My Improvement Journey

1. How did you first get involved in improvement, and what has been your journey since then?

I qualified as a dietitian in 1992 and soon after began working in the NHS. From the moment I commenced work the importance of improvement has been clear to me. This has been at several levels throughout my professional career to date. My career has involved working as an allied health professional lead in the NHS and charitable sector which has involved leading patients, teams, services and systems at a Trust and regional level. As co-director of a limited company which undertakes healthcare service and workforce transformation again improvement has been at the heart of work undertaken with partner organisations.

As an example when working and supporting patients directly I have seen the importance of improvement first hand whether it be ensuring information whether written, digital or verbal is able to be understood and acted upon by people and their carers, family and wider networks or the importance of reviewing and transforming patient pathways to ensure effectiveness, and efficiency to ensure the best quality patient care.

Leading, designing and delivering clinical leadership programmes for professionals that I have been involved in over the years has a strong emphasis on the use of plan, do, study, act model for improvement (How to Improve: Model for Improvement | Institute for Healthcare Improvement (ihi.org) led through a persons clinical leadership and then enabling the professionals on the programmes we have delivered the opportunity for self-reflection and learning shared with others of their own personal experiences. This leadership development has embedded the view of patients throughout and the importance of co-production, co-design and consultation through improvement work undertaken.

Co-leading large scale improvement and moving thinking forwards in the healthcare arena is very important to me for the benefit of patient care. An example of this was co-leading and authoring the prehabilitation guidance for people with cancer published in 2019 (Principles and guidance for prehabilitation within the management and support of people with cancer (macmillan.org.uk). The improvement and development of services since this time has been phenomenal at a national level with interest and engagement at an international level as well.

2. What most inspires you professionally?

I am motivated by making a positive difference to patient care in the work I undertake. This is specifically the case where I hold regional and national roles which enable large scale change and service transformation that will impact large numbers of people using healthcare services.

I am most inspired by the impact of wide collaboration and stakeholder engagement in different programmes and projects to deliver solutions that can really make a positive difference to healthcare service pathways, systems, processes and workforce with the ultimate aim of providing the best care possible. I love to start significant new pieces of work and see them through to fruition including implementation which can often be the most challenging part of any programme of work.

Developing and ensuring professionals have the skills, capabilities and knowledge to do the jobs they are employed to do to the best of their ability and see people grow and develop is also a very important motivator for me.

3. Can you share a hard-won lesson you’ve learnt about what makes for a successful (or unsuccessful) improvement project?

I often think much bigger than a projects scope might start out as. This can be a problem as this can unintentionally widen the scope of work and the timelines for delivery. I have learnt to ensure the scope of any work is clear and agreed by all including it being clearly stated in relevant group terms of reference, project initiation documents and however I am always ambitious.

A clear project brief to communicate work to different stakeholders has been one of the most useful things to write early on. They now always include a short introduction to the rationale for the work, any background information, the project timescale, a description of stakeholder engagement, the intended outputs, the governance structure for the work and who to contact for further information. I use this approach whether it is work in the NHS, charitable sector or through the company.

We are in the process of starting a review of the prehabilitation guidance mentioned earlier. At the outset we have agreed the scope, inclusion and exclusion criteria and the topic themes we will in the guidance review. This has been summarised in a clear project brief. This will prevent ‘scope’ creep and keep the review on track. Patient co-design has been considered from the outset and representatives are being embedded across the programme of work.

4. What change could we make that would do most to embed continuous improvement in health and care?

I think it is critical for health and care professionals to really understand that improvement should be part of their day to day work and not an optional extra. Specifically understanding how to approach the co-production and design of services in a meaningful way is critical to improvement.

For this to happen there needs to be a real focus on:

ensuring staff have the skills, knowledge and capabilities and confidence to undertake co-production as my personal view is that this is not undertaken in as meaningful a way as it really needs to be to ensure services are patient led
Co-production taking into account the diversity of views and opinions
Overcoming and working through the challenges that co-production will throw up

5. Why did you join Q?

As part of the prehabilitation guidance development in 2019 one of the actions from that work was to set up a community of practice to ensure people interested in the topic area could learn and share their experiences with each other from across the country. The opportunity arose to propose and subsequently set up a specialist interest group on prehabilitation and rehabilitation Perioperative Care – Prehabilitation | Q Community (health.org.uk) through the Q community. This has been through a collaboration between the Centre for Perioperative Care and Macmillan Cancer Support.

6. What new connections have you made as a result of joining the Q community – and what have you learnt so far?

I have better understood how the Q community works and the impact the different groups can have and how different people engage. I have connected and am working with people closely from the Centre for Perioperative Care. I have also made connections with the AHPs in quality improvement SIG, the Reimagining Health and Care SIG and the Co-Production SIG.

I am acutely aware there is so much expertise to tap into which I will use as learning going forwards.

7. Can you tell us about something you’re currently working on that Q members might be able to get involved with?

We are in the process of reviewing and updating the prehabilitation guidance for cancer. This will be published in Autumn 2024 and we will ensure there are updates and opportunities for engagement posted on the Perioperative Care – Prehabilitation | Q Community (health.org.uk)

I am acutely aware there is so much expertise to tap into which I will use as learning going forwards.

8. Can you tell us about something you’re currently working on that Q members might be able to get involved with?

June Davis, Macmillan Cancer Support