What we need to build capability for QI

The 2014 Berwick report recommended that “The NHS should continually and forever reduce patient harm by embracing wholeheartedly an ethic of learning” and that the “NHS should become a learning organisation. Its leaders should create and support the capability for learning, and therefore change, at scale, within the NHS.”

We have been thinking a lot about how to make this a reality in relation to helping our teams learn more about quality improvement (QI) and how to apply QI skills as part of their everyday work.

Over the last year, we have we have been running a number of open learning sessions for anyone who is interested in finding out more about QI and understanding the basics.  Those members of the ASPH team (around 120 staff) who have been along to these sessions have helped us to learn more about what training is valuable and they have formed the first cohort of the ASPH QI Academy.

Many of our first cohort have gone on to lead and be involved in some great QI projects and we are really pleased that we have also been able to make much of the training available via the new ASPH Manager’s Toolkit too.

We know that making improvements is not easy in a complex system like healthcare and in a very busy Trust like ours.  So, if we want to equip our staff with the tools and coaching to make improvement a reality, then harnessing the interest of the ‘early adopters’ is a great start, but it will not be enough.

We have tried to describe below some of the supporting elements required to build capability throughout an organisation based on our experience, but would appreciate your comments too.


In 2015, a report from the King’s Fund on a number of NHS Trusts who had started on a journey towards applying quality improvement skills at scale described the challenges they faced in building capability:

“The biggest challenge they have faced has been in freeing up staff time to attend training sessions. Even in an organisation where there is strong support for the programme at every management level, it has proved difficult to get all participants to attend the learning sessions.”

How do we overcome the issue of limited capacity for learning in the daily reality of limited resources?  One way is to focus on making learning opportunities as flexible as possible and making the most of the time staff do have available (learning-at-lunch sessions for example).  Also, making use of online resources like the excellent IHI Open School can help.

Arguably, the biggest contributing factor to making time available for staff to learn is a really committed and brave approach from leadership.  Whether this is a board team choosing to invest in training, or a team leader, making arrangements to allow one or two members of team to attend a learning session – leadership commitment is key.


The challenges, including creating capacity for learning, shouldn’t be underestimated.  However, as the Berwick report also recommended that “the capability to measure and continually improve the quality of patient care needs to be taught and learned or it will not exist” – so it is important that we do our best to overcome these!

Here are some of the key factors we believe we need to build capability and to support effective application of the skills in pursuit of continuous improvement:

  1. Generate awareness and understanding of the QI learning opportunities available
  2. Be brave about creating time and space to take part in QI learning
  3. Give everyone the chance to learn-by-doing and not only accessing the theory of QI
  4. Combine classroom-based learning with access to online resources
  5. Ensure that the training content is appropriate for everyone (clinical and non-clinical staff at every level)
  6. Use learning sessions to build a broad knowledge of an improvement methodology that is simple and repeatable
  7. Think about using a dosing-formula, but ensure the basics of measurement and PDSA skills are taught at all levels
  8. Follow up learning with coaching for staff who are leading QI and create a network of people enthusiastic about QI

Let us know what you think in the comments section below and if you are interested in joining the ASPH QI Academy or accessing other QI learning opportunities…

You can find out more about the ASPH QI Academy here

You can register for the IHI Open School here

You can access a free module of the IHI Open School, just follow this link

Or you can just get in touch to discuss via bethechange@asph.nhs.uk


Mark – @MarkH_Work





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