In the past few decades, much of the national policy discourse on NHS organisations that provide health care in England has focused on how they perform against a core set of quality and financial targets. The policy focus has been on deploying a range of regulatory and payment levers to try to ensure compliance with these targets, or pursuing structural reform to boost performance and tackle variation between providers. As a result, much more attention has been paid to ‘what’ providers have done than to ‘how’ or ‘why’ they have done it, and much more emphasis has been placed on externally driven, rather than internally driven, change.
In recent years, however, there have been signs of a shift in approach. National frameworks and concordats such as Developing People, Improving Care and Shared Commitment to Quality, have looked beyond performance metrics to the capabilities and capacity needed within provider organisations to drive improvement. It is important to measure, recognise and incentivise quality, these documents argue, but this must go hand in hand with a strategy for providers to build the knowledge, skills and infrastructure that are needed for the consistent delivery of high-quality care and for continuous improvement. Similarly, the Care Quality Commission’s (CQC) examination of how NHS trusts rated as outstanding have embedded quality improvement (QI) across their organisations highlights the importance of building the right skills and culture among staff.
The NHS long term plan recognises that successful delivery ‘will rely on local health systems having the capability to implement change effectively’ and commits to 'supporting service improvement and transformation across systems and within providers'. This includes an initiative, in partnership with the Health Foundation, to increase the number of integrated care systems that are building improvement capability.
This report summarises the evidence on building improvement capability to support this evolving agenda, primarily within the context of the NHS in England. It draws on the learning and insights that the Health Foundation has generated over the past 15 years from funding and evaluating improvement at team, organisation and system level.