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An integrated approach to improvement

At Solent NHS Trust, we’ve built an integrated team to support research, quality improvement, audit, evaluation and innovation. These sit within our Academy of Research & Improvement. This is a fairly unique approach - in most NHS organisations, these activities are supported by different teams and even sit in different directorates/ departments. We often get asked why we’ve chosen to work like this and if it works: here’s the story.

As with most organisations, we are trying to create a culture where we are continuously improving and learning. It sounds obvious, but when you are so very busy clinically, it can be hard to find the time to allocate specific time to this. As such, we believe that our job is to make ongoing structured improvement and learning as easy as possible for our staff and patients and a valuable use of their time. Research, Evaluation, Clinical Audit, Quality Improvement (etc) are some of the ways that we underpin continuous improvement - whilst they can employ slightly different methods, and slightly different scope, they are all tools for learning, generating knowledge, and improving. And so it makes little sense to separate them out unless we want to make things harder for our clinical teams. To do so risks the creation of gaps that people fall through, confusion and even unhealthy competition. And it risks fragmentation of improvement rather than continuous cycles.

We’ve tried to view learning and improvement, curiosity and critical thought through the eyes of our staff, our community colleagues and our patients - what can we do to serve them, to make these activities useful and attractive? How can we create a climate where people want to ‘measure’ the effectiveness of care and test out alternative solutions - and one where this is done with input from everyone - those delivering and receiving care.

The first step is to have one single point of support, ie an integrated team. The second step is to be a service that helps people use measurement, and use the tool that works best for their issue or question (. And the third is to support programmes of work that use a variety of methods/ approaches, integrated into services and informing how care is delivered and received. Within the team we have people specialised in different approaches, and of course we can differentiate between the methods used. But we can operate as one team that can support and signpost people across the areas, advocating for each other and ensuring cross cover where appropriate – in all honesty, it also stops us becoming territorial or precious about approaches or methods and it stops our staff or patients being ping ponged around different departments.

It works – we have joined up programmes of testing and learning how to deliver care better. In our sexual health service for instance, we’ve used evaluation to explore what service users want, quality improvement and research methods to test different models of delivery (home STI testing, contraception by post for example): and now that these are usual care, regular audit to ensure safety. Our Vocational Rehab Service is not only co-delivered with service users, but they are participating in clinical trials and using Quality Improvement to test new approaches to rehabilitation. Our Child and Adolescent Mental Health Services have worked in partnership with schools and parents to jointly design a package to support those with neurodiversity, and developed that into a research project.

We were very lucky that we built our team and this approach from scratch and so it has naturally evolved. For those where teams are all separate it’s easy to see why this would feel hard. But I cannot recommend it highly enough – and those that work in direct care, and patients all agree on the common sense and benefits of an integrated approach. It’s a fabulous way to work – do get in touch if you’d like to know more.


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