Implementation of the Value Management method and sustainability of the approach

Teams followed a structured approach to implementing the Value Management Approach within their service. Figure 2 outlines a simplified overview of the core steps.

Figure 2: Value Management Implementation Steps

To learn more about how boards implemented the approach and progressed against milestones within their pilot teams, read the interim impact and learning report.

Areas of focus for improvement

For teams within the collaborative, common improvement areas included:

• staff experience
• access/exit from services (e.g. number of patients seen, length of stay, discharge times, referrals, Did Not Attends, numbers on waiting lists), and
• capacity (time spent on administrative tasks, time spent in meetings, time lost).

Adaptability of the collaborative

Originally designed for face-to-face delivery, the collaborative adapted its approach due to COVID-19 to deliver its capacity and capability programme and events virtually. Coaches and team leads were enthusiastic and positive about virtual sessions in the feedback.

The interim report acknowledged peer support and networking were impacted by the lack of face-to-face events. As conditions allowed, more in-person events were delivered by the Value Management National Team, further strengthening the interconnectedness of the group. Coaches spoke about how important these were for them in generating momentum and enthusiasm, facilitating shared learning and in giving them the confidence to approach each other directly for support.

Benefits of regular reporting

Boards put in place arrangements to report internally on Value Management progress and many integrated reporting into clinical governance arrangements.

Reporting provided a useful opportunity to pause, celebrate successes, identify next steps, and share impact achieved – although at times could also be perceived as an added pressure.

Reporting and collaborative feedback was shared with teams, senior leaders and executive sponsors to enable learning between boards, provide encouragement and have coaching conversations in relation to the work. Each board provided a bi-monthly update to share learning, progress and challenges, which were discussed at monthly coaching calls – successfully sustained throughout the duration of the collaborative.

Benefits of regular coaching

Coaching calls provided an opportunity for NHS Education for Scotland and the ihub to provide improvement coaching, ad-hoc education, quality improvement and measurement support, signposting to other resources and connections to other coaches/teams. The Institute for Healthcare Improvement also provided expert support either directly to coaches via coaching calls or through advice to the National Value Management Team.

Leadership and access to education

Boards with visible leadership support and direct access to organisational level support found it easier to supplement national education with locally delivered education. In these cases, improvement teams either integrated Value Management education into their current quality improvement education offering for individuals and teams or were able to signpost Value Management colleagues towards relevant local quality improvement education.

Fidelity to the approach

Teams that were able to consistently integrate all 3 components of the approach into their regular ways of working made the most progress in improvement activities and demonstrated impact.

Board reporting and coaching calls demonstrated that by the end of the collaborative, 13 teams in 4 boards were:

• Continuously improving and undertaking quality planning and quality control
• Capturing, analysing and discussing capacity data, and
• Networking locally and with other boards to spread learning about the approach and improvement ideas.
  
  

By the end of the collaborative, 61 teams were using all or some elements of the Value Management Approach.

10 teams were regularly updating their box scores and visual management boards and consistently huddling. These teams were more likely to demonstrate improvement, to undertake more detailed analysis to understand their systems, explore additional areas for improvement and embed a continuous improvement culture including monitoring for quality control. Read the case studies to find out more.

Learning from the collaborative demonstrates:

• the box score is integral to the Value Management approach and differentiates it from traditional quality improvement approaches
• coaches within boards played a critical role in supporting teams to:
  • understand the approach,
  • identify appropriate measures and
  • plan improvement activities.
• Team leads and teams benefit from
  • protected time to be able to do all 3 elements
  • sharing team lead responsibility with at least one other, and
  • delegating task responsibilities (e.g. updating box score, visual management, planning improvements, analysing data)