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NHS Education for Scotland

A skilled and sustainable workforce for a healthier Scotland

Teaching from the Scottish Improvement Leader Programme (ScIL), embedded in practice

Teaching from the Scottish Improvement Leader Programme (ScIL), embedded in practice

Teaching from the Scottish Improvement Leader Programme (ScIL), embedded in practice

Stephen McNamee, Programme Manager, Transformation and Change Team in NHS Fife, shared his experiences of the Scottish Improvement Leader Programme (ScIL), and how using a Quality Improvement (QI) approach enabled the development of new tools and resources in NHS Fife.

“The approach that our team uses makes sure that we keep focused on the helicopter view to make sure initiatives are in line with strategy as well as getting down into the operational areas.”

Stephen’s role is to co-ordinate projects and programmes across the organisation. While these are often short-term improvement projects, the team ensures that all projects are strategically aligned with one another and are working towards organisation-wide aims.

Experience of the ScIL programme

“It is one of the best programmes I have ever taken part in.”

Reflecting on his own experience, and the fact that NHS Fife have just been through an application cycle for the next round of ScIL, Stephen highlighted two key elements of the course that really stood out, the quality of the teaching, and the opportunity to become part of community of practice.

“There was thinking time but [it was] thinking time in the company of others who were having similar thoughts so it allowed you to have proper conversations and deeper conversations about theory. At the same time we could connect on a personal level as well which was really good. I think that now I have a really strong community of practice that I am linked into.   

The accessibility of the programme

Stephen’s own background in community education (with a focus on adult literacy and numeracy) has meant that he is acutely aware of the use of language. He was impressed by the approach taken by facilitators to ensure the course was suitable for all types of learners.

“That was one of the great attributes of the programme as everything was rooted in practical examples. You were told in two or three different ways and the information was passed through two or three different mediums. For a big range of people, and 30 plus people in our cohort, you would never get stuff right for everyone but by using a range of different methods it made sure people had the best chance of retaining information.”

This range of information sharing techniques is something Stephen feels he continues to use in his own day-to-day project work, helping him facilitate discussions more confidently.

Putting QI into practice

To help illustrate the added value a QI approach can bring to building staff and service capacity and capability, Stephen shared a details of two on-going projects developed quickly during COVID-19.

Project 1: Developing an outpatient capacity tool for remobilisation

“If we didn’t use the QI approach or methodology we wouldn’t have been able to do it as quickly.”

Asked to develop a tool to ensure the remobilisation of services and increased footfall was safe, and  able to adhere to social distancing, Stephen and his team designed an outpatient capacity tool at pace during COVID-19.

By applying QI methodology and concepts of Demand, Capacity, Activity, and Queue (DCAQ), the team worked closely with site and service managers, and infection control and estates colleagues, to map out and determine capacity across the organisation. This provided the relevant data to create a number of excel tools to be used across sites and specialities. Additionally, by ensuring that all ‘bottlenecks’ were considered, the team also identified additional capacity not in use.

“Quite quickly we realised that we were able to see additional capacity or hidden availability that maybe we hadn’t seen before […] So there is extra capacity that is sometime hidden with the way specialties use and title clinics.”

The work is now an embedded part of the NHS Fife governance structure, with all services required to go through this process. The project is now being adapted for use in community settings.

Project 2: Overcoming COVID-19 restrictions to continue building QI capacity in NHS Fife

The team Stephen works in has an organisation-wide training responsibility for QI. Previously this was classroom based but due to the onset of COVID-19 the team quickly had to adapt.

By using Plan, Do, Study, Act (PDSA) cycles and testing the modules with staff members, they successfully redesigned all of their modules for virtual learning with MS Teams. The application of the QI approach meant that at one point they were the only team with training responsibilities in NHS Fife who were able to continue teaching.

“We didn’t just develop an online module and deploy it, we tested it … any one of our modules will have been through five or six cycles of testing before we were really content and happy to take on large numbers of people for the sessions.”

The lasting impression of the ScIL programme, alongside the value the QI approach has added to projects, has meant the Stephen and his team are keen to continue developing QI capability and capacity across NHS Fife. The team are looking to develop a Fife-wide QI faculty, accessible to all interested staff members. They want to bring together people with a common purpose and interest to share learning, to share the load of training, and develop a network.

For Stephen, the applicability of QI to multiple projects, and being connected with ScIL alumni across Scotland, have been key elements for successful collaboration and development of robust improvement work at pace.

“It [QI background and ScIL] is almost like a wee shot of steroids to those relationships required to drive improvement within the organisation.”



February, 24 2021