Evidence
Alert

Teams of healthcare professionals from a wide range of disciplines and pay grades are most effective at delivering improvements in patients’ experiences

Teams with the most diverse range of skills, knowledge and experience may be most effective at planning and implementing projects to improve patients’ experience of the NHS. A study looked at the resources, or ‘team capital’ of groups aiming to make improvements to the quality of service. They found teams with members from a range of pay levels and disciplines were most successful at delivering change. This may be because team members could offer different insights into patients’ experiences, understanding of how other teams work and they had access to different resources.

Teams from a single discipline had some benefits, such as being more close-knit.

Quality improvement in the NHS has been a hot topic for years but there is little understanding among staff about best practice for delivering it. This research was carried out by ethnographers, who study the culture of organisations. They shared their expertise with frontline staff working on quality improvement projects, and then examined the factors that made a team successful.

What’s the issue?

Large amounts of data on patients’ experience are collected by the NHS, but there is little understanding of how this can be used to improve services. There is also research on how teams can work effectively, but there is little focus on how to use this research to improve service quality. Frontline NHS staff tasked with achieving improvements often have little expertise in quality improvement methods.

Much of the hierarchy in the NHS is based around its payscale bands. This can mean that the views of some members of the team are excluded, or their expertise and role is not recognised appropriately. This can negatively affect the success of projects.

What’s new?

Three ethnographers worked with six NHS wards, to help them design projects to improve quality. They used data on patients’ experiences to guide these projects.

The researchers found that teams with a mixture of clinical and non-clinical members had more resources to draw on when implementing projects. Researchers deemed understanding of processes, links with other teams, and access to funding, to be different types of resources. Mixed composition teams were also more ambitious in the projects they planned. Single discipline teams, such as a ward team made up purely of nurses, had fewer networks, alliances and resources to draw on. However, these teams were found to be close-knit and mutually supportive.

Having team members from a range of points on the NHS pay scale was beneficial. Including lower band workers such as healthcare assistants and porters may be particularly helpful for identifying ways to improve patients’ experience. Unfortunately these members experienced barriers, such as being unable to access work IT from home. This stopped them communicating with higher-level colleagues when they weren’t in the hospital and hampered the team’s progress.

Most hospitals have patient experience officers and central quality improvement teams. Again, in this study those teams which chose to actively involve someone from the patient experience office tended to make more progress. One patient experience officer believed she had been excluded from project meetings and activities as she was deemed to not have sufficient clinical standing, despite having previously worked as a nurse.

Why is this important?

A lot of data is collected from patients in the NHS, and there has been a significant focus on improving quality and efficiency over the past two decades. But there has been little research into the type of teams that deliver improvements effectively.

In the hierarchical structure of the NHS, quality improvement project teams that include members from different levels and disciplines could lead to improved services.

NHS managers tasked with improving the quality of services should consider the value of building teams with clinical and non-clinical staff to ensure diverse perspectives, skills, knowledge and experience.

What’s next?

Researchers actively encouraged teams to involve patients or members of the public as partners in working on quality improvement projects. But patients were notably absent from most of the teams. There is further work to do to encourage quality teams to consider the types of capital that patients and family members can bring to the table.

To aid future projects, the researchers developed a toolkit that outlines best practice for patient experience, data collection, designing a project and different methods that can be used to deliver quality improvements to services.

You may be interested to read

The full paper: Montgomery C, and others. ‘Team capital’ in quality improvement teams: findings from an ethnographic study of front-line quality improvement in the NHS. BMJ Open Quality 2020;9:2

This study was part of a larger, NIHR-funded study looking at the use made of patient data to improve services by frontline staff in the NHS:  Locock L, and others. Understanding how front-line staff use patient experience data for service improvement: an exploratory case study evaluation. Health Services and Delivery Research. 2020;8:13

Further information about this study is available at: Locock L, and others. How do frontline staff use patient experience data for service improvement? Findings from an ethnographic case study evaluation. Journal of Health Services Research & Policy. 2020

An open access online toolkit, developed by The Point of Care Foundation as an output from the original study, is aimed at frontline staff and patient experience teams and has been incorporated into face-to-face training courses: Using Patient Experience for Improvement

Funding

This research was funded by the NIHR Health Services and Delivery Research Programme.

Commentaries

Study author

The bottom line is that where people came together from different disciplines we found strength and creativity, with teams benefitting from a wider range of different resources. There needs to be more reflection on the composition of teams in quality improvement work, and greater recognition of the capital that patients themselves can bring.

Catherine Montgomery, Research Fellow, Centre for Biomedicine, Self and Society, University of Edinburgh

Chief Quality Officer

One of the key factors in the success of quality improvement work is the project team – the diversity and representation from all parts of the system. We need the capacity to undertake the work, and we need to be able to use systematic methods. At the start of all quality improvement work, it is critical that we appreciate the system(s) that we need to involve and influence in order to achieve our aim.

Involving patients, service users and the customers of the process can help us really understand the system from all perspectives. It often helps us identify better ideas for change, and can accelerate the improvement work, bringing a strong sense of purpose to the team.

The way in which we go about quality improvement helps flatten hierarchies – eliciting ideas from all parts of the team, using improvement tools to prioritise and make decisions, and being transparent in our use of data. It will be helpful to find simple ways for a team to evaluate whether it has the necessary attributes to solve complex quality issues, as this is such a critical component in good quality improvement work.

Amar Shah, Consultant Forensic Psychiatrist & Chief Quality Officer, East London NHS Foundation Trust

Conflicts of Interest

None declared by CM or AS. Co-author Louise Locock declares personal fees from the Point of Care Foundation outside the submitted work.