Leading change across a system : how to build improvement capability and foster a culture of continuous improvement. Lessons from the NHS-VMI partnership

Abstract

The NHS-VMI partnership was a five-year collaboration between the English NHS and Virginia Mason Institute (VMI), a not-for-profit consultancy specialising in development of Lean-based improvement capability among healthcare providers. In 2015 five NHS hospital trusts were selected via competitive application to work with improvement experts from VMI in a tripartite partnership with NHS England and NHS Improvement (hereafter: NHS E & I). The goal of the partnership was twofold: first to foster a sustainable culture of continuous improvement capability within each of the five NHS trust partners, and second to derive lessons about how NHS leaders can foster continuous improvement capability across the wider healthcare system. The evaluation adopted a mixed-method approach to data collection incorporating qualitative and quantitative methods of analysis. Around 300 semi-structured interviews were conducted with a range of clinical, managerial and support staff across all stakeholder organisations, alongside more than 300 hours of participant and non-participant observation. Collection of quantitative data included a survey with over 300 respondents, social network analysis within each of the five NHS partner trusts, secondary analysis of performance data using both process-level data and routinely collected data sets (including the NHS Model Hospital), and advanced statistical analysis of improvement and performance data using interrupted time series (ITS) methods