OPINION Creating conditions for improvement
Our quality improvement journey at University Hospitals Coventry and Warwickshire (UHCW) started in 2014 when we launched the ‘Together Towards World Class’ programme. We formed a new vision to be a national and international leader in healthcare and an opportunity to work with the Virginia Mason Institute. We applied to the Trust Development Authority and in 2015 became one of five NHS Trusts to partner with the Virginia Mason Institute.
Our journey so far Firstly, there is a leadership challenge associated with bringing quality improvement and quality management systems into an organisation. It challenges leaders at every level of the organisation to think about how we lead differently. And where that thinking really starts is about the patient. We have to challenge ourselves to think: “Do we absolutely put the patient first and foremost in everything we do and how we plan things?” In every decision we make, every process that we design, and redesign – are we putting the patient at the centre? Secondly, many of us, as we go
through our careers, are promoted because we’ve been able to solve problems. Because we are ‘solution finders’. Where this approach has really challenged us, and certainly challenged me, is that we’re not here to solve problems – we’re here to help frame problems. This comes back to one of the fundamental premises which is a strong belief that those who do the work, know the work. And those who know the work, can improve the work. We need to create an environment and a culture which enables people, in whatever job they do, to feel that they can attempt to solve the problems they see in front of them.
A leader’s role is to help them frame
those problems and let them make the solutions. And to give them the tools to be able to embed those solutions when they come along. Another reflection I have around what could we have done differently, is embedding standard work earlier. We all do standard work. I do standard work as a Chief Executive. Every week if I’m on site on a Monday morning at 9am, you’ll find me giving inductions to new colleagues who are joining UHCW. On a Tuesday morning at 8am, you’ll find
We have to challenge ourselves to think: “Do we absolutely put the patient first and foremost in everything we do and how we plan things?” In every decision we make, every process that we design, and redesign – are we putting the patient at the centre?
me in the main reception doing a stand up – short, sharp presentations with colleagues from across the organisation, talking about the improvement methodology. And of course, that standard work includes trust boards. I’m a rugby fan and if you look at the New Zealand All Blacks, they are the most successful international sporting team. They talk about the fact that they’re successful because they do the basics better than everybody else. And that is fundamental to this. It’s giving people tools to do their basic work, their ‘standard work’, better.
Tipping points What were the tipping points over the last few years? One was around the language. The Virginia Mason Institute programme came out of the work they’d done with Toyota, a Japanese company. There were some Japanese terms and one of the tipping points in my organisation was when I started to hear those words.
I started to hear people talking about the ‘gemba’ – the place of work – and preparing the ground for this work. Now thinking about the leadership challenge and being on the gemba. It’s really important for leaders to be seen and to be visible but to remember that when you go to those gemba’s as a leader, to use big eyes, big ears and a small mouth. You go and see, you ask why. Another tipping point was when I was asked to give a presentation about the programme so far. During the presentation I could stand up with confidence and say that in 94 clinical
WWW.PATHOLOGYINPRACTICE.COM JUNE 2025 About Professor Andy Hardy
Professor Andy Hardy is Deputy Chair of the National Improvement Board. He was appointed Chief Executive Officer of University Hospitals Coventry and Warwickshire (UHCW) NHS Trust in 2010. For the six years prior to that he was Chief Finance Officer of UHCW, as well as Deputy Chief Executive Officer from 2008 to 2010.
and non-clinical areas in my organisation that day, there would have been huddles around focus boards and production boards based on what was facing that part of the organisation on that day. And the third tipping point was
around COVID-19. The way we responded was based around the improvement methodology and the improvement management system that we put in place. Like many organisations we had the traditional emergency response like bronze, silver and gold – but on our wall was ‘remove the rocks in people’s shoes’ – meaning to remove some of the barriers. So, it’s absolutely changed the way that I’ve led, not only as an individual leader, but it’s changed the way my organisation runs. It’s about having that culture where people feel safe to make the changes or try to make the changes that they want to see for their patients and their services. We look to constantly improve our business every day and one of our sayings at UHCW is that “better never stops”.
The next big challenge for us is to see how we can make this a place-based improvement methodology. Thinking about how we can do improvement beyond organisational and across boundaries.
Professor Andy Hardy
Visit the NHS IMPACT website to access improvement resources and events:
https://www.england.nhs.uk/nhsimpact/ 5
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