The Health Foundation’s principles for implementing the NHS Impact approach

The NHS has developed a new ‘Impact approach to improvement’, which aims to address the growing system-wide pressures across workforce, finance and performance. The NHS Impact approach champions collaboration and integration; emphasising the importance of an aligned approach to improve capability and delivery across NHS provider organisations and integrated care systems. 

In this article, we will take a look at The Health Foundation’s five principles for implementing the approach.

1. Set the right pace for sustained improvement

The approach attributes much of its future hopes for a consistent improvement to the wealth of insights that have already been gathered by various NHS trusts and organisations, such as the Flow Coaching Academy and the evaluations of the NHS-VMI partnership. It is hoped that by drawing on past experiences, the implementation of change will be more efficient for the next generation.

They note that it is expected to see a high degree of variation in the pace of improvements and access to healthcare services, given the complexities inherent of an evolving clinical landscape.

The approach cites the imperative need for all policy makers, regulators, provider boards and system leaders to acknowledge the uncertainty of improvement work and to react appropriately when challenges arise. Utilising peer networks and targeting capability gaps are just some of the key ways the NHS are more likely to elicit positive outcomes.

2. Set expectations in ways that build commitment

The Health Foundation highlights that in putting the NHS Impact approach to improvement forwards to be universally applied, NHS England have underlined their commitment to organisation-wide improvement, thus pushing leaders to prioritise it.

They note that the NHS has made a practical and symbolic choice by setting out the expectation; however, rather than a rigid structure of obligations, the approach describes a set of overarching improvements which will allow providers and integrated care systems to “build naturally on their existing improvement assets and skills instead of having to bend their approach to fit a national template.”

However, the Foundation says, the approach carries the risk of superficial compliance and a concern that some ICSs will not have the bandwidth to engage with the approach in a meaningful way. In order to mitigate these risks, NHS England and its partners will need to acknowledge the existing differences in the improvement culture across various heath care sectors.

They add that the NHS should explore ways to close the knowledge and experience gaps by creating networking opportunities for the different sectors and organisations – allowing them to share insight and have honest conversations around system wide improvement.

3. Enable learning across systems

The Health Foundation states that one of the main ways to ensure the approach is a success is to embed a culture of learning across the ICSs. The guidance highlights the importance of creating a robust learning culture, wherein ICSs are continually adapting their strategies and reflecting on previous outcomes.

The fact that the approach offers overarching components rather than a prescriptive template will allow ICSs will have their own unique approach to improvement, the guidance notes, and the new Impact approach gives them the space to forge their own strategies around their local needs.

By creating a space for cross-ICS communication and learning, a broader understanding of how and why each approach has been adopted will emerge – capturing the ICS’s improvement journeys and building a clearer perspective on how to drive effective improvement.

4. Build capability at provider and ICS level to navigate and reconcile competing priorities

“For provider and ICS leaders a key tension relates to the national improvement priorities on which providers and systems are expected to work,” the Foundation states. Whilst having national priorities in place can create a sense of common purpose, they “may also encourage a disproportionate focus on meeting the immediate targets associated with them, potentially at the expense of longer term improvement-related goals and more systemic solutions to challenges.”

In order to avoid this, a ‘strategic ambidexterity’ is needed for the ICSs and providers to balance short, medium and long-term priorities, with the Foundation calling it “a crucial leadership capability”.

Reconciling local priorities alongside national improvements is another potential area of contention. This will require strategic confidence and an authentic strategy for engaging with staff and the wider community in identifying, as a team, the priority areas of improvement.

5. Align national policy around the NHS Impact approach to improvement

The Foundation acknowledges that there are multiple challenges which could affect the implementation of the NHS Impact approach to improvement, including how it is regarded by ICSs and care providers. In order to succeed, they say, the approach needs to be recognised as the defining way to facilitate meaningful systemic change.

This will require alignment with other national policies as well as expectations across national bodies. A joined-up delivery approach is needed to compliment the NHS and ICS’s improvement efforts, cultivating a climate of ‘self-improving systems’ which will be felt cultural as well as locally.

A considered and consistent approach from all parties is crucial, which is supported by the acknowledgement in the NHS Impact approach to improvement, stating that it takes time to embed a comprehensive and integrated improvement strategy.

To learn more about the NHS Impact approach to improvement, please click here.