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.

8. Where will the future take Scotland?

Scotland has built a momentum across the country. The next steps will revolve around integration of local and national agendas, programmes and different strands of the work in order to offer more opportunities for learning and sharing of the learning, and improving relationships and multiagency work. This is already evident in the system-wide Health & Social Care Integration focusing on community asset building but also in the integration of the work on early years and education into a joint collaborative.

Bringing together the different worlds of health and social care, Healthcare Improvement Scotland’s ihub is the new improvement resource and delivery agency for this sector. The ihub supports a mixture of over 14 portfolios, including the Scottish Patient Safety Programme, that support improvements in care delivery and the development of infrastructures and cultures which enable improvement work. These system enablers include the Tailored & Responsive Improvement Support Team which provides flexible support to help NHS boards, Health and Social Care Partnerships, third sector, independent care sector and housing organisations address local priority issues; a range of Improvement Associates – independent contractors with improvement skills and expertise; and an Improvement Fund launched in September 2016 in order to provide grants for organisations wishing to develop initiatives to improve health and social care services.

Considering the Juran Trilogy of Quality Planning, Quality Improvement, and Quality Control, there is now a growing stream of work in Quality Planning alongside the on-going Quality Improvement. With a relentless focus on the system perspective and breaking traditional silos, Scotland is aiming at targeting the root cause of many of the problems. To achieve that, other methodologies are resurfacing and particularly the design methodology is being increasingly combined with the improvement methodology.

There is always room for more improvement. The work needs to continue to expand and become embedded across health and social care; simultaneously the spread across other areas of government business should follow a similar pattern of growth. New ways of supporting this growing body of work are being explored to respond to the ever-increasing demand for improvement skills. Additionally, the 2016 Manifesto stated that the potential for of a new improvement institute would be explored; a 90-day Innovation Cycle has been completed to explore the options, and at the time of writing is undergoing discussions with ministers.


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