How I fell in love with Quality Improvement

Where do I start? Well, if you had asked me as recently as six years ago whether I would be working in a Quality Improvement (QI) role, I would have said, "Hell no!" I would literally roll my eyes at the mention of it. Anyone else ever felt like that?

So why didn't I have a good relationship with QI? It's quite simple: I had never seen it done well.

Too often, it felt like someone had decided they knew what was best and was going to change the way we worked. Usually, these changes were announced on a Friday afternoon and expected to be in place by Monday morning. Sound familiar?

Quite often, these were changes that had been tried before, so I would find myself wondering, "What will be different this time?" The truth was, usually nothing. That's because nobody had spoken to the staff on the frontline. Nobody asked: What happened last time? What would you do differently? Is this even the right change to make?

It often felt like change was being done to us rather than with us.

I even remember people coming to observe our service. Curious, I asked why they were observing us. The answer was that they wanted to see how we could improve. So I asked another question: "Are you going to speak to the staff? We have ideas about how we could make the service better."

The answer?

"No."

That certainly didn't get me on board with the changes, and I wasn't the only one. At the end of the day, we all want the same thing: the very best outcomes for our patients.

By now, you're probably wondering what changed.

The turning point came during COVID when I became part of a new team. Whenever there were niggles, pinch points or incidents, I started talking openly with the team during our huddles. We discussed what had happened, what was causing the problem, and, most importantly, I asked one simple question:

"How do we stop this happening again?"

The ideas that came back were incredible.

We tested them all. Looking back, we were running PDSA cycles, although if I'm honest, I didn't realise that at the time. Some ideas worked brilliantly and became part of our new way of working. Others didn't work so well, so we dusted ourselves off, reflected on what we'd learned, and tried something different.

This was when I started to realise that small changes, developed in collaboration with the team, could have a really positive impact.

Staff felt empowered because they had a voice. They had ownership. They were shaping the future of the service.

This was when I started falling in love with QI.

When I returned to my substantive role, I found myself feeling restless. I couldn't stop thinking about how small, meaningful changes could positively impact services and improve experiences for both staff and patients.

So when I saw my current role advertised, I knew this was my opportunity to help others make a difference.

A completely new role in a new organisation.

Was I nervous?

Just a little bit.

What are my reflections now?

QI, when done the right way, can be incredibly impactful. It can create sustainable change and foster a culture of continuous improvement.

For me, it starts with being willing to show vulnerability, engaging with colleagues, working across services, and, most importantly, involving our service users.

The reality is that we don't have all the answers. If we don't collaborate, we risk implementing changes that were never needed in the first place and losing sight of the real issues.

Communication is key.

Explain the background behind the change. Help people understand why it matters. Invite them to get involved, and yes, that absolutely includes service users.

Share the plan. Explain what will be tested, where it will be tested, and for how long. Think about how you'll gather feedback, analyse what you learn, and demonstrate whether you've made an improvement.

I'm not saying that's everything there is to QI, but it's certainly a step in the right direction.

A Final Reflection

My final reflection comes from a quote I recently heard from a service user, lawyer and author:

"Best is the enemy of better. It means there is no room for improvement."

For me, that perfectly captures what Quality Improvement is all about. It isn't about chasing perfection. It's about continually listening, learning and making things just a little bit better than they were yesterday.