QUALIT Y IMP ROVEMENT
Quality improvement during COVID-19
Kate Woodhead RGN DMS provides an insight into quality improvement efforts during the pandemic and the important lessons learned. She discusses how positive transformation can be embedded, as healthcare adjusts to a new ‘normal’, and argues that empowering staff and ensuring their recovery will be vital going forward.
The Tsunami in healthcare over the last year, caused by a novel virus, has had an enormous impact, as everyone working in it will know. The unprecedented volume of change which had to happen over a very short, acute and critical time, as the NHS began to deal with the pandemic, is now able to be reviewed, a year on. Many Trusts used the existing structures for quality improvement which they had in place and can now reflect on the service delivery changes which had to be made. Quality improvement or health and care improvement mean different things to different people. The Health Foundation who co-ordinate a group of ‘improvers’, describes a systematic approach which uses specific tools and techniques to improve quality, experience and outcomes. It is focused on making healthcare safe, effective, patient- centred, timely, efficient and equitable.1
All of
these are what this author calls professional traits, and they are expected of everyone working in the service. A short survey of the ‘improvers community’ reported by the Health Foundation suggests that, during the crisis, the improvement role generally increased at the individual, team and organisational levels. It was used most for rapidly reviewing and improving processes and for engaging staff in change work. However, due to the crisis, there is a note of caution that many of the methods are focused around short-term goals, out of necessity, with methods used partially and flexibly. What was missing largely from the standard methodology was the application of systematic measurement and also the engagement of patients and carers, neither of which is in the least surprising, given the context. Nevertheless, if this continues, it has the potential for the efforts to be wasted and not provide any sustainability for the changes.2
MAY 2021 Quality improvement
In order for sustainable change to occur, improvement methodology, which is tested and proven, needs to be applied so that it can be embedded into core recovery work. The principles which underlie quality improvement can be summarised, without the jargon, as follows: l Understand the problem, with a particular emphasis on what the data tell you.
l Understand the processes and systems within the organisation – particularly the patient pathway – and whether these can be simplified.
l Analyse the demand, capacity and flow of the service.
l Choose the tools to bring about change, including leadership and clinical engagement, skills development, and staff and patient participation.
l Evaluate and measure the impact of a change.
Regardless of the approach used, how change is implemented, including elements such as leadership, clinical involvement and resources, is vital.3
Two examples of
involvement of the whole team were from Trusts that have a culture of continuous improvement. The first, Leeds Teaching Hospitals Trust had an issue with COVID tests and how long it took for reporting; they used their experience and culture to review the process. Essentially, the leadership in the Trust undertook to review a wide process and to investigate where it was slowing the entire reporting mechanism. These efforts revealed five areas for speeding the process. In order to get buy-in from the whole team, nurses and service managers were asked to identify and test solutions. The Trust increased its timeline for reporting to 95% of all swabs being reported within 24 hours. The Surrey and Sussex Healthcare Trust have also been practising strategies for
WWW.CLINICALSERVICESJOURNAL.COM l 23
▲
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80
