HEALTHCARE DELIVERY
properly, this checklist can reduce post- operative mortality and morbidity and it is now in widespread use. However, I regularly hear anecdotes about surgeons scrubbing up on their own and refusing to take part in the checklist because they feel it is a trivial and meaningless activity. It is surprising to me that this attitude is not seen as a poor professional practice,” he said. “There has been much talk about ‘the
‘Without high quality data and information we will not be able to transform the
quality and safety of care.’ Sir Liam Donaldson.
about how things are done and how they could be done, and to question to what extent the quality measures that are applied are focused on managing the present and creating the future. It is important to remember that there will always be a move away from patient- centred care when clinicians are encouraged to focus on processes.”
Variable standards The next speaker was Sir Liam Donaldson, chairman of the National Patient Safety Agency (NPSA) and he focused on the variable standards of care, saying that the problems of variation in quality and poor safety records are not unique to the NHS. He said: “They affect most other healthcare systems and in most countries these issues have proven to be intractable over the years. They are deep seated problems and no single or simple intervention will resolve them.” Sir Liam went on to highlight three specific areas which need to be considered more closely to improve quality and safety. The first area he covered was the ethos
of professional practice in the medical profession. He said: “Doctors, rightly, see themselves as caring for the individual patient. However, they do not see themselves as needing to have any appreciation of the risks of their practice, of the wider aspects of quality that surround their practice, or the need to regularly seek opportunities for quality improvement. This is often seen as a separate managerial issue and not as an integral part of professional practice. This results in some of the negative features of the current professional ethos.” Sir Liamwent on to talk about his work
on patient safety with theWorld Health Organization, which led to the introduction of a surgical safety checklist. He said: “Early evaluation demonstrated that, if used
MARCH 2012
new professionalism’ but I do not feel that it has yet captured the essence of what needs to change in professional practice,” continued Sir Liam. “However, there is great hope for the new generation. It does seem that there is a critical mass of people who remain idealistic, despite the tendency of medical education to beat it out of them.” Continuing on the subject of education,
he said: “It seems to be unfashionable to talk about education and training as having a role to play in quality. The challenge here is to try and address some of the problems through the implementation of a fundamentally different approach to education and training which is no longer unidisciplinary, and which brings patients and families into the educational process as partners.” The requirement to take information
and data seriously is another area on which action needs to be taken, to improve quality and safety, said Sir Liam: “Without high quality data and information we will not be able to transform the quality and safety of care. Today, both those receiving care and those providing care are largely in the dark as far as objective information on whether their service is good, bad or indifferent.We need to address this issue.” A third area of consideration mentioned
by Sir Liam revolves around the role of patients and their families in the design and structuring of services. He said: “I don’t think that, currently, we do very well in this respect. There are some notable exceptions, but I think we need to look at this idea in much more depth.” He concluded by discussing the need
for a greater understanding of how to produce positive change within organisations and to know when it has been achieved. “With skilled leadership it
Dr Penny Dash.
is possible to transform the attitude of staff and show them that there is a different way of doing things,” he said.
The three domains of quality The final comments of the session came from Penny Dash, vice-chair, Board of Trustees at the King’s Fund, who reminded the audience about the meaning of quality – speaking about the three defined quality domains – safety, outcomes and the patient experience. “It is important, when thinking about quality in healthcare, to look at it in terms of these three domains,” she said. Dr Dash emphasised the point that
there is already a great deal of information and data available, which would enable Trusts to measure whether they were delivering against the expected standards of quality across all areas of care. “The information is available,” she said. “We have a Care Quality Commission that could put all of that information in the public domain.We need to go through a rapid step change process, with Trust Boards making better use of this data.” In conclusion, Dr Dash said: “We need
to put relevant data into the public domain and we need the CQC to explain what the data means.We need hospital Boards to show an interest in the data available and to start to question and challenge it. Most critically, we need the equivalence of a Board for out of hospital care. Currently, there is only a management and governance structure around the 50% of healthcare activity that takes place in hospitals. There is nothing for the other 50%.”
‘Currently, the most important barrier to achieving both quality and patient centredness as well as efficiency is the failure to acknowledge the
complexity ofmedical care.’ Professor Albert Mulley.
THE CLINICAL SERVICES JOURNAL 23
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