The key ingredients of system change and improvement – our learnings from the International Forum on Quality & Safety in Healthcare 

Posted by: NHS Horizons - Posted on:

By Marc Harris, Head of Insight and Impact NHS Horizons

Transformational change isn’t just about incremental improvements – it’s about reimagining systems, fostering trust, and embracing collective impact. Recently, we attended the International Forum on Quality & Safety in Healthcare, where thousands of international leaders came together to tackle today and tomorrow’s critical health and healthcare challenges, connect to form long-term partnerships, and consider new ways of thinking about healthcare. At the Forum, we (Horizons) facilitated 10 events with hundreds of attendees across the three days. Here we share our key messages from across these events and the wider forum.  

Zoe Lord Deputy Director, NHS Horizons Facilitating during the International Health Forum. Image Credit: Quality Forum

Embracing change-in-kind 

Many of the ways we go about change today involve continually improving services and ways of working with incremental developments over-time. This type of change is necessary, although there is also a need for more change-in-kind, which represents a paradigm shift—a transformational departure from existing norms and practices—rather than incremental adjustments. Embracing change-in-kind demands bold leadership, innovative thinking, and interdisciplinary collaboration to drive meaningful, sustainable improvements. 

“We need to stand back & take a systematic view to address large scale, complex problems” – Helen Bevan 

We need to create a different world in healthcare, where people who use services are equal partners in care. Most of our current change practice in health and care are designed for incremental change and development. This is important, but we also need landscape shifting change. We need to look at other sectors and systems and see what a completely different way of doing things could look like. Very often in our change work we focus on our methods and our frameworks. We need to focus on approach – because this is the only way we will be able to create new frameworks and methods for change. 

“Co-producing change is the most valuable approach we have” – Göran Henriks 

Helen Bevan and Göran Henriks. Image Credit NHS Horizons.

Simple rules for complex change 

Embracing change-in-kind calls for more trusting and flexible leadership which governs less through instruction and more through simple rules. Simple rules allow us to embed change into daily work. If people are put into boxes, they become like that and act like that. Simple rules provide a more networked approach which creates alignment. Complex rules – for example, clear policies, operating systems and high levels of accountability – support change-in-degree. Simple rules, in contrast, facilitate change-in-kind. Simple rules provide an overarching set of basic principles which everybody is accountable for and allow people to work with greater individual freedom.  

Emma Challans-Rasool, Director of NHS Horizons. Photo Credit NHS Horizons.

Evaluating differently 

The ability to demonstrate impact and effectively scale and spread are essential to health and healthcare improvement. The forum was packed with brilliant insights relating to the importance of design and evaluation in improvement. There is a pressing need to shift our approach to evaluation, placing a stronger emphasis on learning rather than solely on outcome measurement. Traditional evaluation often focuses on assessing the success or failure of interventions based on predetermined metrics. However, a learning-focused evaluation framework prioritises continuous feedback, adaptation, and improvement throughout the implementation process. By adopting a learning-oriented approach, organisations can uncover what works, what doesn’t, and why, enabling informed decision-making and course corrections in real-time. This iterative process not only enhances the effectiveness of interventions but also cultivates a culture of continuous improvement and innovation. 

Marc Harris, Head of Insight and Impact, NHS Horizons, Image credit NHS Horizons

Simple rules for evaluating differently could be to:  

  • Capture change-in-flight – Understanding what’s changing as opposed to just the change.  
  • Evaluate change over-time in as real-time as possible and with a rich blend of quantitative and qualitative methods 
  • Use observational methods to generate the type of real-time processual change understanding which is needed 
  • Be flexible in our evaluative designs 
  • Broaden our perception of evaluation to focus on learning 
  • Nurture a culture openness, trust, and being critical friends 
Team Horizons at #QualityForum2024
Photo credit, NHS Horizons

What did you take away from the forum?

How do these learnings relate to the work you do?

Please let us know in the comments below.  

Discover more about Rapid Insight (CC) here

Discover more about Rapid Insight (CC) here