HEALTHCARE DELIVERY
Quality assurance: the way forward
Millions of interactions take place every day between patients and healthcare professionals, without any problems. However, when there are problems do we have the correct systems in place to meet the expectations of the public, the hopes of the patient and the frameworks in place to learn ‘how do to better next time’? KATE WOODHEAD RGN DMS reports.
Many different healthcare organisations currently have and use frameworks for assessment, measurement and reporting mechanisms on the various dimensions of quality care, both within organisations and external to the providers. Many of the systems are overlapping and it is not always clear to clinicians how to report breaches in expected standards or to whom. Many of the current organisations to whom failings may be reported will be abolished in the new NHS and it is incumbent on everyone in healthcare to understand the new structures, reporting mechanisms and published standards. Failings reported by the Francis
Inquiry into quality at the Mid Staffordshire Trust and more recently, the equally shocking findings at Winterbourne View show that we have not yet found the right framework for assuring quality of care. The long awaited final report from Robert Francis QC, has recently been delayed until after Christmas, and is widely expected to establish considerable (additional) change across the NHS. Meanwhile, the shadow National
Quality Board has published a draft report which it will update in the light of the Francis Report recommendations, on the future shape of quality assurance within the new systems of care due in April next year.
Quality and standards Lord D’Arzi established the vital component of quality in the last government’s Next Stage Review entitled High quality care for all published in 2008.1
In addition, he signalled the development and publication of the NHS NOVEMBER 2012 THE CLINICAL SERVICES JOURNAL 17
Constitution which puts quality and safety at the centre of healthcare delivery. The definition of quality is now
enshrined in legislation in The Health and Social Care Act 2012 and forms the basis of the National Quality Boards’ vision of future frameworks for quality. It is defined as: “care that is effective, safe and provides as positive an experience as possible.” These three clear dimensions of quality must all be present in order to provide a high quality service: • Clinical effectiveness – quality care which is delivered according to the best evidence as to what is clinically effective in improving individual’s health outcomes.
• Safety – quality care is care which is delivered so as to avoid all avoidable harmand risks to the individual’s safety.
• Patient experience – quality care is care which looks to give the individual as positive an experience of receiving and recovering from care as possible, including being treated according to what the individual wants or needs, and with compassion, dignity and respect.
The patient’s voice The coalition’s first white paper on healthcare established patient centred care
Kate Woodhead.
and the patient experience in the strap line ‘no decision about me without me’.2 It also set out to strengthen the influence and voice of the patient in the new structures of the NHS, which are now beginning to take shape and will be in place by April next year. NHS Scotland published a similar
focus on person centred care in its Quality Strategy.3
As well as being safe
and effective, care must be person centred. Mutually beneficial partnerships between patients, their families and those delivering healthcare services must
‘All staff working in health or social care have a responsibility to regularly review that the care they are delivering is of appropriate quality and meets the expectations of the public whom they serve.’
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