At an event I recently attended – our Design Day for KQuIP – everyone in the room agreed that there are four basic yet important things we need to have in place to make quality improvement happen across kidney services. I agree wholeheartedly with the sentiment and I want to share some of my reflections on them.
The first was that we need to collaborate and share our quality improvement work. The best way to learn is from each other and by sharing what we’re doing – what works and what doesn’t work – we stop people from reinventing the wheel or always having to start from scratch. We all have the same aim – to improve services for our patients – so sharing and learning from each other is the simplest and most effective way to create change. I think we all acknowledge that we have limited resources, certainly financial, so what better way to stretch what we’ve learned and encourage improvement elsewhere than by sharing what we know is effective and brings about lasting change.
The second was commitment. KQuIP would like to see everyone in the multidisciplinary kidney team taking quality improvement on board. Sometimes the simplest of ideas for change can have the most impact and I believe along with everyone else that improving quality is something all should be doing. It should be part of the day job for us all and not a box-ticking exercise. We shared the belief that that people should just be getting on with it. Yes, we may need to build people’s skills and knowledge around QI and that’s exactly what KQuIP is set to do.
Stability is the third requirement for quality improvement – not a constantly changing agenda. So KQuIP’s USP is exactly that. At a time of constant change when organisations come and go KQuIP has the opportunity to run independently from all that inconsistency because it’s led by the kidney associations, clinician and importantly, patients. These will always be there, so KQuIP can be stable and always moving forwards without the threat of organisational or system change and this will create the stability we need.
Finally, the fourth element is culture, because the right environment, support, encouragement and enthusiasm for people to get involved in QI will make it happen. We have to support people to do things differently – stop doing some things, start doing others – and engage and involve people from every aspect of kidney services. And we need to celebrate and share success.
Culture was once again identified as a key enabler to improve quality. Feedback suggested that professionals should look more often at things they should stop doing, about being more collaborative, involving patients more and accepting that all have a responsibility to improve quality. Trust and primary care Chief executives who are quite vocal and supportive of quality improvement tend to bring influence to the culture that will make initiatives sustainable and measurable.
It was Thomas Edison who famously said “there is always a better way” and while that may have become a bit of a cliché, it’s a statement I stand by, and judging by the agreement of the people I was working with – the KQuIP faculty – so do they.
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Ron Cullen
Ron is Director of the UK Renal Registry and has more than 30 years’ experience working in the NHS, starting his career after his degree at Aberystwyth University as a biomedical scientist. Ron then went on to work in the fields of governance and quality improvement with senior roles in these areas including Director of the National Clinical Governance Support Team and Head of Healthcare Quality and Standards within the Department of Health. Ron has lectured and presented on quality improvement across the globe.
When he’s not working, Ron likes spending time with his family and is a bit of a Rugby nut – he coaches an under 16 Rugby team and says ‘it’s the best game in the world’.
Ron can be contacted at Ron.Cullen@renalregistry.nhs.uk