QIPP FOCUS
Vincent Desmond of the Chartered Quality Institute examines the concept of quality within the NHS, the impact of QIPP on staff, and argues that quality needs to be completely integrated and embedded much more widely.
T
he NHS is experiencing a period of un- precedented change as a result of the
cost saving agenda and the wholesale reor- ganisation. Throughout all of these initia- tives, the concept of quality has been often repeated, yet the term, in terms of health- care at least, has not been clearly defi ned, leaving the public and staff confused about what is meant by improving quality, and their role in delivering it.
What is clear is that quality in healthcare has many facets, incorporating clinical quality, patient experience, operational ef- fectiveness and fi nancial management and that these elements can operate as confl ict- ing, rather than cohesive and complimen- tary, quality strands.
In order to ascertain how quality is operat- ing and viewed within the NHS, the Char- tered Quality Institute, the body that repre- sents 10,000 quality professionals, includ- ing hundreds in the healthcare sector, has undertaken a quality survey of NHS staff. The survey provides a ‘real time’ assess- ment of quality by NHS staff and it throws up some startling results.
Perhaps most concerning, the CQI-com- missioned research reveals that quality in the NHS is being interpreted in different ways by different functions; for example, clinicians believe it’s all about delivering and improving patient care, fi nance heads believe quality is about effi ciency and so on. Quality, it seems, is both subjective and poorly articulated. What is missing is a na- tional quality vision and strategy that can align the policies, planning and provision of NHS Foundation Trusts, and all the staff within them.
32 | national health executive Jul/Aug 11
Of those quality initiatives that do ex- ist, there is also deep-rooted scepticism among NHS staff. When asked to rate the effectiveness of QIPP in delivering quality improvements, the majority of responses were negative. There was also an apparent policy mismatch when respondents were asked to identify which elements of qual- ity are refl ected in the health bill. Over half thought the health bill failed to refl ect any aspect of quality.
Other questions were also very revealing, as to how quality is applied. In other sec- tors there has been a real drive to adopt in- ternational quality standards but respond- ents to this survey highlighted that only 15% of their organisations were working to an ISO standard and 24% to other stand- ards. Many more (61%) either didn’t know or didn’t work to any quality standard.
Quality has not been embedded at an in- dividual level either. More than a quarter of staff questioned (28%) said they had received no quality training at all, and this fi gure rose for managers to 34%. This lim- ited focus on quality in the development of staff was mirrored in the failure to include quality measures in staff objectives and ap- praisal processes.
The research also demonstrated a lack of engagement with patients, a critical fac- tor in delivering quality. The responses show that although NHS organisations are becoming more proactive in engaging pa- tients, they are still at the earliest stages of system and process design in terms of pa- tient interaction.
The CQI’s research reveals that there are
many challenges for delivering improve- ments in healthcare using proven quality management techniques.
Yet prioritising the most important ar- eas of quality and the measures to deliver and assess them are vital if quality ambi- tions are to be realised. From driving staff behaviours to ensuring organisational commitment, from engaging patients to improving patient care and from deliver- ing service re-design to implementing cost savings, quality is key.
And to be fully effective, quality needs to be embedded into human resource prac- tices and all staff training programmes; it needs to be incorporated into staff objec- tives and performance reviews. Even more fundamentally, quality strategies need to be delivered in line with other internation- ally recognised quality practices and be in- dependently assessed. Last, but not least, quality practices need to be enshrined within a national healthcare quality frame- work, which establishes a clear commit- ment for all healthcare providers for the delivery of quality management frame- works throughout the NHS.
The CQI recognises the challenges and opportunities that the successful deliv- ery of quality man- agement in the NHS can bring.
Vincent Desmond FOR MORE INFORMATION
To read the report or to fi nd out how the CQI can help you to deliver quality improvement visit
www.thecqi.org
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