3.1 Indicators of improvement

Taking stock with others of your understanding of the service in the round, what it comprises and what improvement consists of, can liberate your grasp of healthcare work. No one expects there to be full agreement over all facets of a service or what constitutes improvement. That said, improvement is arguably predicated upon a common, thoughtful and collegiate recognition of different ideas. Until you are ready to express such ideas and welcome those of others, then improvement cannot begin.

The last stage of reflective practice work is to determine the next steps – what you will do with the new information and insights gained. In service improvement, this is closely related to the business of identifying progress. If, as a result of your reflective exercise, you have a new, broader understanding of improvement, then you will look for signs of progress in a different way. You will not only reflect on the benefits of it, but will quite possibly accept new indicators of progress within the chosen service.

Logically, progress exists when incremental work can be seen towards what you (and others) accept as improvement. Perhaps the work is being done faster, there is a more efficient mechanism in place to gather and process information. Perhaps you, and others in your healthcare setting, can cite episodes where patients or other stakeholders in your service are able to negotiate agreements more easily. The key question here may be around who has authority. Who identifies progress towards a given goal, towards a higher quality of service delivery? There is a real chance that if you evaluate your own service, without recourse to inviting stakeholder opinion, that you might congratulate yourself prematurely.

There’s a variety of ways to involve others’ perspectives on progress towards service improvement, particularly if you are a healthcare practitioner. Some that may be suggested are:

• Using satisfaction surveys (note however, it is worth questioning whether these address the stated improvement or blandly refer to broad categories of client satisfaction). It may be tempting to survey only that which is required by statute or policy.
• During healthcare episodes, asking individuals to expand on why they are either content or unhappy with the stated service.
• Reviewing letters of satisfaction and complaint – what are the recurring themes relating to the stated service?
• Inviting stakeholders to join focus group discussions on the progress or otherwise of a service.
• Running an inter-agency/inter-team/interprofessional workshop where feedback is fostered. For example by reviewing case studies of the service in delivery and asking stakeholders to indicate what was best or problematic about them.

The interactive guide ‘In Safe Hands’ [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] , produced by Health Education England (HEE), offers guidance and examples of how healthcare workers can adopt safe clinical practice and improve the safety of patients in the care sector.