HEALTHCARE DELIVERY
called the Advancing Quality Alliance who state that their methodology combines five techniques which improve outcomes for membership organisations and customers. These are: l Analysis – provide meaningful comparative information about quality and safety priorities.
l Improvement – use programmes to target local quality improvement priorities.
l Training – build workforce capability in quality improvement skills.
l Collaboration – learn and share with peers through networks and partnerships.
l Innovation – access to national and international expertise.2
Three leaders in improvement science demonstrate that it is not easy to define as a discipline. However, they make the following observations in attempting to find some distinguishing features. Improvement science, they say, aims to create practical learning that can make a timely difference to patient care. It is characterised by its large domain of interest, its applied nature and its commitment to generation of practical learning that can be applied in real-life situations. Improvement science recognises and integrates many contributions, similar to the way that engineering science uses scientific knowledge and theories to address real-life problems.3 It is important to distinguish, when thinking about quality improvement, that this is not quality assurance, which is about audit and inspection. Since Mid Staffordshire, the politician’s response to the NHS has largely been to increase the amount of assurance (i.e. regulation and inspection) rather than enabling and empowering leaders and practitioners to make quality improvements. The route to improvement may include some aspects of inspection, but not as a major
When we have good baseline data, we can make better decisions. It also allows us to see where variation in care lies, and we can make substantial investigations based on patient practices, costs and outcomes.
component. The role of the Care Quality Commission needs to be realistic about how much they can improve aspects of care by regulation.
Deming and data
Dr William Deming had a huge impact on the early science of improvement and his principles are important, or could be important in healthcare improvement. Deming looked specifically at process management in the car industry many decades ago. The last few industries in the world that have yet to accept and implement his principles are said to be healthcare, higher education and politics. Deming clearly understood the usefulness of data and data of good quality.
When we have good baseline data, we can make better decisions. It also allows us to see where variation in care lies, and we can make substantial investigations based on patient practices, costs and outcomes. In order for us to increase our quality and productivity, we have to reduce variation. We are all signed up to evidence based practice, but then bizarrely want clinical freedom to do something individual and different – flying in the face of the evidence. From a change perspective we also need to assess and analyse where we can make the greatest impact on patient care, as quickly as possible. Change is never easy, so quick
wins are essential to motivate and sustain the effort required. It is impossible to design and redesign effective and efficient patient care processes without good data.
Designing quality improvements
Improvements in the quality of care do not happen by chance. They are carefully designed by intentional action from staff equipped with the skills required to bring changes to care, directly and supported by leaders at all levels.4
Improvements do not
come free; they come with the requirement of substantial and sustained commitment of time and resource.
One of the most motivating aspects of the
Berwick report on patient safety in 2013, was the exciting prospect of all staff from CEOs to every working member of staff to be part of the programme to build lifelong learning on quality improvement and patient safety into the NHS. The report ‘A promise to learn – a commitment to act’ explained this by recommending that the entire NHS should commit to lifelong learning about patient safety and quality of care through customised training for the entire workforce on such topics as safety science, quality improvement methods, approaches to compassionate care and teamwork. The most powerful foundation for advancing patient safety in the NHS lies much more in its potential to be a learning organisation, than in the top down mechanistic imposition of rules, incentives and regulations. Collaborative learning through safety and quality improvement networks can be extremely effective and should be encouraged across the NHS. The best networks are those that are owned by their members, who determine priorities for their own learning.5
It is a sad fact that the
progress on this aspect of patient safety has not been realised since the publication of the report – different priorities have taken over. The King’s Fund6
recently made much of
an argument which is about investing in the NHS so that it can deliver value, reducing variation and waste as well as becoming far more patient and carer
focused.There are many examples of high performing organisations in health systems around the world, from whom we could learn valuable lessons. They call for a coherent strategy to deliver system-wide improvements, understanding what is best delivered at a national or a local level. They emphasise the need for leaders who understand the value of quality improvement and cultures in which
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WWW.CLINICALSERVICESJOURNAL.COM OCTOBER 2016
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