Identify an issue to be tackled


The first part of improving is being able to see the challenge clearly - not always easy to do in our busy work lives. We can be really good at rolling our sleeves up and ‘fixing’ problems (usually in a crisis) to give a short term resolution, but what we really need to do is to make improvements that give us a sustainable solution. 


We advocate a simple approach to identifying issues for improvement:

  • Pause
  • Curiously Reflect
  • Take Action

The first step is to pause and take time to consider what we do and how we are doing it and where there are challenges. We already have formal and semi-formal opportunities to do this pausing – we just need to get better at using them for the purpose of thinking about improving. Some examples are:

  • Team meetings
  • Supervision (group, 1:1)
  • PDP
  • Formal audits
  • Team away days

It may also be that taking the time to pause and reflect is a key element of your role. If you are leading or managing this should definitely be something you are scheduling into your diary. Alternatively, it could be that we need to create specific opportunities to pause and reflect.

Finally, there may be other personal or informal opportunities to pause and reflect, for example; on the journey to and from work or through a piece of study such as the Leadership Academy, perhaps. However we pause, we should try and keep it simple and part of ‘the day job’ – but make sure we do it!

Pausing is the opportunity to do some curious reflection. What do we mean by that? We mean actively and purposefully thinking (critically) about what and how we do things and the impact of that.

We mean stopping ourselves from rationalising our current approaches – this limits our critical thinking. We mean deliberately taking ourselves out of accepting that ‘this is the way we have to do it round here’.

Ultimately, we mean asking ourselves some simple questions about things that we do:

  • ‘Is this OK? Is this “great care, great outcomes”?’
  • ‘Does this deliver what the people who use our service need / want?’
  • ‘Are people satisfied with this?’ (us, service users, carers, commissioners, the public)
  • ‘Can we do this better / in a better way?’

If the answer to these questions is ‘no’ (or yes to ‘can we do this better’) then we have found something to improve.

At this point, we must stop ourselves from immediately thinking about ‘how’ this will be improved. This is to avoid two potential traps:

  1. talking yourself out of starting to make an improvement because it seems difficult or you’re not sure how you will do it
  2. jumping to a solution without fully understanding the problem

For the moment, we should let the fact that this is something that needs to be improved sink in and take on an importance such that we will want to do whatever we can to improve it. This is the point we are making a commitment to taking action – and that will come in the form of starting an improvement ‘project’.

But what are we asking those curious reflection questions about? Well, it depends. We all have so many things we do that could be improved, we need to focus on the important elements – the ones that contribute to delivering ‘Great Care, Great Outcomes’ the ones that impact on:

  • the quality of service user, carer and staff experience,
  • on safety,
  • on the value we deliver,
  • on positive partnership working

Some of what we should be curiously reflecting on comes at us in a very direct but retrospective way, often following an event or situation:

  • an incident or near miss
  • poor performance or targets being missed
  • errors leading to us having to ‘fix’ something

There are other things that we should be curiously reflecting on in a prospective way - deliberately making an assessment against some framework / model, standard or expectation:

  • Auditing the quality of care and support plans
  • Assessing the safety of an inpatient unit
  • Searching for wasteful activity
  • Declining performance trends

Curiously reflecting in the retrospective mode is often easier; simply put, the challenge has come to us. Curiously reflecting in the prospective mode is ultimately a more positive approach to identifying areas for improvement and is helped by questions, tools and techniques that give a particular focus or perspective to looking at what we do.

These tools will be many and varied and some will need specific time to be created to apply them. However, using them is a powerful and positive way of identifying improvement opportunities. Often the questions (‘is this OK? Is this “great care, great outcomes”?’, 'does this deliver what the people who use our services want / need?', ‘are people satisfied with this?’ and ‘can we do it better?’) are implied in the tool or technique, but if not then we must ask them.

In either mode – retrospective or prospective - once we have identified a challenge we need to be clear about it and the impact that it is having, and then commit to taking action.  We therefore need to capture a good description of the challenge and you can find out about doing that here.