1. Organisational Development and Quality Improvement: An STP Approach to Building Capability
Ceri Feltbower, Associate Director for Service Improvement, Sherwood Forest Hospitals NHS Foundation Trust
Linda Pitchford, Deputy Programme Director, Improvement and Transformation Team, Nottingham University Hospitals NHS Trust
Luke Baumber, Trust Head of Quality Improvement, Nottinghamshire Healthcare NHS Foundation Trust

2. Session Aims
Exploring the ‘traditional view’ and our own perceptions of Organisational Development (OD) and Quality Improvement (QI)
What does the academic literature say?
Sharing a positive example of collaborative working between OD and QI in Nottinghamshire STP
Reflections on our learning from this approach
Next Steps

3. OD:QI Spot the Difference
Dr Joy Furnival

4. What is OD? What is QI? Measured and ‘observable’ results
Tools and processes
Cultural element
Building Improvement Capability
Theory based
Testing Changes
User focussed

5. ‘Formal Definitions’ Quality Improvement Organisational Development
‘….the combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead
to better patient outcomes (health), better system performance (care) and better professional development’
Batalden, P and Davidoff, F
‘the study of successful organisational change and performance. Emerged from human relations studies (1930s), psychologists realised that organisational structures and processes influence worker behaviour and motivation. … work on OD has expanded to focus on aligning organisations with their rapidly changing and complex environments. Theory includes: organisational climate, organisational culture and organisational strategies. Wikipedia
‘…..better patient experience and outcomes achieved through changing provider behaviour and organisation through using a systematic change method and strategies’
Definition adopted by NHS Improvement Scotland, 2014, based on the following article Øvretveit J. Does improving quality save money? A review of the evidence of which improvements to quality reduce costs to health service providers. London: Health Foundation, 2009, p8.
In the NHS, the purpose of OD is to improve the quality and safety of patient care and we describe OD as enabling people to transform systems. OD is a field of practice where behavioural science is applied to organisational and system issues in order to align strategy and capability. OD enhances the effectiveness of systems through the provision of interventions that build capacity and capability to achieve our collective goals. OD improves the performance and health of systems by amplifying the humanity in our organisations, enabling people to flourish, thrive and have meaning in their work. 
Do OD NHS Employers
‘…. the systematic use of methods and tools to try to continuously improve quality of care and outcomes for patients’.
‘Quality Improvement Made Simple’ The Kings Fund 2013
‘..is the work of facilitating organisational success, by aligning structural, cultural and strategic realities of work to respond to the needs of an ever-evolving business climate.

6. So what does the literature say? More questions than answers!
Strong focus and support on role of culture in ‘supporting excellence to flow’ and being a critical factor in the successful implementation of QI initiatives
Speroff T, Nwosu S, Greevy, R et al. Qual Saf Health Care Dec;19(6): doi: /qshc
Focus on ‘hard’ and ‘soft’ (QI perceived as ‘hard’ – tools, measures, processes, operations. OD perceived as ‘soft’ - people and relationships, results often less tangible).
Wilkinson, A The other side of quality: soft issues and the Human Resource dimension. Total Quality Management 3:323-9
Does OD build culture or does culture come from QI (practiced well)?
OD is strategic, QI is tactical application?
OD is staff focussed, QI is user/customer/patient focussed?
Anyone can practice QI but can anyone practice OD?
Are any differences just
professional protectionism?

7. An OD/QI Approach to Building Capability Across the Nottinghamshire STP

8. Agreed at the Nottingham and Nottinghamshire STP Leadership Board
28th July 2017
(being revised November 2018 )

9. The agreed OD Priorities for the Nottinghamshire STP / ICS 2017 & 2018

10. Delivery Priority 2: Building a culture of innovation and continuous improvement - September 17 – November 18
Train senior leaders across the Nottinghamshire STP footprint in best practice tools for quality, service improvement and redesign (QSIR)
Scope and deliver QSIR training across the Nottinghamshire STP footprint building on existing exemplar Improvement methodology practice
Establish virtual community for where ideas and best practice in improvement methodology can be shared
Identify a mechanism where the STP footprint can celebrate and acknowledge and recognise the individuals and teams who lead cross system improvement to health and social care delivery
Identify available resources (finance and personnel) who will provide recognition and support for innovation and improvement that has the Nottinghamshire STP endorsement

12. Reflections on the Approach
The link with the ‘Workforce’ agenda has brought QI into the heart of the STP, and has attached it to a substantive programme of work It has ‘doubled’ our own professional networks, and introduced us to more people working ‘in the same space’ across the area Organisations are left ‘at the door’ and we work collectively to make the best use of resources and value; this is the opposite of ‘empire building’ It brings teams from different organisations together on key STP priority pathways, to develop a common ‘QI language’, to break down silos and to share learning

13. The Future
Nottinghamshire appears to be first in delivering an STP approach to QSIR training - sharing resources and skills across multiple health providers. The ACT Academy who commission QSIR training nationally have recently used Nottinghamshire as a national exemplar
Patient and public representatives have undergone one day QSIR Fundamentals training, to better inform and equip people to co-design improvement and to enable us to share a ‘common’ QI language
Discussions in place to potentially provide QSIR training across a wider regional footprint
Aligning QI training across organisations; bronze, silver, gold
Secure further funding to support going forward into 2020/21

14. In Summary
Any approach that reduces silo working and promotes a ‘shared’ QI language is a step forward
The ‘jury is still out’ on the OD:QI debate – but they can work in harmony together.