Using action learning to develop a more strategic approach to quality improvement at Oxleas

We worked with the quality board at Oxleas NHS Foundation Trust to redesign the trust’s approach to quality improvement. This helped the trust to develop a strategic approach and build commitment to quality improvement across the organisation.

The King’s Fund has been immensely supportive and helpful in leadership development at Oxleas. We have worked together for two years and this work has helped clinical leaders prioritise improvement projects that will deliver improved outcomes for patients and eliminate waste. The combination of sharing learning from other organisations and exploring how we do things was particularly suited to our group of leaders. We certainly hope to continue on this journey with the help of the Fund.

Dr Okocha, Medical Director, Oxleas NHS Foundation Trust

Oxleas NHS Foundation Trust provides a wide range of community health, mental health and learning disability services in south London. Its 3,500 staff members work in community locations including schools and children’s centres, as well as providing services from sites managed by the trust and visiting people in their own homes. The trust has more than 125 sites in south London, and also provides health services in prisons in Greenwich and Kent. Overall, the trust provides care for around 30,000 people every month.

The concept of quality improvement is already well understood at Oxleas, and the trust undertakes a programme of quality improvement and clinical audit every year. However, the Oxleas Quality Improvement Board felt the trust would achieve better outcomes if it took a more organised approach to quality improvement.

Our approach

Over a nine-month period in 2015, our leadership and organisational development team worked in partnership with Oxleas to examine the trust’s existing approaches to quality improvement.

We set out to find ways of helping the trust to appraise its own approach to quality improvement, with a view to improving performance, achieving better clinical outcomes and building its capacity as a learning organisation.

We didn’t go in with all the answers but instead facilitated an action learning process to stimulate discussion that would help the trust come to its own conclusions.

Throughout the process, from planning to evaluation, we worked collaboratively with 30 clinical and non-clinical staff from each of the trust’s five directorates, the board and the existing quality improvement team.

The process had a number of stages:

  • First, we gathered information on existing quality improvement projects to understand the trust’s current approach.
  • Then we held a workshop to establish how different parts of the trust defined and implemented quality improvement work.
  • A second workshop focused on exploring leadership approaches, bringing in knowledge and experience from other health care organisations around the world. Topics included: inspection and regulation; assessing ability in the key lines of enquiry in the Care Quality Commission’s ‘well-led’ domain; and exploring the current state of clinical or medical engagement within each directorate.
  • This was followed by an assessment of participants’ readiness to innovate.
  • Finally, three months after the final workshop, we held a follow-up session to identify what was learnt.

Our impact

Making quality improvement a strategic imperative can be challenging for health care organisations. Our work with Oxleas highlighted areas that really helped to make it a reality and gave the senior management confidence that its investment in quality improvement was worthwhile.

Introducing peer-to-peer learning helped to build a community of people who have gone on to create a real quality improvement movement at Oxleas. The process helped to build leadership at all levels of the organisation and built capacity and capability in a core group of 30 people. Directorates reported that participating in this process had captured the energy and imagination of many clinicians.

The process built rapport between directorates and this helped facilitate conversations about the importance of creating the right infrastructure for quality improvement. As a result of the process, participants accepted the need to do some new things, to review what had worked, to drop some activities that didn’t add value, and to do some things differently. Participants were surprised at the levels of duplication they uncovered in the quality improvement work going on across the trust. As a result directorates were able to review the number of active projects (more than 300) and reduce them by 50 per cent.