The three Cs of improvement: Compliance, Culture, and Competency

Last week, Healthy London Partnership held an event on ‘Building London’s capacity for improvement:Shaping the Future’. Success of an improvement programme was categorized as: Compliance, Culture, and Competency.

Steve McNair, Quality Director at BAE Systems, spoke about how the airline industry moved form a culture of inspection and regulation to one of global collaboration: where near misses were shared and lessons learnt from all aspects of safety in a systematic manner. Key to this change was compliance.

For improvement to become the way of doing things, an organisation needs to understand its need for compliance. Compliance needs to balance effectiveness (doing the right things) with efficiency (doing things well). As illustrated in the matrix below.

So how can we achieve a better balance between effectiveness and efficiency?

Culture is often undervalued during a process improvement effort, but without strong positive culture — stimulating innovation, creativity, and team work — improvements cannot occur. When there is a negative culture mistakes are hidden and are not used to drive improvement; so blame is the first port of call when something goes wrong.

‘you can’t fix problems in the boardroom’

Dr Amar Shah, Associate Medical Director & Consultant Forensic Psychiatrist at East London Foundation Trust (ELFT) spoke of how ELFT fostered a culture for improvements by first accepting that ‘you can’t fix problems in the boardroom’. Instead leaders created an environment where frontline teams were empowered to identify problems and develop solutions. (Black Box Thinking by Matthew Syed, offers some interesting insights here).

Vince Desmond, Acting CEO of the Chartered Quality Institute, spoke about the competency framework to underpin the delivery of improvement. Competency to deliver improvement is more than just giving people a set of tools and techniques. Many organisations ‘sheep dip’ people through improvement training programmes and they then never use what they have learned.

Competency is not just about the technical side of improvement. It also requires a structured approach to improvement, where priorities are based on overall strategies (such as patient safety and experience) and where evidence is the basis of the changes made. In this way people understand why the improvement is required, as well as how to deliver and quantify the improvement.

There is also an interpersonal dimension to competency — the attitudes and behaviours that enable people to work collaboratively to deliver beneficial and sustainable change. This is often compromised by the lack of time people have to devote to genuine improvement tasks. People can work to solve problems but these are often ‘quick fixes’ which fail to address the underlying root causes — resulting in the problems recurring over and over again.

Bringing it all together
Improvement takes time. A reoccurring theme through the day was the recognition that changes to compliance, culture or competency takes time. You need the time to develop improvement solutions; you need time to embed solutions into an organisation, time to train staff but most importantly time to develop your three Cs.