Helen Bevan On the road to Perfection

Published: 15/07/2004, Volume II4, No. 5914 Page 27

Over the past two years, a small number of English health and social care communities have taken part in a remarkable experiment called Pursuing Perfection. It has created learning about setting and achieving improvement goals, which has profound implications for the whole NHS planning system. The Pursuing Perfection movement is a group of health and social care organisations in the US, England, the Netherlands and Sweden. Their mission, supported by the Institute of Healthcare Improvement in the US and the Modernisation Agency in England, is to deliver services that transcend current standards and expectations to such an extent that they recalibrate thinking about what is possible.

The Pursuing Perfection teams aspire to a health and social care system where there is no needless death or disease; no needless pain;

no feelings of helplessness or despair; no inequality of delivery; no delay; no waste.

Many of their plans have already become reality. Ideal diagnostic processes have been tested and introduced, as well as ideal services for people with chronic diseases and ideal processes for elective surgery.

The ambitious plans of the Pursuing Perfection communities stand in stark contrast to those of many NHS organisations that are limiting the extent of their aspirations to complying with the minimum requirements of the NHS improvement plan, getting a three-star performance rating and maintaining financial balance.

At the beginning, there was a fear that the very term Pursuing Perfection would not fit the cautious English NHS culture and might not be taken seriously. But leaders of the Pursuing Perfection communities report that NHS staff respond well to the label. Just talking about the idea of pursuing perfection helps people to reconnect with the values that brought them into healthcare in the first place. It creates a different mindset and level of aspiration among staff.

The credibility of the approach is the result of the efforts of senior clinical and managerial leaders, particularly chief executives.

They are leading the pursuit of perfection, positioning it as a 'mission critical activity' and seeking to embody it through their own behaviour, actions and priorities.

Is it possible to eliminate waste or delay entirely in a healthcare system? Of course not, but just aspiring towards a 'perfect' service creates the conditions for higher levels of improvement. This was explained by a service user who has been leading service redesign in one of the Pursuing Perfection communities: 'If you aim for the top and get half way there, You have got something that will still make an enormous difference. If you only aim half way and do not get there, patients are going to lose out.'Aiming for 'perfection' encourages continuous improvement as opposed to aiming for a fixed standard or target which, when reached, provides a reason to stop improving.

So, as you reflect on the aims of your local delivery plan or your primary care trust or trust improvement plan, think about the level of care you would want for yourself or a member of your family. Doesn't every patient deserve something similar?

Helen Bevan is director of innovation and knowledge at the NHS Modernisation Agency.

Pursuing Perfection: www. modern. nhs. uk/pursuingperfection or www. ihi. org.