Intended for healthcare professionals

Rapid response to:

Views And Reviews Taking Stock

Rammya Mathew: We must build capacity and infrastructure for effective quality improvement

BMJ 2019; 367 doi: (Published 29 October 2019) Cite this as: BMJ 2019;367:l6150

Rapid Response:

Building Effective Quality Improvement: start with Joy in Work

Whilst training in QI methodology is important we wholeheartedly believe that ‘anyone can have a go’; indeed for quality improvement to have the impact at pace and scale which is required, there is no other option. The answer doesn’t just lie in formal QI programmes, disseminated from top-down hierarchies. We need to mobilise informal power in an organisation to help staff to create their own short change cycles

Quality Improvement has three main elements; patient safety (doing it right); cost effectiveness (doing it well) and Joy in Work (doing it with a smile). The majority of QI work looks at process and structure, such as pathway redesign or reducing variation. While these endeavours are important and often successful, they risk overlooking Joy in Work.The Institute of HealthCare Improvement (IHI) has established that Joy in Work is the single biggest factor in improving patient safety and experience - and yet it is the branch of QI which often is left in the shadows.

The beauty of Joy in Work is that it truly is something which everyone can be involved in; that finding Joy in Work is an act of quality improvement than no course needs to teach.

But how? There are insufficient time and resources to offer QI training to simply EVERYONE. Well, we have created the answer. 15 seconds 30 minutes is a social movement, which asks members of staff to think of a small 15 second task they can do which will save someone else 30 minutes later on, and in doing so reduce frustration and increase joy for themselves, colleagues, and patients. We call these tasks 15s30m missions and anyone, from the chief executive to a hospital porter, can get involved. Since 2017 we have grown from a ‘little idea’ to a social movement which is in 100 NHS organisations, university courses and leadership training schemes.

Quality Improvement is as essential to the modern NHS as Infection control: yet Infection control isn’t something we have timetabled – “oh yes, I am the team leader for Infection Control: I have 2 hours every second Thursday afternoon protected time to really Control Infection in a big way”.

Infection control is woven through every part of our day: its included in estates planning and procurement. It’s discussed at board level. Wards display the results of their monthly Infection Control Audits. Its everyone’s job, all the time.

Time and again through our daily work, contact with patients and their families, we do good. We help. We bring joy to others. So why don’t we recognise that joy ourselves? What if once a day, we reflected on one way we or a colleague have helped someone – just 15 seconds of encouragement is all it need

The change in approach that 15s30m encourages – to do small acts to benefit someone else – can become embedded in everyday work; it has the potential to be used to examine every process a staff member undertakes, be that a phone call, filling-in a form, creating an appointment or interacting with a patient. In this way the principles of 15s30m will become sustainable.

Over time staff no longer consider these actions a 15s30m Mission, they simply become part of how you are at work, knowing that this approach will make the job more rewarding, create joy and reduce frustration. We are all about transforming mind sets, not processes. Then wherever the member of staff goes in the organisation, they carry the ethos with them.

15s30m offers an unprecedented amount of flexibility in a Quality Improvement programme – we can truly “ go where the energy is” and build momentum.

There is no standard to which participants must work; no threshold to pass to take part. 15s30m change is not driven by planning, data, spreadsheets – instead we appeal to the emotional currency, their personal convictions and values. Passion creativity and initiative are the driving forces for change.

And having dipped a toe in QI, staff who are engaged, interested and motivated may then choose to go on to formal training and larger projects - but without having a way for staff to ‘know how it feels’ very few, even with formal training, will complete successful QI projects.

You can find out more about 15s30m at, or follow us on twitter @15s30m

Competing interests: I am the co-founder of 15seconds 30 minutes, a social movement established in the NHS to reduce frustration and increase Joy in Work. Rachel Pilling and Dan Wadsworth were 2017 winners of the NHS IMprovement Peter Carr Award for Quality Improvement

04 November 2019
Rachel F Pilling
Consultant Ophthalmologist Co-Founder 15s30m
Dan Wadsworth
Bradford Teaching Hospitals NHS Trust