Deming developed a model to ensure that changes are carefully planned, implemented, monitored and maintained long term. His ‘Plan, Do, Study, Act’ (PDSA) cycle (also known as the Deming wheel) has been widely adopted within healthcare improvement as it is simple and logical to use (Langley et al., 1996). However, Deming identified that even the most simple change is likely to require numerous PDSA cycles to be undertaken before the change becomes embedded in practice, with each subsequent cycle refining the process yet further.

Now let us go back to the interview situation and consider how an employer is likely to view someone who not only understands how to analyse work processes in order to find ways to improve, but is able to demonstrate understanding of the ‘human factors’ associated with behavioural change. Clearly this person is going to have a greater chance of convincing employers that they can make a difference in the tough world of work. Of course, no employer can realistically expect a new graduate to be an expert in this field. However, engaging with even simple improvement projects will provide you with considerable experience that will help you to start developing the resilience that is vital for seeing changes through from the drawing board to measurable, sustainable improvement in the real world. This chapter is intended to help you to see this for yourself and, therefore, to inspire you to learn more about service improvement and managing change.