Article Text

Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies
  1. David Wright1,
  2. John Gabbay2,3,
  3. Andrée Le May1,3
  1. 1School of Health Sciences, University of Southampton, Southampton, UK
  2. 2Wessex Institute, University of Southampton, Southampton, UK
  3. 3NIHR East of England Applied Research Collaboration, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr David Wright, School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK; D.Wright{at}soton.ac.uk

Abstract

Background Previous studies have detailed the technical, learning and soft skills healthcare staff deploy to deliver quality improvement (QI). However, research has mainly focused on management and leadership skills, overlooking the skills frontline staff use to improve care. Our research explored which skills mattered to frontline health practitioners delivering QI projects.

Study design We used a theory-driven approach, informed by communities of practice, knowledge-in-practice-in-context and positive deviance theory. We used case studies to examine skill use in three pseudonymised English hospital Trusts, selected on the basis of Care Quality Commission rating. Seventy-three senior staff orientation interviews led to the selection of two QI projects at each site. Snowball sampling obtained a maximally varied range of 87 staff with whom we held 122 semistructured interviews at different stages of QI delivery, analysed thematically.

Results Six overarching ‘Socio-Organisational Functional and Facilitative Tasks’ (SOFFTs) were deployed by frontline staff. Several of these had to be enacted to address challenges faced. The SOFFTs included: (1) adopting and promulgating the appropriate organisational environment; (2) managing the QI rollercoaster; (3) getting the problem right; (4) getting the right message to the right people; (5) enabling learning to occur; and (6) contextualising experience. Each task had its own inherent skills.

Conclusion Our case studies provide a nuanced understanding of the skills used by healthcare staff. While technical skills are important, the ability to judge when and how to use wider skills was paramount. The provision of QI training and fidelity to the improvement programme may be less of a priority than the deployment of SOFFT skills used to overcome barriers. QI projects will fail if such skills and resources are not accessed.

  • quality improvement
  • qualitative research
  • healthcare quality improvement
  • hospital medicine

Data availability statement

Due to the nature of qualitative data and assured confidentiality to participants, no data are available.

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Data availability statement

Due to the nature of qualitative data and assured confidentiality to participants, no data are available.

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Footnotes

  • Contributors JG, ALM and DW contributed to design of the study, recruitment, data collection, analysis and the drafting of all iterations of this paper.

  • Funding This report presents independent research funded by the Health Foundation (award number 1273806).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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