Determining the skills needed by frontline NHS staff to deliver quality improvement Findings from six case studies

Funded by

The Health Foundation Logo

11 August 2021

Published journal: BMJ Quality and Safety

Abstract

Background

Previous studies have detailed the technical, learning and soft skills healthcare staff deploy to deliver quality improvement (QI). However, research has mainly focused on management and leadership skills, overlooking the skills frontline staff use to improve care. Our research explored which skills mattered to frontline health practitioners delivering QI projects.

Study design

We used a theory-driven approach, informed by communities of practice, knowledge-inpractice-in-context and positive deviance theory. We used case studies to examine skill use in three pseudonymised English hospital Trusts, selected on the basis of Care Quality Commission rating. Seventy-three senior staff orientation interviews led to the selection of two QI projects at each site. Snowball sampling obtained a maximally varied range of 87 staff with whom we held 122 semistructured interviews at different stages of QI delivery, analysed thematically.

Results

Six overarching ’Socio-Organisational Functional and Facilitative Tasks’ (SOFFTs) were deployed by frontline staff. Several of these had to be enacted to address challenges faced. The SOFFTs included: (1) adopting and promulgating the appropriate organisational environment; (2) managing the QI rollercoaster; (3) getting the problem right; (4) getting the right message to the right people; (5) enabling learning to occur; and (6) contextualising experience. Each task had its own inherent skills.

Conclusion

Our case studies provide a nuanced understanding of the skills used by healthcare staff. While technical skills are important, the ability to judge when and how to use wider skills was paramount. The provision of QI training and fidelity to the improvement programme may be less of a priority than the deployment of SOFFT skills used to overcome barriers. QI projects will fail if such skills and resources are not accessed.

Citation

Wright D, et al. (2021), BMJ Quality & Safety; 0:1–12. doi:10.1136/bmjqs-2021-013065.

 

You might also like...

Press release

Continued pressure on emergency services not safe or sustainable

Press release

Health Foundation response to the NHS England monthly performance statistics.

Press release

Severe pressures in A&E should be a wake up call for Government to tackle the workforce crisis

Press release

Our response to the NHS England monthly performance statistics.

Blog

Five recommendations for strengthening NHS management and leadership

Blog

With the Messenger review nearing publication, we draw on our recent research – including interviews...

Kjell-bubble-diagramArtboard 101 copy

Get social

Nurses trained outside the UK have long played a vital role in delivering NHS services. This week's data from… https://t.co/LB82AZrCpF

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more