QIPP challenges

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QIPP is a cornerstone of the government’s drive to make the NHS take a more preventative and patient-centred approach.

Against the backdrop of spending constraints, staff will need additional skills, plus the motivation to break the status quo and deliver services more effectively.

The most successful implementers of QIPP will not only be patient-focused, efficient and streamlined; they will also measure, analyse and demonstrate the productivity improvements they have achieved.

Health service managers faced with this responsibility to improve and measure their efficiency can now download a free practical guide to QIPP.

The Rising to the Challenge guide explains how to embed QIPP principles when preparing for change, building capability and sustaining the momentum of improvement.

The guide includes six case studies on transformational change using QIPP principles.

Topics covered are:

Improved care for stroke patients. Opportunistic screening by pulse palpation of patients over 65 has been used in 18 regions to improve detection of atrial fibrillation. It has been co-ordinated by the NHS Stroke Improvement Programme.
Electronic blood transfusion. Oxford Radcliffe Hospitals have implemented an electronic system to reduce transfusion errors and the time taken to deliver blood. Productivity has improved by reduced blood usage, wastage, and staff time.
Enhanced recovery from elective surgery. A Department of Health partnership using evidence-based interventions to improve pre-, intra-, and postoperative care has enabled earlier recovery and discharge from hospital.
Improved efficiency in cervical cancer screening. Under the NHS Cancer Screening Programme, efficiency in screening has been used in 13 regions. Quality is improved by avoiding duplication and reducing overhead costs through centralised laboratory analysis.
Care and efficiency in acute settings. The NHS Institute for Innovation and Improvement has a QIPP programme that makes ward processes more efficient. In one mental health trust, medicine rounds were reduced from 3.5 hours to 40 minutes while time spent on direct patient care rose from 12 per cent to 32 per cent in an older people’s assessment ward.
Embedding staff wellbeing in NHS systems. A QIPP-informed project in two NHS trusts aimed to reduce current levels of sickness among staff. At the end of the project, workplace stress was reduced by half.

At the heart of any successful transformational change programme is the need for effective sponsorship, often involving multiple health and social care organisations. Once sponsors are in place, the actual delivery consists of five steps: prepare for change; create the road map; implement the improvements; sustain the gains; and maintain momentum.

Preparing for change

It is vital to bring any disparate activity streams into one coherent transformation map that sets out the journey. You also need to canvass the support of stakeholders and build the capability of your internal team to actually lead and deliver the improvements.

Underpinning all this is an effective communications plan that details goals, messages, frequency of contact, resources and audiences. The plan should cover how you will provide staff with ongoing information and how you will promote and share good practice.

You should also identify any weaknesses or risks that will affect the success of the programme.

Creating the road map involves scoping and designing new models and ways of delivering services.

Being clear about the various problems you are attempting to tackle is the key to the whole road map process. There are different ways of scoping projects including project initiation documents and scoping papers.

Implementation

A robust implementation process will require a nominated “owner” for the project, a steering group to set the pace of change, and activity owners to take it all forward.

Sustain the gains

Transformation programmes need a strong follow through to generate long-term change and convert improved processes into new behaviours.

Key elements of success include a process to deal with minor problems that occur during the first few weeks, team meetings to reinforce the new processes and systems and visible sponsorship.

Maintain the momentum

The last stage is to avoid the momentum loss that will occur when you treat each project as a discrete ‘initiative’ rather than part of a coherent improvement process.

The message here is to follow up and follow through. To keep the levels of interest and enthusiasm positive, you need to establish ongoing communication activities, case studies, further events and training activities. Above all, create a culture for continuous improvement.