Continuous improvement approaches in many NHS organisations are not fulfilling their potential. Not because the principles are wrong, but because organisations fundamentally misunderstand what improvement actually means.
This is the stark assessment from Dr Felix Davies, Healthcare Director at Develop Consulting, speaking on the latest episode of The Improving Healthcare Podcast.
With over 25 years of experience across mental health, community and social care settings, Felix has witnessed countless improvement initiatives fall flat.
“What I’ve seen quite a few times is that organisations will think improvement, continuous improvement is purely about tools and techniques,” Felix tells host Darren Jones. “So if we grab a few tools, a few techniques and we give them to a few staff in a couple of pockets within the organisation, job done. We’ve done continuous improvement, box ticked, let’s move on.”
The problem is that this approach delivers nothing but temporary change. For continuous improvement to genuinely take hold, it requires something far more fundamental: a complete shift in organisational culture from top to bottom.
Felix describes a problem he sees repeatedly – too many leaders “lead from behind the desk” and rely on filtered information passed through multiple layers of the organisation. What often happens is that organisations set priorities for improvement only at board level, meaning improvement activities will hit the target but miss the point because they’re not focusing on what’s important to individuals on the frontline.
Then there’s the targets problem. Organisations set targets that look like they’re chosen because they knew they could achieve them, whilst avoiding the hard targets. Felix introduces the concept of being on the hamster wheel. Whilst people are on the hamster wheel, there’s a sense of threat which means they can’t think clearly, leading them to focus on simple, straightforward things rather than the wicked problems that really need tackling.
There are two hamster wheels in health and social care – the executive hamster wheel and the clinical hamster wheel. Felix speaks about the critical need for strategic alignment between these two worlds.
To listen or watch the full conversation, visit develop-consulting.co.uk/podcasts or find us on Spotify and Apple Podcasts.
