Launch of a new report: How do we define and demonstrate value from continuous improvement in the NHS?
By Professor Bernard Crump, Professor Helen Bevan and Dr Kathryn Perera
April 2024
We want to address a topic that is often not discussed or underdiscussed amongst leaders of health and care: the value arising from continuous improvement (CI) activity, particularly economic value.
In September 2023, Warwick Business School and NHS Horizons joined forces to explore this topic. We convened two in-person roundtable events with 150 senior leaders from across the NHS.
You can access, download and share the report of the outcomes of the roundtable meetings here.
In setting up the roundtable meetings, we were mindful of at least five significant opportunities. Firstly, leaders can be reluctant to even consider the question of the value of CI, putting it in the box marked ‘too difficult’. For example, Warwick Business School was commissioned by the Health Foundation and NHS England to undertake an evaluation of a 5-year investment into NHS trusts working in partnership with the Virginia Mason Institute. The evaluators found that the question of ‘value for money’ had been explicitly excluded from the initial objectives set for the work – there was a concern that that to have a specific focus on financial outcomes might alienate a frontline workforce, whose contribution is pivotal to successful improvement. Advancing the thinking and practice on what constitutes ‘value’ will support NHS leaders to consider this as part of future significant investments in continuous improvement.
Secondly, the recent national review of continuous improvement across the NHS in England, led by NHS Regional Director Anne Eden, engaged more than 1,000 people across the service and partner organisations. A key finding was that CI is most effective when it is ‘baked into’ the strategic priorities of an organisation or system. Achieving this aim will be easier where organisations and systems share an understanding of the value proposition for CI activity.
Thirdly the launch of NHS IMPACT (Improving Patient Care Together) and the National Improvement Board bring fresh energy to efforts across the NHS that encourage and support everyone to improve the work that they do every single day. People leading CI at the point of care often struggle to free up time to invest in that work. Describing its value in clear, credible terms will better equip them to make the case for investment and support.
Fourthly, across the NHS, there is wide variation in how people define and demonstrate value from CI activity. This variation can make it tricky to gain an overall picture of ‘what works’ and ‘why’ in terms that are compelling to policymakers and those with the decision-making power to invest resources into continuous improvement. Exploring promising models and methods for defining and demonstrating value will sharpen our thinking, giving more scope for people across the service to collectively influence this agenda.
Finally, as our report describes, we also used the roundtables to learn beyond our borders. We introduced examples of work happening to define and demonstrate value across international health systems. This was key – our challenges to define and demonstrate value in England are far from unique. Some of the most exciting thinking and practice is being developed in other parts of the world.
Alongside presentations from leading academics and practitioners globally, we posed three questions at the roundtables:
- How can we make the economic case as strongly as the social and business case for continuous improvement?
- What approach could be developed to support organisations to evidence the value arising from their continuous improvement activity when considered through all three lenses?
- How can we demonstrate both the value and return on investment of continuous improvement in NHS operational currency?
Our joint report sets out the outcomes from these discussions. We summarise the differing perspectives and experiences of the roundtables’ participants. We raise a ‘call to action’ for those seeking to promote work to embed continuous improvement across the service, setting out recommendations for how we ‘mainstream’ it as core to business-as-usual. As David Fillingham, Chair of the National Improvement Board, wrote when launching NHS IMPACT, we cannot just rely on improvement enthusiasts to lead this work:
“We need staff at every level to see the benefits in their daily work. We need the Boards of organisations to put time and effort into leading this change. We need not just the Medical, Nursing and HR Directors to be involved, but Chairs and Non-Executives, Chief Executives, Finance Directors and Chief Operating Officers too.”
If we want CI to become fully operationalised, we need financial measures of value that fit with other activities. The developing maturity of system level working and the adoption of NHS Impact suggest that the time is right to address this challenge.
We hope that this paper can provide a stimulus for leaders across health and care to develop a more consistent approach to the measurement and capture of value arising from continuous improvement.
Professor Bernard Crump, Warwick Business School
Professor Helen Bevan, Warwick Business School
Dr Kathryn Perera, Director, NHS Horizons