Taunton and Somerset Model

At Taunton & Somerset NHS Foundation Trust we think we have done something special.  

Like Trusts across the country, we face unprecedented financial challenges and increasing demand.  However, our response has gone against the grain.  In 2016 our board took the bold step of making a big investment in developing our own permanent, internal improvement capability.  This wasn’t just about investing in colleagues, but also about creating the right culture, structure, tools and processes to enable and empower our people to improve from within.

This is the first of a series of posts about our model.  In this post we will share the rationale for our approach and introduce our model.

What was the problem?

Historically, our approach was to use external ‘experts’ and management consultants to bolster our own ability to deliver improvement.  This was costly and unsustainable.  Promised results and benefits were not always delivered, measured or sustained.  The ‘experts’ we worked with each had their own approach, tools and processes for delivering change.  Projects often operated in organisational silos.  There was no one clear picture of improvement projects across the trust and accountability between projects was inconsistent.   

What did the data tell us?

Before jumping to a solution we gathered data.  We mapped the current structure of improvement projects, who was working on them and where they reported.  This generated a messy picture of a proliferation of boards, steering groups, and projects across the trust.  Theoretically all projects were managed by our executive team.  However, in practice this was virtually impossible.  We quickly realised that we needed to radically rethink how we did improvement to survive and thrive.

Our model

Based on our internal data and mapping, and external evidence of what had worked elsewhere, we proposed a new structure for improvement consisting of 5 elements:

  1. A proprietary “blended” methodology that combines proven IHI improvement methodology with project management and benefits realization. This blended approach is designed to ensure effective governance and monitoring of projects, and drive out and capture project benefits.
  2. A dedicated improvement team with the technical skills and experience to partner with and coach clinical and operational teams to deliver improvement projects in their areas. The improvement team is centrally financed and structurally detached, and is focused on delivering results at the organisational level.  
  3. A governance structure of clinician led ‘Improvement Boards’ based on ‘constant’ themes within the hospital.  These boards bring together clinical and operational leaders and ensure that all projects are managed, prioritized, directed and supported in the same way. 
  4. A comprehensive and ambitious training plan to equip individuals and teams with the skills they need to improve their own part of the organisation using proven IHI improvement methodology.  Our tiered or ‘dosed’ approach means that we offer different levels of focused and experiential training, which links learning to live projects.  This ensures that our training is engaging, relevant and has real impact.
  5. An evidence based approach to improvement, ensuring that we leverage the experience and best practice of others and proactively share our own learning.  We believe we are the first trust in the country to have a dedicated improvement librarian!

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