10 principles at the human heart of improvement: Tell us what you think

Marjorie Godfrey says improvement in health care is 20% technical and 80% human. This is worth unpacking, as I explored at this year’s Q community event. Check out the recording to understand why I think it may be more fruitful to think about the technical and human sides of improvement as more deeply interwoven than people might take from Marjorie’s quote:

Having conversations that recognise the importance of a person centred approach, and the technical skills needed to achieve it, is really important for where we are now. We will only find a sustainable path to health sector recovery, and greater equity, if we involve people well, and if there’s shared leadership of the radical changes that lie ahead.

My experience of the now nearly 5,000-strong Q community suggests that a focus on people using and delivering services is core to both the beliefs and skills of those leading improvement. It informs the way improvement as a discipline has developed. Yet the value of this approach can be lost in a health sector under huge pressure, when it’s most needed.

This blog sets out simply why and how the people side of improvement is important, and gives a taste of some of the work Q members are doing.

• Health and care is a people business. Fundamentally, we work in a sector that’s all about people: health and care experience and outcomes are co-produced. Quality and safety of care relies on people’s agency and skills, and good health and care experiences and outcomes rely on people working well together. The Q community is home to a range of member-led projects that seeks to boost teamwork or quality of care: from human factors to Q Lab UK’s work on partnerships and a growing focus on equity. There’s a Special Interest Group on co-production and a wealth of Q Exchange and other projects that boost partnership with service users and communities, and take a more holistic view of health.

   

• Change and improvement relies on people. We know that people support change when they see the reasons for it or help to shape it, and that individuals and teams need support through change. Q’s insight work on the adoption of video consultations and on improvement during COVID used member voices to surface this. And work within Q on behavioural insights, and the Q Exchange project, ​‘psychology 4 improvement’, has helped us dig deeper into the theory. We also know that ideas and innovations spread through people: that’s a big part of the value Q offers.

   

• A focus on people underpins all we do as an improvement community. Members use improvement to empower teams to collaborate and lead change and, through Q Exchange and Q Lab UK, we help create the spaces for this. We create connections and opportunities for people from all backgrounds to participate with purpose, and we activate and build improvement and collaboration skills. There’s a wealth of capability building activity happening across the community. Q Lab UK’s skills for collaborative change, network weaving, and the liberating structures approach are all helping to focus on the use of collaboration as a tool for improvers. Through our insight work with national partners we also help to influence and create the conditions that support improvement.

In the infographic below, I’ve set out the 10 principles in more detail. These are informed by looking across the hundreds of conversations, projects, blogs and events emerging from the Q community. They’re also informed by my own sense of the motivation, beliefs and core skills that underpin this rich diversity of insight and action.

I would love your feedback. What resonates and feels most important? What’s not right or missing? And what examples come to mind that illuminate and add depth to what these principles mean in practice?

I believe we need to state clearly and consistently that change only really lasts when people from diverse backgrounds are involved in diagnosis and solution design. And when you build skills and understanding in the process so that those delivering services can do the ongoing iteration and embedding that makes solutions last and work for all. Improvement offers a particular ability to boost agency, morale and teamwork in the process.

The ​‘human heart’ of improvement is such a strong thread through the community, and ties to the biggest challenges in the health and care sector right now: this is Q’s recovery phase mission. Please help us be clear about why this is important, and shout louder about it.