Navigating Quality Improvement with Sally Greensmith

Meet Sally Greensmith!

Head of Quality Improvement at Ashford and St. Peter's Hospitals NHS Foundation Trust.

Welcome back to the Locum’s Nest Best Practice series, where we dive into the journeys and insights of incredible NHS colleagues! For our fifth blog of the series, we had the pleasure of speaking to Sally Greensmith, Head of Quality Improvement at Ashford and St Peter’s Hospitals.

Q1: Can you share a bit about your career journey and how you came to be the Head of Quality Improvement at Ashford and St. Peters?

Sally: I started my career as a physiotherapist. I studied for a degree in physiotherapy at Manchester University and worked in the field for 20 years. My first role was at the Royal Surrey Hospital in Guildford. Over time, I specialised in musculoskeletal outpatients, working at a few local hospitals, ending up at Ashford and St Peter’s Hospitals.

In my last clinical role, I managed the outpatient department at Ashford Hospital working clinically as a musculoskeletal specialist. It was during this time that I was successful in my application to participate in the NHS Leadership Academy Clinical Fellowship programme. This was a two-year post-graduate training in healthcare leadership and improvement. Undertaking this programme was a transformative experience that really opened my eyes to leadership, helped me to better understand my values and what it means to be a leader rather than just a manager.

As part of this, I had to undertake an improvement project. This is when I first discovered the Improvement Team at Ashford and St. Peter's – who knew!!. It was my first taste of project management and healthcare improvement and I found it fascinating and energising. I realised that the problem-solving skills I used in physiotherapy could be applied on a broader scale to improve healthcare systems. During the course, an opportunity came up to apply for a secondment role with the Improvement Team - I took it. The secondment allowed me to explore working in a non-clinical role without completely stepping away from my clinical job. I ended up loving it so much that I eventually moved into the Improvement Team full-time. That was nearly 13 years ago and for the past 5, I’ve been leading the team!

When I first started working, I remember taking my Dad to my workplace at Guilford, where we saw the superintendent’s office. My Dad said to me, "you’ll be in there one day," but I told him, "no way, I’m all about the clinical work and the patients." However, that gradual shift in perspective about leadership through various opportunities eventually led me on my current path….. my Dad was right, but I am still all about the people.

Q2: How would you describe your current role and what kind of projects do you and the team drive?

Sally: My team, known as the Improvement Partnership Team, partners with departments across the Trust to facilitate improvements in patient safety, quality, experience, and efficiency. 

The team is small, just 7 of us, but we have a great mix of skills including project management, quality improvement coaching and facilitation and a dedicated business analyst who handles a lot of our data. Data is central to everything we do; it helps us understand where the problems are and measure whether the changes we’re making are effective. We partner with other teams and departments to help them make improvements in various areas, whether it’s patient safety, patient experience, staff experience, efficiency or the development of new patient pathways.

When it comes to big programmes involving many people or multiple projects, we use a structured project management approach. We have our own (D5) methodology and documentation to guide teams through planning, timelines, and communication. On the other hand, quality improvement is more about coaching and facilitating teams to identify and make their own improvements. We use the IHI Model for Improvement as our methodology, because it’s simple, easy to understand, and repeatable. We want everyone in the organisation to be able to carry out local improvements where they are and to know that they are all improvers.

Q3: How do you prioritise projects and manage the different sources of improvement ideas?

Sally: Prioritising can be tricky because ideas and projects come from all over ASPH….. and we don’t like to say no! Some of our work is driven by strategic objectives or directives from our Chief Executive. For example, right now, there’s a big focus on eliminating corridor care in our emergency department, which is something our Chief Executive has challenged us to address. On the other end of the spectrum, we have our "Be the Change" program, which allows any staff member to submit an idea for improvement. We receive about 40 "Be the Change" projects a year, and while they’re often small-scale and quick to implement, some of them can lead to significant changes.

We also rely on data and intelligence from various sources within the organisation, such as patient experience feedback, complaints and incident reports from our Datix system. These can sometimes highlight areas that need improvement and we’ll take on projects based on that information as well. So, it’s a mix of top-down and bottom-up approaches, we try to balance the two and join the dots where there are common themes.

Q4: What are some of the biggest challenges you and your team face?

Sally: The biggest challenge is managing our workload and not spreading ourselves too thin. We’re a small team and we’re very much a “can-do” group. We don’t like saying no, so we try to help wherever we can. But that can sometimes lead to us being overloaded, which makes it harder to add the value we want to every project. Prioritising and focusing our efforts is a constant challenge.

Another challenge is ensuring that we’re always building capability and skills within teams so they can continue to improve on their own. Our goal is to walk alongside, providing support and coaching, rather than just taking over. That way, everyone can be better equipped to carry on making changes after our role is finished.

Q5: Could you tell us more about the "Be the Change" programme and how it started?

Sally: "Be the Change" started as an idea from a group of junior doctors 10 years ago. They wanted to collect change ideas from across the organisation and came up with the name "Be the Change." We helped them run a publicity campaign, which included getting t-shirts printed and distributing postcards attached to everyone’s payslip—this was back when payslips were still delivered in paper form! The postcards asked people to describe a problem they had noticed, suggest a solution and indicate what help they might need. For a couple of weeks, there were post boxes around the hospital where staff could submit their ideas.

The junior doctors wanted to pair up ‘change champions’ from different areas to work on these projects and they were given some funding from the Chief Executive to support the best ideas. I think we received over 200 submissions in that first round, which was amazing. The winning idea came from the portering team, who suggested marking lines on the floor to help people navigate the hospital more easily. This simple but effective idea was implemented, and the coloured dots are still there today.

The programme was such a success that we decided to keep it going. Over time, it’s grown, and we’ve even developed an online change portal and app where staff can submit their ideas digitally (see https://bethechangeasph.com/ for details). The fact that it’s been running for 10 years shows that people really see value in this.

Q6: What have been some standout quality improvement projects during your time?

Sally: There are so many great projects that it’s hard to pick just one. But a couple of "Be the Change" projects stand out. One was from the play team in Paediatrics, who created videos for children coming into the hospital for surgery. The videos show the children what to expect, which helps to ease their fears. These videos are now sent to the families of children coming in for surgery and they’re available on YouTube. It was a simple idea but has had a big impact.

Another "Be the Change" project started small but became something much bigger. Our dietetics team wanted to create a risk-feeding pathway for patients with swallowing difficulties. They developed and tested the pathway on one ward, then expanded it across the hospital. It was so successful that it’s now part of national guidance, which is something we’re really proud of.

On a larger scale, one of the most challenging projects I’ve been involved in was developing a direct access pathway for GPs to refer suspected lung cancer patients for CT scans. This project aimed to reduce the time these patients have to wait for their first cancer appointment. It was particularly challenging because it involved working across the primary and secondary care boundary, with different IT systems that don’t easily communicate. But we managed to pull it off, and it’s made a real difference in patient care, saving valuable time in the cancer pathway.

Q7: What is your favourite part of the job, and what keeps you motivated?

Sally: Honestly, it’s the people. I love working with so many different people across the organisation. Seeing them light up when they realise they can make a difference in their workplace is incredibly rewarding. I’m passionate about helping people find joy in their work, especially in areas where that’s been lost. Knowing that I can be a part of that and that I can help make things better for the experience of both staff and patients is what keeps me motivated.

I’ve been in situations in the past where I got frustrated – always being told to do more, work faster and harder, without being given any time to think about doing things differently. I knew I couldn’t keep going like that. So, when I can help others see that there is another way, it’s brilliant. That’s what keeps me motivated.

Q: Finally, what do you see for the future of quality improvement at Ashford and St. Peter's?

Sally: I think the future is about continuing to build improvement skills within our teams. We want everyone to feel well equipped to make improvements, no matter how small and to know that they have the permission, the tools and the support to do so. As the healthcare landscape changes with current and new challenges, I believe our focus on partnership and collaboration will be more important than ever. We’re a small (but mighty!) team, who, though continually building improvement  skills, delivering successful projects and working with people across the local healthcare system, can enable everyone to achieve the best for themselves and for those we care for.

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Thank you very much to Sally for taking the time to share her valuable insights. For more updates and behind-the-scenes glimpses, be sure to follow the ASPH Be the Change team on X.

Stay tuned for our next blog!