許多全球性組織已經接受了持續質量改進的概念。日本人把這個概念稱為改善，這意味著改善。改善戰略包括持續改進的努力，包括組織中的每一個人，而不僅僅是管理團隊。持續質量改進的最流行的方法是全面質量管理（TQM）、持續質量改進（CQI）。全面質量管理/質量是由戴明在20世紀50年代的日本，并從上世紀80年代末在國際商業界變得更加突出。然而，盡管大量的雜志文章和書籍的TQM / CQI沒有確切的定義。
This assignment has been written using a first person perspective rather than the 'impersonal style', as similarly to Hamill (1999) I believe that this will assist in conveying and expressing my personal beliefs and insights. All names and identifiable descriptors have been changed to protect confidentiality.
Numerous global organisations have embraced the concept of continual quality improvement. The Japanese refer to this concept as Kaizen, which broadly means improvement. Kaizen strategy involves continuous efforts for improvement encompassing everyone in the organisation, not just the management team. Two of the most popular approaches to continual quality improvement are Total Quality Management (TQM) and Continuous Quality Improvement (CQI). Gustafson and Hundt (1995) state the terms TQM and CQI are now used interchangeably. TQM/CQI was developed by Deming in Japan in the 1950s, and became more prominent in the international business community from the late 1980s. However, despite a plethora of journal articles and books on TQM/CQI there is no definitive definition.
In 2006, the senior management of the Royal Navy and Royal Marines embraced TQM; albeit it I do not believe that the approach has permeated throughout the Naval Service. Before studying for this module I had heard the term TQM but had no idea what it involved. One hypothesis for this lack of holistic integration is the relatively short time period since the approach was adopted. Deming suggested approximately a seven year period would be needed for adequate implementation of TQM/CQI, and perhaps longer in complex organisations, such as the Armed Forces (Counte and Meurer, 2001).
A disadvantage of the TQM concept is that it is predominately a medium to long-term approach, whereas in the military there is often a priority given to short-term approaches. The key principles of TQM/CQI are measurement and feedback, which are both essential to a successful outcome. This is somewhat different to project management, which is used throughout the Naval Service, where the success is principally measured by schedule, cost and performance.
This assignment is structured on the NHS six-stage Service improvement framework to help improve the service quality delivered by my team (NHS, 2011). This framework has a number of similarities to other improvement models such as the Six Sigma DMAIC model. I have slightly adapted the NHS framework by integrating TQM/CQI and incorporating a feedback loop to monitor service improvements. Additionally I have used a range of improvement diagnostic tools and approaches including cause and effect diagrams, PDSA cycle and statistical methods to measure and assess the process.
This assignment focuses on improving the service quality within my team; Royal Marines Welfare (RMW) is a specialist occupational welfare team. Our mission statement is to maintain the operational capability of service personnel by providing professional welfare support to the individual and their family. The RMW team are geographically located throughout the UK at Royal Marines Commando units from Arbroath in Scotland to Plymouth and are managed, remotely by myself from the Naval Command Headquarters located in Portsmouth. The team consists of sixteen Specialist Welfare RMW workers, two Admin workers and six Family Support Workers (FSWs). The FSWs were introduced into RMW in 2009 with little thought or planning. Accordingly, it came as no surprise to discover that they were being misemployed and accordingly their moral was suffering. This problem was confirmed when a number FSWs approached me stating that they felt disillusioned by not working with families in need, instead they were being used in an admin role. It was clear that this problem needed to be addressed using a continual quality improvement approach to ensure a successful outcome for the team and just as importantly service users.
Stage 1: Starting Out
Having been presented with a problem regarding the FSWs, it is vital to establish the rationale for improvement. From the outset, it is imperative to have a clear initial 'problem statement' before embarking on a voyage of quality improvement. The temptation at this early stage is for managers to jump straight to solutions, which invariably involves 'sticky plaster' fixes of the symptoms and not of the 'root cause'. I have certainly been guilty of this quick fix approach in the past. Oakland (2004) equates this temptation to managers' instinct, in that they often want to swiftly solve problems through 'detect and resolve' mindsets to enable them to quickly move onto the next problem or task at hand. Therefore it is by no mistake that the majority improvement project frameworks have in common a number of detailed stages, which help guide a project manager through the improvement process (Maylor, 1996). The first stage in the majority of the commonly used quality improvement models is to identify and clearly define the problem. In this project, the initial perceived problem statement is:#p#分頁標題#e#
'Family Support Workers are not being fully utilised by Royal Marines Welfare to support military families in need.'
The problem statement needs to be both clear and avoid any implied solutions that can often short-circuit the improvement process. However, it is important to emphasis that this is only an initial problem statement and as the improvement process progresses this statement may alter as further analysis is carried out. After the initial problem has been defined the objectives should be considered. Objectives can assist the improvement teams understanding on what they are trying to achieve. Although, Martin et al (2010) state that setting effective objectives is far from a simple evolution, as there are often inherent variables that make the process problematic. Therefore, before the objectives can be formulated it is important to determine the membership of the improvement team so they can contribute towards the formulation of the objectives, which will increase the likelihood of ownership and ultimately success. The improvement team is usually drawn from the key stakeholders, hence it is paramount that the stakeholders are accurately identified and understood.
One of the initial steps that should be taken in a continuous improvement project of this nature is a 'Stakeholder analysis' (NHS, 2011). This stage in the process enables the improvement manager to identify key individuals, organisations or groups who need to be involved in or affected by the project. The stakeholder analysis can be broken down into three distinct steps. Firstly, it is important to brainstorm a list of all the stakeholders; they can be either individuals or organisations that have a vested interest or influence in the project. For the purpose of this assignment I have brainstormed a list of stakeholders that have a vested interest in the FSW role and their service delivery (see table 1). Brainstorming has been defined as 'a method of free expression and is employed whenâ€¦ creative new ideas are required' (Dale et al, 2007, p. 359). Brainstorming achieves best results when used in a group setting; therefore, in reality I would brainstorm with the RMW team during a team away day.
However, being mindful that there are a number of intrinsic problems with brainstorming, which includes the potential for arguments and deliberate omission of ideas from the group, albeit using an independent and trained facilitator, can mitigate these problems.
Secondly, the list of stakeholders should be prioritised from people or groups with the greatest interest and power, through to more 'peripheral' individuals or groups. The more important the stakeholder is to the success of the project, the more time and resources are needed to maintaining their commitment. Some of the stakeholders may have the power either to block or advance, some may be interested in the project and others may not be concerned. Oakland (2004) comments on the importance of understanding the 'stakeholders' needs and their potential to do both good and ill.' (p. 208). One method of illustrating these often-complex power dynamics is using a 'Power/interest Grid' (Gardner et al, 1986) see fig. 1.#p#分頁標題#e#
Fig. 1For example, in this project my line manager has high power and influence and a high level of interest. Whereas the FSWs, as a group, have a high interest, but are unlikely to have much power. The Power/Interest grid is a useful tool as it identifies what actions should be taken with each sub-group i.e. high power, interested people must be fully engaged and greatest efforts made to keep them satisfied and on side. However, a potential limitation of this tool is its high perception bias, which can be mitigated by obtaining the improvement teams views. Additionally, power is complex as it can be overt or covert and can also dramatically change over time making it a variable that is difficult to predict or accurately identify. For instance, if a FSW engaged with a trade union regarding a contested change to their role, this could significantly alter the power dynamics in a situation and potentially lead to conflict. Therefore, I believe the power/interest assessment should be an ongoing process, which is monitored and frequently reviewed by the improvement team.
The final stage of stakeholder analysis is to find out more detailed information about the key stakeholders. For example, what they feel about and how they might react to the FSW improvement project, how best to engage/communicate with them and establishing their level of support. An instrument that is useful in illustrating the stakeholders' commitment to a project is the 'Commitment Planning' tool (Martin et al, 2010). This tool enables the improvement manager to plot, in a table, each stakeholder's current and the desired level of commitment to the project (see Table 2). This analysis is essential because successful improvement management requires 'anticipation of [stakeholders] reactions by understanding how they will be affected by the change' (Scholtes et al, 2003, p. 10).
After the key stakeholders and their current level of commitment have been identified a strategy should be formulated to enable them to move to the required level of commitment. For example, in this project the RMW Social Workers are currently at the 'indifferent' level of commitment and they need to be at the 'will help level' in order for the project to be successful as they will be the sole instigators for FSW referrals. Therefore a strategy to move them to this level may include listening to their fears, concerns, barriers to change and gaining their trust.
As mentioned earlier, it is advisable to develop clear SMART (Specific, Measurable, Achievable, Realistic and Timely) objectives before moving onto the second stage of the improvement framework. This is best achieved by group participation and agreement from the nominated improvement team. For the purpose of this assignment, I have developed three key objectives:
To gather data on FSW involvement with service users, including the type of services being delivered.#p#分頁標題#e#
Analyse the FSW referral process and assess if it is 'fit for purpose' and efficient.
To improve the referral rate of FSWs to service users who are assessed to be in need.
It is advisable in the final element of this stage to summarise all the information in a short report to enable the project sponsor, in this case my line manager, to be kept informed of the scope of the project. Additionally, this report can be used to gain permission and/or agreement to use resources, which may be used in the ensuing stages of the project. In the NHS project management guide, this is called 'gateway criteria', because certain criteria must be met before moving onto the next stage (NHS, 2011).
Stage 2: Define and Scope
There are invariably underlying contributory factors or issues to every problem; the key is uncovering them so the current situation can be improved. The main method for this is to undertake a root cause analysis to help identify these underlying issues. There are a number of diagnostic tools that can be utilised in this task e.g. the Five Whys and the Fishbone (Cause and Effect) Diagram.
For this project, I would initially use the 'Five Why's' tool to drill down to the root cause of the problem. This tool works by repeatedly asking the question "Why" so layers of symptoms can be removed which can eventually lead to the root cause of a problem. Using this tool the perceived reason for a problem will often uncover other previously unknown issues, which will also require further investigation. Although this technique is entitled the 'Five Whys' it may require more or less than five questions before the root cause is identified. The benefit of this tool is that it is simple, can quickly uncover the root causes and can help determine the relationship between different root causes of a problem; it is particularly useful when problems involve human factors or interactions (Lambley, 2009). For the purpose of this assignment I have used the following exemplar to demonstrate the 'Five Whys' technique (see table 3).
Why are FSWs not working with service users?
Because they are not being referred by the RMW workers.
Why are FSWs not being referred by the RMW workers?
Because RMW workers are too busy.
Why are RMW workers too busy to make a FSW referral?
Because a FSW referral involves more paperwork and they don't fully understand the referral process.#p#分頁標題#e#
Why don't RMW workers understand the FSW referral process?
Because it varies between RMW offices.
Why does the referral process vary between offices?
Because FSWs were introduced into the organisation without
clear direction, policies or procedures being put in place.
Table 3 - Example of the 5 Whys tool
As can be seen in table 3, there are a number of alternative questioning routes that could be further explored e.g. the FSW referral paperwork, why are RMW too busy. The 'Five Whys' tool is akin to a funnel, in that the more questions that are asked the more narrow the focus. In the example above, it would appear that the root cause of the problem is a lack of policy and procedures. However, this may be only one of many contributory factors, and it would be prudent to repeat the process to identify any further root causes. Again the risk at this stage is for the improvement manager to 'solve' the symptoms without conducting further analysis. This leads to the main criticisms of the 'Five Whys' tool in that it is too simple and the results are often not repeatable in that different people will come up with diverse responses for the same questions (Bulsuk, 2009).
Often used in conjunction with the 'Five-Whys' tool the fishbone (also known as Ishikawa or Cause and Effect) diagram visually displays the many potential contributory causes for a problem. Therefore, creating a fishbone diagram provides a pictogram of the potential root causes. It is an effective tool to record the responses from the 'Five Whys' questions. The causes in the fishbone diagram are often categorised, for example using the 4 S's (Suppliers, Surroundings, Skills and Systems) alternatively they can be developed from brainstorming, as a prescriptive format is not essential. Fishbone diagrams can reveal key relationships between a variety of variables, and the possible causes provide additional insight into the process behaviour. I have created a fishbone diagram using causes that have derived from brainstorming based on the organisation (see fig. 3). During this stage the improvement team may offer recommendations to solve the problem e.g. produce a set of FSW referral procedures. However, without further analysis the temptation to jump to a solution should again be avoided, albeit the recommendations should be recorded.
Once the fishbone diagram is complete the causes can be prioritised using 'Pareto voting', this involves the improvement team voting 'on what they believe are the causes of the [problem]' (Dale et al, 2007, p.359). The Pareto principle occurs when a large majority of effects/problems (approximately eighty per cent) are produced by a few key causes (approximately twenty per cent), it is also known as the 80-20 rule. Therefore, employing this principle enables the improvement team to focus their time and energy on dealing with the causes with the highest votes first because once resolved these offer the greatest benefit to the project. Additionally, at this stage supplementary data may be required to confirm the prioritised key root causes (Dale et at, 2007). For example, in this project data collection would be required to determine the number of FSW referrals/cases over a previous specific period.#p#分頁標題#e#
To conclude this stage, the improvement team should define the scope of a project by identifying what will and what won't be included. This ensures that the team remains focused and understands the aims and extent of the project (NHS, 2011). Without a clear focus on what the improvement project is trying to achieve there is the danger of mission creep and therefore wasting valuable resources. For the purpose of this assignment it would appear that the FSW referral process should be examined in more detail.
Stage 3: Measure and Understand
Stage three of the improvement project is similar to the 'Measure and Analyse' stages of the Six Sigma method DMADV (Define, Measure, Analyse, Design and Verify), which is used to develop new processes (De Feo and Barnard, 2004). The aim of the stage is to measure the current situation and understand the level of change required in order to achieve the project objectives (NHS, 2011). Having selected the key causes using Pareto voting, in this stage a data collection plan will need to be developed to evaluate the current situation, this is also known as benchmarking.
From a Pareto perspective one of the key causes of this projects identified problem is an inconsistent FSW referral procedure, as the process varies between RMW offices. However, one RMW office has developed their own FSW referral procedure, which is reported by the team to be working well. One tool that can help understand and assess this established referral procedure is a process map. Process maps are effective communication tools that help improvement teams understand the process and identify opportunities for improvement (Kelemen, 2009). This is important because making changes without truly understanding how the process is currently working, and why, can lead to errors. It can also create conditions that make it difficult for the team to work effectively, and often creates further problems. A process map can give you a clear picture about what the team is currently doing. From this process map the improvement team can develop a future status map that will show the processes needed in the future. When both maps are compared the improvement team should be able to understand the process improvement required in order to achieve the objectives. An advantage of having a process map is the simple graphical representation of a process. This will highlight the problems in the process e.g. an overly complex referral form, which are opportunities for improvements.
A useful toolkit for managing processes is Statistical Process Control (SPC). SPC will reveal whether a process is 'in control' stable and exhibiting only random variation, or 'out of control' and requiring attention (Dale et al, 2007). In this project, I would use SPC to monitor FSW referral rates, open and closed cases rates and their timesheets. SPC can be used to warn when performance is deteriorating, and can assist with reduction or elimination of causes of variation (Kelemen, 2009). In SPC, numbers and information form the basis for decisions and actions, therefore a thorough data recording system is essential. In addition to the tools necessary for recording the data, there are a number of tools to analyse and interpret the data. The benefits of SPC tools are that they require no prior knowledge of statistics on how to use them.#p#分頁標題#e#
One of the key tools of SPC is a Control Chart, which is used to monitor processes using mean averages and ranges. The Control charts are useful as a historical record of the process and for detecting and predicting change (Dale et al, 2007). Other SPC tools include histograms, matrix analysis, scatter diagrams and check sheets. However, SPC is only effective when used correctly and with the full involvement and support of the team. It is important to recognise that SPC alone cannot 'solve problems' it can only highlight them by confirming the 'presence of a problem' (Dale et al, 2007, p.442).
In this project there must be a clear understanding of the service users needs regarding what support/services they require from the FSWs; indeed if they need a service at all. Additionally, the improvement team should measure and analyse the level of service user satisfaction with the current service they have received from their FSWs. This can be achieved by a combination of 'voice-of-the-customer' matrix and SERVQUAL questionnaires (Dale et al, 2007). The term 'voice of the customer' is used to describe the specified and unspecified needs or requirements of the service user (Bicheno, 2006). These needs/requirements can be collected in a variety of ways by using interviews; surveys; focus groups; direct observation; case records; complaints, etc. The next step is to develop survey questionnaires to measure customer satisfaction with the various aspects of the FSW service, such as the processes followed by the allocated RMW worker and the service quality they received. Gronroos (1983) sub-divides service quality into 'technical quality' and 'functional quality' i.e. how a service is delivered; he makes the case that 'functional quality' has a substantial role in the service users perception of service quality.
There are different theories and models for understanding customer needs and arriving at specific factors for measuring overall customer satisfaction. One widely used framework for measuring customer satisfaction is SERVQUAL, it is also known as the RATER model, because it measures customer satisfaction in five dimensions:
'Reliability - An organisations ability to perform the promised service dependably and accurately.
Assurance - The knowledge, competence and courtesy of employees and their ability to convey trust and confidence.
Tangibles - Physical evidence, equipment etc.
Empathy - The level of caring, attention, access, communication and understanding that the customer perceives.
Responsiveness - The willingness displayed to help clients and provide prompt service.' (Parasuraman et al,1988)
Using these five dimensions a survey questionnaire can be designed to accurately capture service user satisfaction regarding FSWs. Additionally, by assigning an importance weighting to each dimension of the survey can help the improvement team identify areas for development. Parasuraman et al (1988) recommend that SERVQUAL can be used to track quality improvement. However, its limitation is that service users require knowledge of the service for it to be effective. In this project, some of the RMW offices have evidently not been using their FSWs to support families; therefore service users of those offices would be unable to accurately answer a SERVQUAL survey. Additionally, Dale et al (2007) raise the concern that service users expectations, perceptions and satisfaction are unique and often change during service delivery.#p#分頁標題#e#
Utilising these results as indicators is an effective method of tracking whether the quality improvement project is making the desired progress towards the set objectives. However, it is essential that all measurements are captured and regularly analysed during and post project to ensure that the changes that have been implemented are having a positive effect (Kelemen, 2009).
Stage 4: Design and Plan
The aim of this stage is to 'design and plan' the activities required to achieve the objectives (NHS, 2011). This can be achieved by breaking down the project into a number of tasks and delegating them to the appropriate people or sub-groups within the improvement team. With each task, the improvement manager should create a list of all the activities required to complete the allocated task, which is also known as an action list. For example, in this project a sub-group could be tasked with redesigning a FSW referral form that fulfils the requirements identified in stage 3 of this framework. Therefore, the action list for this task might include: review the current form, simplify and remove duplicate information.
Three useful tools that can be employed in this stage are the Six Thinking Hats, Affinity diagrams and Brainstorming. Additionally, creative thinking may assist in finding innovative ways of achieving the allocated tasks and making improvements to existing processes (NHS, 2011). In this stage I would consider using the Six Thinking Hats tool, which is based on a principle of parallel thinking i.e. thinking in the same direction from the same perspective (De Bono, 1987). The tool identifies six separate states in which the brain can be 'sensitised' which are each assigned a different colour hat. In each of these states the brain identifies and focuses on aspects of the task being considered e.g. ideas, benefits and emotion, this has the advantage of providing a holistic oversight and not 'blinkered' thinking. Essentially the Six Thinking Hats tool should improve communication and decision-making within the improvement team. However, although the tool is simple it can be misused by unbalanced power dynamics within a group, such as when a powerful individual changes the emphasis of their hat and therefore skews the outcome in their favour. Therefore, recognising this potential shortfall underpins the importance of the stakeholder analysis to ensure where possible the correct power balance is achieved within each sub-group.
Within the NHS (2011) project management framework, it is recommended that 'Responsibility Charting' be used at this stage to ensure that each person is clear about his or her roles and responsibilities. This prevents duplication of effort and ensures only one person is responsible for each task. This tool can be used concurrently with a gantt chart to monitor each phase of the task in relation to how far it is from completion.#p#分頁標題#e#
Stage 5: Pilot and Implement Change
Fig 2. - Deming's PDSA cycleThe aim of this penultimate stage is to trial the proposed improvement changes via pilots before they are fully implemented by the team (NHS, 2011). The proposed changes/ideas, developed by the improvement teams in the previous stages, require rigorous testing to ensure they are workable and fit for purpose. Deming's (1986) PDSA cycle provides a useful framework for developing, testing and implementing changes leading to improvement (see fig. 2).
The PDSA cycle involves trying out improvement ideas on a small scale before initiating comprehensive change (Dale et al, 2007). This has the advantage that barriers to change can be reduced when stakeholders are involved in trying out a new idea on a small scale before wholesale implementation (NHS, 2011). By measuring outcomes to see if improvement has occurred, the PDSA cycle can be used a number of times to refine the improvement idea and therefore reducing risk.
Working on the basis that no improvement project is perfect, prior to piloting it is important to establish what could go wrong. Without this scrutiny improvement teams can often overlook the obvious and waste valuable time and resources even at the pilot stage (Hafford-Letchfield, 2006). The Potential Problem Analysis is a simple tool that can reduce the probability of failure by identifying potential problems. It is similar to the 'bullet proofing' tool, in that the improvement team and key stakeholders brainstorm what could go wrong and how likely is it to occur. After the potential problems have been identified, countermeasures can be developed using creativity tools such as an affinity diagram or brainstorming.
In this project, I would identify an RMW office and pilot the new FSW referral procedures and service delivery. Data from this office would be collected using SPC to demonstrate whether changes result in any improvement. The data collected would be compared with the benchmark data collected in stage three using a Control Chart. Changes that are identified to have made the greatest benefits would be taken forward to wholesale change across the team.
Although change is an integral element of everyday life, it is a highly complex process often resulting in resistance and the feeling of loss for those affected (Kubler-Ross, 1987). Therefore, effective management of change in improvement projects is vital. In this project, a key factor in managing the change to the FSW referral process and service delivery is giving the team time to come to terms with the new arrangements. Lambley (2009) suggests that by giving people time to 'grieve' for what has been lost maintains morale, and mitigates both stress and poor health. Additionally, Lewin (1951) proposes that managers should where possible ensure the team are involved in the change process and provide encouragement and support when required. This would be achieved in this improvement project by involving stakeholders in the process and the wider team would have been consulted on the reasons for change and my future vision i.e. FSWs supporting families in need in order to maintain operational capability. However, there will still be some resistance to the proposed changes.#p#分頁標題#e#
A useful tool for assessing forces for change (driving forces) verses forces opposed to change (restraining forces) is 'Force Field Analysis' (see fig. 4).
Fig. 4 - Force Field Analysis
This tool is based on Lewin's (1951) observations that driving forces for change needed to exceed the restraining forces in order for change to occur. Using a graph the improvement team allocates a score to each force using a scale from one to ten (where one is very weak and ten is very strong), and then explores ways of either reducing or increasing the forces to create the desired change in equilibrium. However, Lewin (1951) advises caution when trying to reduce the opposing force as is can often cause its own difficulties, for example team members can resist if change is being forced through. Therefore rather than trying to force individuals to change their beliefs, the improvement manager should try to reduce some of their reasons for resisting change thereby enabling change to occur. The findings gained from using Force Field Analysis can be used to develop an action plan, consisting of clearly defined steps, to implement and deliver the intended change. The criticism of this tool is the subjective nature of the scoring can significantly skew the results and potentially devalue the resulting action plans.
Stage 6: Sustain and Monitor
The aim of this final stage is to ensure that changes, which have been implemented, are sustained and regularly monitored to ensure they continue to provide improvement. Following wholesale implementation, the improvement manager should determine whether the objectives and benefits have been achieved. This evaluation should not be treated as optional but as an integral part of the improvement project, planned from the beginning. However, there is always the risk for the team to revert back to the old ways of working i.e. not making FSW referrals. Therefore there is a need to regularly monitor the new procedures using SPC data such as the referral rates, case statistics and service user feedback.
For the project to be a success the whole team must fully understand and recognise the changes that have been implemented regarding FSWs. This is imperative because if RMW workers do not follow the implemented procedure then the project would have failed. The NHS (2011) quotes evidence that up to 70 per cent of all their organisational change fails. This is a shocking failure rate, which possibly indicates that the projects did not follow a continuous quality improvement framework i.e. there was no feedback loop. Continuous Quality Improvement is a voyage not a final destination, it should be seen as a cyclical never-ending process that permeates throughout the whole organisation.
In writing this assignment I have had what I can only describe as an epiphany. For many years I have seen 'good ideas' often poorly implemented to the detriment of good practice, adding further layers of bureaucracy. Quality improvement models such as the one used in this assignment provide organisations with a framework to follow; they also promote team inclusivity and creative thinking combined with an analytical approach. I believe that continuous quality improvement projects should begin with the assumption that there will always be areas for improvement, however small, and that there will always be problems to solve. This was demonstrated in this assignment involving FSWs, which began with what appeared to be a straightforward problem. However, it became clear that as I progressed through the NHS six-stage Service improvement framework this initially 'simple' problem is potentially multi-faceted and complex. Without a clear quality improvement framework I believe that I would have been tempted to jump straight to a quick fix solution, which is exactly the behaviour I have learnt to loathe.#p#分頁標題#e#
In following this quality improvement process I have learnt many valuable lessons that I intend to take forward into my practice as a manager and leader, such as using a quality improvement framework, stakeholder involvement etc. I have found this new knowledge empowering and it has changed the way that I approach problems. I believe that as continuous quality improvement is introduced into a large organisation, such as the Royal Navy, it is similar to dropping a pebble into a pond - eventually as one success leads to another the ripples will eventually reach the sides.