Driving improvement: Case studies from NHS trusts

Published: 14 June 2017 Page last updated: 12 May 2022
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We spoke to staff, patients and local patient representative groups at eight trusts that have shown significant improvement.

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We set out to explore what a selection of NHS trusts had done to become 'well-led'. We chose eight trusts that had achieved a significant improvement since a previous inspection.

We asked people in those trusts how they had achieved improvements, looking at the steps their leaders had taken and the effect of those actions on staff and patients.

We interviewed people from each trust, including chief executives, medical and nursing directors, non-executives, heads of communications, frontline staff, patient representatives and external stakeholders.

Key themes

  • Reaction to initial inspection report/rating
    Trusts were able to make rapid improvements when leaders viewed our inspection report as an opportunity to drive change.
  • Leadership
    Leaders knew they needed to be visible and approachable in order for staff to feel supported.
  • Cultural change
    Trusts knew that it was not enough to create an improvement plan – they had to engage and motivate their staff to help drive it and move from a culture of blame to one that celebrates success. They also recognised the need to tackle equality and diversity issues relating to staff and patients and in the wider community.
  • Vision and values
    Leaders placed an emphasis on getting to know how staff felt about working at the trust and understood that staff needed to have ownership of the values if they were to be meaningful.
  • Governance
    Addressing problems with governance was a priority for most of the trusts. The right connections needed to be in place from board to ward.
  • Improving safety
    Improving trusts ask questions about the quality of their services.
  • Patient and public involvement
    Taking the views and experiences of patients and the public into account is vital to making improvements.
  • Looking outwards
    Trusts pointed to the power of being open with staff and the public.
  • CQC engagement
    As well as identifying problems and helping trusts develop improvement plans, inspection reports can help to give structure to improvement work as well as giving clinicians and managers the vigour to effect change.