Quality is Everyone's Business: Our Journey Towards Whole System Quality in NHS Lanarkshire – Karon Cormack
As Director of Quality at NHS Lanarkshire, I've spent the last few years leading our journey towards what we call Whole System Quality. Our ambition was straightforward but significant: to create a culture where quality is not the responsibility of a specialist team, but something owned by every member of staff across the organisation. That ambition became the foundation of our quality strategy and our enduring message: Quality is Everyone's Business.
Why We Needed a Different Approach
Like many healthcare organisations emerging from the COVID-19 pandemic, we faced unprecedented pressures. Staff were exhausted, services were under strain, and there was a real risk that quality could become something people viewed as an additional task rather than an integral part of everyday work.
We also recognised that many of the elements needed to deliver quality already existed across the organisation, but they were often disconnected. Quality improvement, complaints, adverse events, assurance, measurement and governance operated in parallel rather than as a coherent system.
Perhaps most importantly, when we spoke to staff about quality management systems, many viewed them as management tools rather than something relevant to frontline care. The language itself had become a barrier to engagement.
Listening First
As we developed our quality strategy, we spent considerable time listening to patients and staff. We gathered views in clinical settings like vaccination centres and from teams across the organisation, asking people what quality meant to them.
One message from staff stood out above all others. Many described the frustration of knowing exactly what good care looked like but feeling unable to consistently deliver it because of competing demands on their time and resources. That insight shaped our thinking from the beginning.
It reinforced our belief that quality is not only about patients. It is also about supporting the workforce. If staff feel overwhelmed, burnt out or unsupported, their ability to deliver high-quality care is inevitably affected. This is why compassionate leadership became a central component of our strategy.
Early Challenges
While the vision was clear, implementation was far from straightforward.
One of our first challenges was awareness and engagement. We launched the strategy with enthusiasm. We delivered presentations, produced communications materials and promoted it widely across the organisation. Yet a year later, many staff struggled to recall the strategy or its key messages. I quickly realised that a successful launch does not equal sustainable implementation. We had to keep repeating the message and continually reconnect people with the purpose behind the work.
Another challenge was language. We discovered that terms such as "quality management system" felt technical and remote. During consultation, staff told us that quality management sounded like something for managers rather than clinicians or frontline teams. To overcome this, we deliberately reframed our approach as "Whole System Quality" and used simple, practical language wherever possible.
We also encountered organisational silos. Individual teams often worked effectively within their own areas but found it harder to collaborate across services, departments and organisational boundaries. Building shared ownership and encouraging people to see quality as a collective endeavour required consistent effort and relationship building.
Like many organisations, we faced challenges in translating learning into action. Complaints and adverse event reviews frequently ended with recommendations to remind staff about procedures. While well intentioned, these actions rarely addressed the underlying system issues and often failed to deliver lasting change.
There were practical barriers too. Quality improvement projects launched by trainees and junior doctors were often left unfinished when individuals rotated to new posts. Valuable learning was being lost and projects frequently restarted from scratch.
Finally, securing dedicated improvement capacity was a challenge. Staff were keen to improve services but balancing improvement activity alongside day-to-day operational demands was difficult. Creating protected time and demonstrating the value of improvement work required strong executive support.
Creating Our True North
To make the strategy practical and memorable, we developed seven "True North" statements based on what patients and staff told us mattered most:
- Person-centred care
- Right care, right time, right place
- Harm-free care
- Learning organisation
- Quality improvement and innovation
- Making Lanarkshire a great place to work
- Compassionate leadership
Initially, people often asked, "What's a True North?" We spent time explaining the concept and helping teams understand how it connected to their daily work. Over time, however, the language became embedded. Teams now discuss their True North priorities as part of normal business, and senior leaders routinely ask about progress against them.
Turning Strategy into Action
We wanted the strategy to do more than sit on a shelf.
Every year, each service develops quality improvement actions linked to one or more True North priorities. These actions are co-produced with teams, monitored through governance structures and reported regularly. This process has helped us move quality planning from a theoretical exercise to a practical organisational discipline.
We were fortunate that we had the supporting quality functions under one directorate such as complaints, adverse events, data and measurement, system development, cancer and clinical audit and knowledge services. The quality improvement, quality assurance and evidence for quality teams all worked together supporting each other and learning from each other. This integrated approach has improved collaboration and reduced many of the barriers that can arise when related functions sit in separate departments.
Building a Learning System
One of the developments I am most proud of is creating stronger links between learning and improvement.
We introduced a Quality Improvement Repository and Proposal Hub where projects can be registered, shared and searched. This allows staff to learn from previous work and avoid duplication. It also provides a mechanism for improvement ideas arising from complaints, adverse events and governance processes to be translated into tangible projects.
We have also developed thematic analysis of complaints and incidents so that recurring issues can be identified and addressed at a system level. Rather than focusing solely on individual cases, we now have greater visibility of patterns and opportunities for improvement across services.
Investing in Capability
Another significant milestone has been the launch of our Quality Improvement Academy. Our aim is to make improvement everyone's business, not just the responsibility of specialist teams. Through training, coaching, networking opportunities and dedicated support, we are building confidence and capability across the workforce.
Securing protected clinical time for improvement was a major step forward. With support from our executive team, consultants and senior nurses have been given dedicated time to lead improvement work within their own services. This has helped build credibility and strengthen engagement among frontline staff.
What Have We Learned?
Reflecting on our journey so far, several lessons stand out.
- Leadership support is essential. Without visible commitment from executive and clinical leaders, improvement efforts struggle to gain momentum.
- Communication cannot be a one-off exercise. People need regular reminders, practical examples and opportunities to engage with the strategy.
- Simple language matters. Staff are far more likely to engage with concepts they can understand and apply to their daily work.
- Quality improvement works best when it is integrated with planning, governance, data, learning and assurance. These activities are most effective when they operate as parts of a single system rather than separate programmes.
- Sustainable improvement depends on understanding people. Building trust, listening carefully, addressing fears about change and supporting teams through challenges are just as important as the technical aspects of quality improvement.
Our journey is ongoing, but we have learned that quality management is not principally about frameworks, tools or methodologies. It is about creating a connected system where people can work together to continuously improve care. When quality truly becomes everyone's business, improvement stops being an initiative and becomes part of everyday practice.