Using results to continuously improve integrated care

The value of monitoring and evaluation

Ultimately, the value of monitoring and evaluation activity rests on how the evidence is used to do the following.

• Monitor activities and results to manage budgets and performance on an ongoing basis.

  Depending on the nature of the programme and the scale of the investment, monitoring should be done daily, weekly, monthly or quarterly. It should be clear who is responsible for delivering in relation to – and reporting on – each measure. It is also important to establish lines of accountability and reporting arrangements.

• Report on progress for purposes of local and national accountability.

  This means ensuring that the local evidence in relation to activity and results is collected and submitted to relevant stakeholders both within the local area, the STP area or region, and nationally.

• Inform decisions about commissioning and decommissioning.

  It is critical to set out a plan for how the progress reports should be used to ensure that the evidence is actually utilised to inform investment decisions and drive improvement and sustainability.

• Underpin a culture of learning across the system that supports continuous improvement and transformational change.

  This involves honesty and openness about how to deliver the health and care outcomes most cost-effectively and sustainably.

Using results to drive continuous improvement is an ongoing challenge that requires continuous commitment and effort across the system. This section sets out a few examples of how to use evidence to inform change.

Whole-system dashboards

Across health and care, there are numerous different quality, performance and finance measures, systems and cultures. In some areas, key measures have been pulled together into an integrated ‘dashboard’ which can provide an overview on progress and may replace some of the current reporting arrangements. Consider aligning measures to cover the six domains to assess integrated care. An integrated dashboard can help provide a whole-system view at a glance and inform tactical and strategic decisions to accelerate improvement.

A dashboard:

• provides relevant and up-to-date information on a page
• can engage system leaders through infographics and data bridges
• reflects the range of services provided across the pathway with an increasing focus on health outcomes
• includes the range of measures and standards to be achieved and monthly/ yearly to-date performance and forecasting information
• uses a data quality ‘kite mark’ system to help provide a good sense of the quality of the data being used
• includes further measures as it develops.

Establishing a learning culture

The NHS and local authorities have a long tradition of innovation and improvement. Over recent years, this has accelerated with a range of pilots, innovation test-beds, new models of care and new ways of working. There is a growing evidence base about what works (local, regional, national and internal), and the challenge to localities is to make use of this evidence to learn and improve on an ongoing basis.

It is important to build a process for continuous learning, training, evaluation and development. This means:

• using local insights and research, improvement theory and the growing evidence base about what works
• creating spaces for a broad range of stakeholders (people, frontline staff, managers and leaders) to reflect on every stage of the journey, based on data, evidence and impressions
• encouraging frontline staff to share feedback and capture results
• acting on what has been learned
• identifying best practice and sharing it widely.

Action learning sets

Action learning sets can help build a learning culture. They are defined as a ‘continuous process of learning and reflection, supported by colleagues, with an intention of getting things done’ (see McGill and Beauty: Action learning – a practitioners’ guide). Individuals work on real work issues and openly reflect on their experiences with a view to taking subsequent action. One of the fundamental aims of action learning is to help participants develop the skills for, and make time for, active reflection to solve their own problems. Action learning sets can be linked with coaching/mentoring. Participants are recruited to a ‘set’ and meet regularly (every six to eight weeks) to sustain momentum and commitment. Less often than this and a group can often repeat the cycle of trust formation and not get any further.

There are three key benefits of action learning sets:

• Learning from others

  Because the focus of action learning is work-based issues, shared with others, one of the most important benefits is being able to learn from others’ experiences of dealing with similar issues.

• Changing methods of interaction with others

  By asking open, probing and challenging questions – all of which help to draw out what has been referred to as ‘exploratory insight’ which in turn leads to action (see Revans: ABC of Action Learning).

• Enabling people to both reflect on a work-based issue and share it with others

  Thus formulate actions and decisions that they can take back to their workplaces, which results in change.

Reflect, measure and learn rapidly about what is and is not working to help implementation become more successful.

Improving quality in the English NHS – A strategy for action

Checklist: using results to continuously improve

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