Insights from the Institute for Healthcare Improvement’s 27th National Forum Blog Series – Why context is everything when sharing your lessons learned

Earlier this month, Knowledge and Intelligence Coordinator Polly Pascoe headed out to the Institute for Healthcare Improvement’s 27th National Forum to learn from experts in the field of Quality Improvement. This blog is the second in a three-part series that considers how the knowledge and insight gained at the forum can better support the NHS on their journey to becoming the world’s largest learning organisation. This blog piece focuses on context, specifically, its importance in adding value to knowledge sharing. As always, we welcome comments and feedback!

Ever wonder why improvements in health and care just never seem to spread and be adopted at the rate we’d hope? Even on wards that have similar numbers of patients and staff, serve comparable health populations and exist in the same socio-economic environment, learning and improvement just doesn’t seem to be catching on at the scale needed to tackle the increasing challenges we all face.

While the mini-course I attended on the Sunday at IHI, Publishing your Improvement Work, aimed to support attendees to publish their improvement work, interesting themes arose around how we can best share lessons learned to support  the effective spread and adoption of improvement across health and care, whether they are formally published or not.

But I thought improvements were being shared?

You’re right! Head to any healthcare conference in the world and you will find hundreds of improvement storyboards and posters detailing the improvement work carried out by others. Open any issue of BMJ Quality and Safety and there will be quality improvement reports that provide detailed accounts of work undertaken in practice. Additionally, informal methods of knowledge sharing such as The Academy of Fab NHS Stuff are thriving too.

The rate at which improvement stories are captured and shared isn’t necessarily the problem – in fact, the amount of knowledge available can sometimes be overwhelming and assessing what’s relevant to you can often be confusing. Something is missing and we need to tackle it head on sooner rather than later to realise wide-reaching, sustainable improvement.

So what’s the answer?

While there are many solutions we can call upon, the likes of knowledge translation being one (watch out for my blog about this next week!), the best way in which we as individuals or groups can support our colleagues to effectively pick-up and utilise learning from our improvement project is by focusing our efforts on context.

The difficulty with describing context is we often think we’re doing it properly. Typically, we’ll outline the macro elements of our improvement project such as health populations and staff numbers, or we might list job roles when we describe the make-up of our improvement team. However, these factors are unlikely to be the most significant factor in an improvement project’s success.

 Previously we might have said our improvement team consisted of, say, two nurses, a physiotherapist, two administrators and one improvement advisor. However, we might fail to add that our two nurses have thirty years combined experience, one is a specialist, in say infection prevention and control, and the other has been on a measurement for improvement course.  Their experience is significantly more important than their roles!  Equally, statements such as “effective administration” or “engaged leadership” can vary in meaning across contexts and don’t always mean the same thing to different people. It’s the actions that lie behind these statements which are the real nuggets of gold that will enable others to better understand how they can quickly and easily translate improvements of others into our own context.

While these are only brief examples, it helps to demonstrate that without the next level of detail, we aren’t supporting our colleagues in health and care to fully understand the critical success factors that have enabled improvement implementation. Understanding that next level of detail, such as the qualifications or levels of experience of a successful improvement team, can better support other organisations to not just pull together their improvement team, but pull together an improvement team of the right people. Providing context doesn’t just help team members take action, it helps them understand which actions to take – and why. In essence, context is key!

Can I get any more help?

The age old ‘five whys’, whilst not discussed at IHI in this instance, can work perfectly when attempting to pinpoint the critical success factors (or of course barriers!). For example, if effective communication between team members is identified, then analysing further why the communication was effective provides much more useful information for those wanting to adopt those elements into their improvement work.

More formally, if you are hoping to publish your improvement work, the SQUIRE 2.0 guidelines can support you to not only provide better context, but help you to better report your methodology, results and more!

In conclusion, those who wish to share their improvement work should never assume that others see the world in the same way they do – remember, what ‘supportive leadership’ may mean to you can completely differ to what it means to someone else. When sharing improvement work, always as yourself why – messaging will be much clearer and improvements will be much easier transferred from team to team and organisation to organisation.

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