Make Change Happen
Six Vital Steps
Step 6: Continuous improvement
In any change programme, there is a risk that initial gains are not sustained. Focus can be lost in the face of competing priorities. Changes in personnel can contribute to this. Demographic and other changes can offer fresh challenges, and new opportunities for quality and productivity gains can emerge. It is important at the outset to think about setting systems in place to ensure that improvements are maintained and extended over time.
Data dashboards such as the one planned in North West London can empower commissioners to monitor service delivery and outcomes. Peer review, such as that undertaken in the South West, can identify opportunities for improvement and enable organisations to learn from one another. Further information on these initiatives can be found in the Case Studies section of this website.
In Somerset, where major amputation rates have been substantially reduced after service redesign, the CCG is now focusing on root cause analysis of major amputations, in order to reduce rates further.
Rachael Rowe is the lead diabetes commissioner at Somerset CCG.
Diabetes prevalence in England is predicted to increase by around 20% by 2030, so it is likely that demand for diabetic foot services will grow in the coming years, and pathways will need to be reassessed to ensure that there is adequate provision for patients to be assessed regularly, and for medium and high-risk patients to be referred and triaged rapidly, according to NICE guidelines.
It will also be necessary to continue to involve all stakeholders, to ensure that the momentum for delivery of high-quality care is maintained, that understanding of diabetic foot problems is refreshed, and that there is sustained clinical leadership for diabetic foot care.