Bringing Science to the Artistry of Improvement


On a beautiful, sunny day in June, whilst holidaying in the Limousin in France; the land of the Impressionists, my husband and I visited the delightful little village of Fresselines. It’s situated in the Creuse department of central France.

In the spring of 1889, Monet painted at least twenty-three works depicting the area around the confluence of two rivers in Fresselines. The Petite Creuse and the Grande Creuse. John and I retraced Monet’s steps to the very same spot that he positioned his easel 126 years ago. It’s on the steep bank of a ravine through which the Petite Creuse flows. There’s an information board marking the spot. It describes Monet’s time there including a small replica of one of the wonderful paintings. It’s very tranquil and we felt transported back to that time. Just like everywhere in the Limousin, little has changed in the landscape and culture in the last century. Monet himself would still undoubtedly feel at home, were he to return.  

I thought about Monet and how he was driven to return again and again to paint from that river side, determined and focused. He wasn’t satisfied with his first painting and was drawn back over and over again, seeking to carry on improving upon his last painting and do the beautiful scenery justice. It was easy to see why he was inspired by the landscape and why he wanted to capture all the subtle variations. It must have been a struggle for him to get down to the edge of that river with his easel and paints in all weathers. Even now, there is no defined footpath. Every day he would have seen something completely different. That scene captured his imagination. At the risk of sounding pretentious; I began to think of Monet and his time at Fresseline and the analogue for me with improvement. Is Improvement as much an art as a Science?

Monet was inspired by the landscape and I am constantly inspired when I work with frontline healthcare teams, supporting them to improve Patient Safety. If done properly, it’s possible to create an improvement “masterpiece” together. All teams are different. Their patients are different and improvement with them requires creativity, artistry and definitely talent. Improvement embraces variation and doesn’t try to control it. I love nothing more than a simple run chart which shows improvement. It’s a work of art. I am often tempted to frame them and hang them on a wall at home. They bring joy to me and the teams from whose work they emerge.  

And there lies the rub. Improvement is called a science and therefore an Improver is deemed to be a Scientist not an artist. However, just giving someone a title of improvement does not make them able to deliver improvement. Just if someone was given the title Artist, it wouldn’t necessarily make them able to create a pleasing painting that someone would be happy to hang on a wall and pay money for. I would argue that Improvers are born not created. The art of Improvement is hard work. It’s not glamorous and requires stamina. It’s messy and complicated. 

The problem is that it’s easy to impress with poor “improvement”. Everyone can get carried away with the emotion of everything. Throw in a gimmicky campaign title and glossy tool kits and everyone is convinced of improved patient care but all too often, it doesn’t hold up under scrutiny. No demonstration of sustained improvement.  

Some improvers can be irritatingly evangelical and blinkered, leaving their work justifiably open to criticism. There’s no substance and they don’t do the science of improvement any favours. Clear outcomes and processes measures are commonly missing and mean that improvement initiatives still remain on the whole, unsuccessful and lacking in credibility. Those that profess to be doing improvement, have to stop being lazy and start to evidence measured improvement that stands up under scrutiny. They have to be disciplined and include robust and rigorous evaluation and measurement from the beginning.

The Improvement Academy was recently successful in a bid to the Health Foundation to “Scale Up” Safety Huddles, across three acute hospitals in Yorkshire. Our bid was informed by the seeming success of the safety improvement work undertaken over the last year with several frontline health teams where following the introduction of daily Safety Huddles, we observed what seems to be a corresponding reduction in harm and an improvement in the safety culture of the same teams. Some of the results have been quite frankly staggering and the Health Foundation must have been impressed because we were one of only 7 teams awarded the money from an original list of 250 applications!

The Health Foundation requested in the bid, quite rightly, a very rigorous evaluation plan which has to be carried out by an objective third party. In our case it’s a team from the University of Bradford. It’s the first time I’ve worked so closely with Academics whilst undertaking Improvement. It’s challenging. Our lead Evaluator, Eileen, certainly keeps us on our toes. No assumptions are allowed. We can’t leap to conclusions that things are happening because of Safety Huddles that may have happened anyway. No unfounded, emotional sweeping statements. Under Eileen’s direction and guidance, we will be measuring and analysing everything to within an inch of its life and it’s brilliant. It doesn’t mean that we can’t bring artistry and creativity to the work but we must capture it. We’re bringing Science to the artistry of Improvement!

We’re on a learning journey in partnership with academic evaluators to understand how, when and why, team Safety Huddles work and we will continue to learn every day over the next two years. Watch this space.