There’s no QI without a fire

By 29th January 2019Uncategorised


Quality Improvement is all about making healthcare safer, effective, patient centred, timely, efficient and equitable.

The NHS has embraced the principle wholeheartedly, with NHS Improvement tasked with building capacity and capability in QI across the NHS.

The number of staff with in depth QI training and expertise is undoubtedly growing. The success of initiatives like the ACT Academy’s  Quality, Service Improvement and Redesign (QSIR) programme and the Health Foundation’s Q Network have been a real boost. But what happens when the badge is pinned on the lanyard and the certificate filed ready for appraisal. How do we weave Quality improvement through everything we do?

Here’s the question no one dares answer: Is quality improvement an echo chamber?  Do front line staff, those at the coal face, the majority of NHS staff who don’t occupy a leadership or managerial role, know about quality improvement?


If you don’t have “Quality” in your job title, is QI your role?


I heard a QI leader speak at a meeting recently.  She lamented how, on being introduced to the board, the word “Quality” in her job title had been greeted with enthusiasm.  “Excellent, so all these things are your responsibility now? So you’ll take Data Quality Control, Quality Assurance, Care Quality Commission Inspection lead, Quality Standard Review, CQUINs….” If you don’t have Quality in your job title, then Quality Improvement  isn’t your role, is how the organisation thought.

Perhaps we need press the reset button.

I’ll ask another question:  who’s responsibility is it to prevent the spread of infection in a hospital?

Let me tell you when I was a junior doctor that was the nurses job…I won’t tell you how many times I washed my white coat (yes, it was that long ago….) during my training and house officer year..but infection control wasn’t something doctors really got involved with.


How times change.. nurses, doctors, physio, OT, all allied health professionals will wash hands before and after patient contact.

And patients – yes we expect them to gel their hands as then enter the clinic;  Relatives – please don’t visit if you have a cold, vomiting or diarrhoea.  Even Pop Stars and Politicians roll their sleeves up and tuck away their ties  when they pay a visit to a ward.

Infection control isn’t something we have timetabled – “oh yes, I am the team leader for Infection Control: I have 2 hours every second Thursday afternoon protected time to really Control Infection in a big way”.


Infection control is woven through every part of our day: its included in estates planning and procurement. It’s discussed at board level.  Wards display the results of their monthly Infection Control Audits.  Its everyone’s job, all the time.


So how do we get to the place where Quality Improvement is woven into everything we do?

There are some great examples up and down the country: pockets of people who look at every interaction as a way of improving the care we offer our patients. But bringing the theory learnt in a soft chaired teaching room onto the strip-lit ward is a challenge.

What works? Its difficult to say exactly. But I think its something like lighting a fire.

To light a fire you need three things:

Oxygen          Fuel     &     Heat

If you don’t have all three, you don’t have a fire.  You can smother a fire to cut out oxygen. You can pour water on it to cool it down.  You can run out of fuel and burn out.

Training sessions give us fuel – great big logs –  the theory, the tools, the action plan templates, the language.  But if we lock them away in an airtight box in our “tool shed”  we wont’ get anywhere. There’s no oxygen, no heat

So what if we get the fuel out the box and present these big logs to staff.   “Off you go,” we say.  “I’ve told you about a driver diagram, go and start a fire”. It will fail.  As the saying goes, ‘There’s no QI without a fire’.  People get frustrated.  They’ll light a match, hold it to the log…and what…nothing.  It won’t take. They walk away. “I tried to light a fire once’” they say, “It doesn’t work. Its not worth the bother.”


As the saying goes, ‘There’s no QI without a fire’.

What we need is HEAT.  How do we generate heat? Rubbing our hands together in excitement? Bouncing up and down trying to get our idea heard? It comes from within.  We need to help our staff to warm up, generate a buzz, create the right temperature in the team culture for quality improvement.

And here’s where we come in.  15s30m is your kindling.  We aren’t the whole answer to embedding QI.  You can’t sustain a cosy fire on 15s30m – but we can get the fire started. If you Open up your QI tool shed,  get us out in the open air, surrounded by the heat of your staff’s own enthusiasm; a group of people who want to do the best job they can, want to come to work to thrive, and strike the match…well watch what happens.


Once you’ve got the kindling alight, that’s when you can add a bigger bit of fuel, and a bigger, and then finally your big logs.  Which will burn and burn and generate their own heat, enough to warm staff up and get them started faster and faster.

And the thing about a fire, once its going,  its heat spreads to fill a room, a building.  The light is seen a long way off. Once it starts, its difficult to stop. And work is a warm friendly place, people drawn in to add another log to the fire. And Quality Improvement becomes just “what we do around here”.


Want to know more about our social movement to reduce frustration and increase joy in work? Quality Improvement for those who think Quality Improvement isn’t for them.




Rachel Pilling and Dan Wadsworth are the winners of the 2017 NHS Improvement Sir Peter Carr Award. They’d love to hear from you…follow them on twitter @miss_pilling  or @danwods or get in touch using email above.