Background
Quality improvement (QI) has been defined as ‘the systematic use of methods and tools to try to continuously improve quality of care and outcomes for patients’.1 UK national regulatory bodies in health and care have identified knowledge of QI as a key condition common to high performing systems.2 QI is playing a vital role in enhancing services not just nationally, but globally in health and care today. The National Health Service (NHS) Long Term Plan (p.111) argues that QI is ‘an evidence-based approach for improving every aspect of how the NHS operates’,3 stating that delivery of the plan will rely on local health systems having the capability to implement change effectively.
There is a clear need and desire to improve capability in QI. However, there is no single agreed way of achieving this. It has become apparent that the education of staff does not adequately prepare them for the changing world of health and care.4 In particular, staff working in health and care are often not equipped to carry out continuous QI and do not know where to go to access training and support. A review in the English NHS found that arrangements for improvement and leadership development were insufficient,5 and recommended a digital platform for e-learning to drive enhanced skills and capability in the workforce.
E-learning programmes, in particular massive open online courses (MOOCs), are increasing in number in health and care. Traditional models of face-to-face learning are becoming less practical for learners working across diverse and geographically spread settings.6 Spector argued that ‘MOOCs can make a significant contribution in the context of a tightly focused short course on a topic that is very well-defined with mostly declarative knowledge (facts and concepts) and simple rules and procedures’.7 The use of MOOCs, however, has been a matter of debate with frequent poor retention rates8 and feelings of isolation among students reported.9 There remains a lack of evidence of the efficacy of MOOCs in health and care.
This article reviews the impact of a community-focused, introductory-level MOOC, ‘Improvement Fundamentals’, in QI run between April 2015 and March 2019 by an improvement team embedded in a UK national regulatory body (initially NHS Improving Quality and subsequently the sustainable improvement team in NHS England and NHS Improvement). NHS England and NHS Improvement leads the NHS in England. The course was specifically targeted at a global audience of learners and the single eligibility criteria for access to the course was for learners to have an interest in QI in health and care.