The Scottish Improvement Journey: a nationwide approach to improvement

This paper shares the story of the Scottish Improvement Journey encompassing 50 years of clinical audit and improvement programmes.

6. Building Capacity and Capability in Scotland

Initially, Scotland sourced its improvement expertise from the NHS Modernisation Agency as well as broadly from various UK programmes. Subsequently, some of those that became key in the Scottish improvement world undertook various extensive trainings - Derek Feeley was a Harkness Fellow at Kaiser Permanente and in 2005, Jason Leitch was the first Scot to undertake the Quality Improvement Fellowship at IHI. The latter was part of a scheme funded by the Health Foundation sending up to 4 fellows per year from the UK to IHI. These initial two were then followed by others who took part in the Improvement Advisor Programme at IHI.

Two improvement capacity and capability training schemes emerged in Scotland: 1) the NHS Improvement Advisor Professional Development Programme (started in 2009) and 2) the Scottish Patient Safety Fellowship, now called the Scottish Quality & Safety Fellowship (started in 2008). The latter focuses on safety and is targeted only at clinicians with the aim to build strong clinical engagement with improvement methodologies. It runs once a year and was developed in a way that allowed Scotland to quickly take charge of it with their own faculty. Currently on Cohort 9, there are already about 190 Fellows, of which 125 are in Scotland and others come from 6 other countries. The Improvement Advisor Professional Development Programme was initially a core product provided IHI and brought into Scotland with multiple waves of this training graduating over 120 Improvement Advisors. Taught by the IHI faculty from the start, the Scottish improvers became more and more involved in the teaching and coaching over time.

As Scotland became more confident, experienced and involved in these capacity and capability building programmes, it became appropriate to start internally developing and delivering the improvement advisor programme. There was an emerging need for adaptation of the IHI course to include non-healthcare areas such as social work, police, or education. Therefore in 2014, NHS Education for Scotland ( NES) and the Scottish Government jointly developed the Scottish Improvement Leader ( ScIL) Programme. It was a lead level quality improvement course, described as “the world’s first whole nation public sector improvement leaders programme” (In NES, 2015). The improvement content is similar to the IHI-run Improvement Advisor Programme but the model of delivery is perhaps more interactive and challenging for the participants. It is a 10-month long programme with three residential course workshops of three days and the participants work on a live large scale improvement project. Participants are required to submit monthly reports, and mentors as well as the programme and cohort leads provide them with feedback and support them throughout with the use of regular WebEx sessions and project surgeries. A higher level of expectation has been introduced in this programme - the programme leads expect progress in return for their commitment and if the participants do not apply their learning into their projects, they may not be able to finish the programme.

The current model for the ScIL programme is based on funding from HIS for 2 cohorts and the Scottish Government for one cohort a year. This results in two thirds of ScILs from health and social care and one third from the wider public sector each year. The faculty is sourced from across existing Improvement Advisors working out in NHS boards, the LIT team and beyond. However, the demand is growing and a scale up of this programme, and others, is on the horizon.

LIT plays a crucial role in capacity and capability building within Scottish public services. Since the establishment of the team, they have been developing various training programmes. LIT provide a 2-day Quality Improvement Practitioner Training Programme to groups of people, ‘in-institution’ training as and when required and various introductory sessions. The 2-day practitioner training has to date completed 23 cohorts. In 2013, the team completed a 90-day study on Leadership for Improvement which introduced an introductory programme for leaders and directors in SG to learn how to lead on improvement in a policy context. It is hoped that this course would be brought back in the near future.

Other sources for capacity and capability training include the IHI Open School and the Scottish Improvement Skills course run by NES as a three-day workshop with follow-up conference calls and a one-day follow-up workshop. It is aimed at NHSScotland staff and has been completed by over 400 staff members.

Additionally, individual organisations have since begun to launch their own centres or programmes focusing on improvement capacity and capability building. In June 2015, Shona Robison, Cabinet Secretary for Health, Wellbeing and Sport, launched the Scottish Improvement Science Collaborating Centre ( SISCC) based in the School of Nursing & Health Sciences at the University of Dundee. It brings together academic researchers, health and social care staff, policy makers, educators, and the third sector to strengthen the evidence base for improvement science. The Scottish Ambulance Service is planning to run a programme that will embed improvement into the workforce development plan accompanied by divisional micro system learning.


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