Post by Deborah Udy Okusaga Akanne (@deborah_udy_okusaga)

The One Competency Every NHS Panel Is Scoring — That Every Profession Keeps Failing.

Three days into this masterclass and I want to name something that connects every post I have written this week.

Every profession. Every band. Every specialty. Every question.

There is one competency that runs underneath all of it — that NHS interview panels at every level are scoring, regardless of whether the question is clinical, governance-based, values-based, or leadership-focused.

And it is the competency that internationally trained doctors, physiotherapists, occupational therapists, pharmacists, and HCAs consistently underperform on — not because they lack it, but because they have never been shown how to make it visible.

The competency is Quality improvement thinking.

And here is why it matters more than almost anything else in the NHS interview room right now.

The NHS is currently operating under the most significant workforce and financial pressure in its history. NHS England's 2024/25 Operational Planning Guidance requires every NHS Trust to deliver efficiency savings while maintaining clinical quality standards.

The NHS IMPACT programme — Improving Patient Care Together — launched in 2023 as the NHS's primary framework for embedding continuous improvement thinking across clinical services.

Every NHS Trust, every department, every ward is being asked the same question: how do we deliver better outcomes with constrained resources?

The answer to that question is Quality Improvement. And the NHS is actively looking for clinicians who already think this way — who see every clinical encounter, every ward process, every pathway gap as an opportunity to identify something that could work better and contribute to making it so.

Here is what quality improvement thinking looks like in an interview answer — and why it scores at Outstanding across every profession:

For doctors: During my ICU rotation, I noticed that post-extubation patients were being assessed for dysphagia at inconsistent time intervals, which was creating variation in discharge planning. I raised this observation at the departmental governance meeting, proposed a standardized assessment protocol, and contributed to a simple SOP that was piloted over six weeks. Compliance with standardiszd assessment increased from 60% to 94% and average time to initiation of oral feeding reduced by one day.

For physiotherapists: I identified that patients being discharged from our MSK service were not receiving standardized self-management resources — the information given varied by clinician. I proposed and developed a standardized self-management pack, mapped to NICE guidance NG59 for low back pain, that was adopted across the department. Patient-reported confidence in self-management at discharge improved from 58% to 79% on the PSFS.

For occupational therapists: I noticed that our home visit waiting time was extending because assessments were not being prioritized by functional urgency. I proposed a triage tool — adapted from the MOHOST domains — that allowed us to stratify referrals by occupational impact severity. Within eight weeks, urgent home visits were completed within two days rather than five.

For pharmacists: I identified that medicines reconciliation on admission was being completed inconsistently — some patients were having their regular medications reviewed within 24 hours, others not until day three. I proposed and implemented a ward-level prompt system aligned to NICE NG5 medicines optimization guidance. Reconciliation within 24 hours increased from 67% to 91% over one quarter.

For HCAs: I noticed that patients in my bay were repeatedly pressing their call bells for water during night shifts — and that the same patients were not drinking enough during the day. I raised this observation with the Ward Manager and suggested we add a simple hydration prompt to the evening handover checklist. The Ward Manager implemented it within the week and the number of night call-bell activations for water reduced noticeably.

Five professions. Five answers. One competency — quality improvement thinking.

Every answer contains: an identified problem, a proposed solution, an implemented change, and a measurable outcome. Every answer demonstrates that the candidate does not wait to be asked to improve something — they see the gap and they act.

That is the clinician the NHS is actively looking for right now.

That is the answer that earns the offer.

📩 Quality improvement thinking is the competency I build into every answer in every session I deliver — across every profession, every band, and every specialty. If you have an NHS interview approaching and you do not yet have a QI story that is specific, measurable, and outcome-evidenced — DM me "NHS" today.

This is the competency that separates the shortlisted candidates from the ones who get the offer.
#NHSJobs2026 #SovereignHealthcareAdvisoryGroup #clinicalgovernance #AHPsNHS

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