Navigating Partnerships: A Guide for Leaders Implementing NHS IMPACT

Originally published on NHS Providers.

NHS IMPACT articulates a detailed vision for quality improvement across the NHS. The task of mobilising that vision, however, falls to leaders. 

As a result, leaders at many of our England’s health system’s 200+ trusts are looking for help — a partner organisation to guide the transformations in culture, management practice and improvement capabilities that are necessary to bring NHS IMPACT to life. 

How do you find the partner you need? Look for these five qualities. 

1. Someone who meets you where you are 

Every trust is complex and unique. So each one will follow a unique path of transformation, with a unique starting point. Leaders should seek a partner that respects those differences and takes time to understand them.  

When looking at potential partners, be sure to ask:  

• How they determine what each client needs 
• How they adapt their services based on those needs 
• How they would assess the needs of your organisation in particular 

Virginia Mason Institute (Virginia Mason) thoroughly analyses an organisation to figure out the ideal starting point for its transformation. We call this process our ‘readiness diagnostic’. It includes site visits, interviews, focus groups and surveys that document the ‘current state’ in various areas, from workforce engagement to how the organisation measures performance and improvement. 

We then place your organisation on a continuum that visualises your readiness for change — and goes far beyond the simple grade or ranking established by other maturity models. First, it reveals your immediate needs and helps you chart a strategic path forward. Second, it provides a baseline for tracking progress and updating strategy over time. Organisations can update their placement on the continuum as they evolve and repeat the diagnostic process. 

Adam Sewell-Jones saw the readiness diagnostic applied in multiple trusts while serving as NHS director of improvement, and more recently at East and North Hertfordshire NHS Trust, where he is now chief executive. He says, “This diagnostic not only gauges your readiness for change but multiplies your odds of succeeding. Even if a leader can’t undertake a full partnership with Virginia Mason Institute, the diagnostic alone is very powerful.” 

2. Someone who takes a holistic management perspective 

For improvement to persist as an organisational priority, it must be part of a broader management system that touches everyone ‘from board to ward.’ Look for a partner who will help you make improvement part of your trust’s DNA and part of everyone’s job. 

We worked with a large academic medical system in the U.S. that learned this lesson the hard way. Leaders cycled through many improvement methods that failed to take root because each one was a special initiative, separate from the daily work of patient care. Eventually, leaders collaborated with us on a more comprehensive change. They established a single management system that spanned the entire organisation and empowered everyone to contribute to the mission of improvement. While that required considerable groundwork, it paid off magnificently. The organisation reduced patient harm incidents by half and positioned itself to tackle numerous other challenges.  

For a holistic management system like that to work, leaders must change the way they lead. For example, they need to do less directing (‘Here’s what you should do …’) and more framing (‘It sounds like this is the problem …’) That way, frontline workers can do their part as problem solvers. 

I recently met with an executive whose trust had adopted a new improvement method with disappointing results. The method was solid, and frontline workers were highly engaged. But they weren’t able to follow through because — the executive eventually realised — leadership behaviour remained unchanged. The trust had built a state-of-the-art plane but provided no runway for it to take off. 

3. Someone who approaches equity at the systems level 

Advancing diversity, equity and inclusion in healthcare has become a strategic imperative for all of us. But to make lasting progress, we can’t just treat the symptoms. Leaders today need a partner who can help them address the underlying condition: systemic inequity. 

A systems approach to healthcare equity is one that embeds equity concepts in improvement methods, staff and leadership training, and daily practices. Virginia Mason Institute has developed practical ways to do this, based on the experience of systematising equity in our own medical system. These include tools such as: 

• The Inequity Waste Wheel, which consists of a visual aid and questionnaire that help teams recognise different types of inequities. Inequities range from the omission of certain voices to the barriers to access faced by some people. These cause harm in various ways, from depriving patients of opportunities to preventing staff from contributing at their fullest, which translates to waste for the organisation — value that can be realised if we interrupt and question certain mindsets and habits. 
• Equity Pauses can be added to meetings of all kinds, from daily huddles to executive planning sessions, to step back and evaluate decisions and activities through an equity lens. They include questions like ‘Does everyone benefit equally from this?’ and may be guided by the Inequity Waste Wheel or tailored to the work at hand. At Virginia Mason, equity pauses have helped teams remove eligibility barriers for potential transplant patients and remove bias from our diagnostic algorithm for kidney disease. 

Tools like these provide a clear and methodical way of prioritising equity. They comprise part of a pervasive effort to centre the experiences of historically marginalised and underrepresented communities and support safe, culturally responsive care. 

4. Someone who has their own experience in clinical settings 

The closer a professional services organisation is to the daily realities of leaders, workers and patients, the more relevant and up-to-date its services can be. Look for a partner whose expertise comes not only from working with healthcare but also from working in healthcare themselves. 

An organisation with boots on the ground in real healthcare settings is better positioned to: 

• Keep pace with the rate of change in healthcare. 
• Work with you like a peer, with a deep understanding of your needs and circumstances.  
• Help you avoid missteps and accelerate your transformation. 

Virginia Mason has been on its own improvement journey for 20+ years. As a result, we know what happens every day in the operating room, lab and exam room. We see firsthand what helps and hurts an organisation’s transformation efforts. And we bring these lessons to every partnership. 

5. Someone who has previous experience with NHS trusts 

The NHS is a unique ecosystem. Trusts must pursue their own goals while also satisfying national goals and mandates. How can you take on large-scale transformation at the same time? 

The right partner will have experience helping leaders join organisational and national goals together with transformation activities as one complementary effort.  

For example, Leeds Teaching Hospitals NHS Trust (LTHT) held a ‘requires improvement’ Care Quality Commission (CQC) rating in 2014, before its five-year engagement with Virginia Mason. But rather than view improvement as ‘one more thing’ to take on in a difficult time, leaders embraced it as their way through a difficult time.  

LTHT developed a new trust-wide management system and used it to improve not only its quality rating but also its finances and staff morale. Sir Julian Hartley, the chief executive at the time, told researchers from Warwick Business School, “The trust overall has moved in terms of the absolute measures from a £100m deficit to a £19m surplus, from a position of ‘poor quality’ through ‘requires improvement’ to ‘good’ CQC, from one of the worst staff surveys to one of the best.”¹ 

Professor Phil Wood, the current chief executive at LTHT, has continued the Leeds Improvement Method journey. He commented, “Working with Virginia Mason Institute has allowed us to systematically embed a quality improvement approach as our management method and ensure improvement activity across the trust delivers against our most important strategic priorities.” 

The right partner will also include experts with experience inside the NHS itself. At Virginia Mason, leaders from LTHT and two other trusts serve as valuable members of our delivery team. They conduct trainings and perform other services, right alongside our own experts, to help leaders at other trusts make the same leaps they did at theirs. It’s true peer-to-peer engagement, ensuring that trusts build capacity that is unmistakably for the NHS, by the NHS. 

Learn more about what leaders at other trusts have learned about transformation and how Virginia Mason Institute helps leaders pursue the changes their organisations need.