Beyond the Toolkit

Beyond the Toolkit

Leading Quality Improvement in Health and Social Care

Brian Marshall, Janet Smallwood, Liz Wiggins


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There is increasing recognition within the NHS that quality improvement methodologies such as Lean, Six Sigma, Theory of Constraints and Experienced Based Co-design can significantly improve patient flow, patient pathways and clinical and administrative processes that lead to better quality outcomes and experiences for patients. Financial savings and improved use of scarce resources can be additional benefits. Given the pressures on the NHS in terms of shrinking funding, aging demographics, technology and increasing patient demand, we believe that helping those on the front line understand how to use QI methodologies well is vital service / offer.We are not seeking to add to the sizeable number of books and papers on specific methods and toolkits. Instead our intent is to draw attention to, and challenge, a number of what we believe are unhelpful patterns in the application of QI that limits their practical application. We have noticed an over dependency or slavish adherence to a particular toolkit or methodology. Advocates of particular QI methodologies can be more ready to parade their own expertise than to inquire into other approaches. Becoming a disciple of one approach can lead to QI being seen as a special interest group or even a cult which means the potential value they have to offer is ignored by the mainstream. In addition, there can be insufficient attention to paid to understanding relationships, the need to adapt to fit the context and the personal challenge of initiating changes to practice.In terms of the four leadership domains that comprise the curriculum of Generation Q, this book will start with the technical domain but argue that success only comes through paying attention to and integrating QI toolkits and methods with the contextual, relational and personal leadership domains.We use the word ‘argue' but in fact our intention is to share powerful , real life stories told in the main by the NHS leaders who have been Fellows on GenerationQ. In sharing their stories we will be answering some of the many questions we know Leaders often have when wanting to introduce and benefit from QI methods.