Quality improvement

Establishing quality improvement approaches which actually work has much to do with suitable leadership and organisational culture, according to a new King’s Fund report.

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This report explores the factors that have helped organisations to launch a quality improvement strategy and sustain a focus on quality improvement. It identifies three common themes for successfully launching a quality improvement strategy: having a clear rationale; ensuring staff are ready for change; understanding the implications for the organisation’s leadership team in terms of style and role.

The report finds that NHS leaders play a key role in creating the right conditions for
quality improvement. Leaders need to engage with staff, empower frontline teams to
develop solutions, and ensure that there is an appropriate infrastructure in place to
support staff and spread learning.

Full reference: Jabbal, J| Embedding a culture of quality improvement | Kings Fund

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The death of QOF?

The death of QOF? | BMJ Talk Medicine Podcast

The Quality and Outcomes Framework (QOF) is one of the most ambitious pay-for-performance schemes introduced into any health system. It’s now being scrapped by bits of the NHS, and is under reform elsewhere.

Martin Marshall, GP and professor of Health Improvement at University College London, thinks it’s time to rethink the experiment. This BMJ Talk Medicine podcast discusses how we got here, what we’ve learned, and what will replace QOF.

Full editorial: The future of the Quality and Outcomes Framework in England

CQC State of Care report

State of Care is the Care Quality Commission’s annual assessment of health and social care in England. The report looks at the trends, highlights examples of good and outstanding care, and identifies factors that maintain high-quality care.

This year’s report shows that the quality of care has been maintained despite a number of challenges. Most people are receiving good, safe care and many services that were previously rated inadequate have made the necessary changes and improved.

The CQC stress that the fact that quality has been maintained in the face of a number of challenges is testament to the hard work and dedication of staff and leaders. However, as the system continues to struggle with increasingly complex demand, access and cost, future quality is precarious.

The report makes the following points:

  • Health and care services are at full stretch
  • Care providers are under pressure and staff resilience is not inexhaustible
  • The quality of care across England is mostly good
  • Quality has improved overall, but there is too much variation and some services have deteriorated
  • To put people first, there must be more local collaboration and joined-up care

 

See also Health Foundation response to CQC State of Care Report

 

Quality improvement

Making the case for quality improvement: lessons for NHS boards and leaders | The King’s Fund | The Health Foundation

This briefing outlines the following ten lessons for NHS leaders which provide a starting point for those seeking to embed quality improvement in their work:

  • Make quality improvement a leadership priority for boards.
  • Share responsibility for quality improvement with leaders at all levels.
  • Don’t look for magic bullets or quick fixes.
  • Develop the skills and capabilities for improvement.
  • Have a consistent and coherent approach to quality improvement.
  • Use data effectively.
  • Focus on relationships and culture.
  • Enable and support frontline staff to engage in quality improvement.
  • Involve patients, service users and carers.
  • Work as a system.

The briefing makes the case for quality improvement to be at the heart of local plans for redesigning NHS services.

Full report available here

Nine in 10 GPs rated good or outstanding following CQC inspection

Care Quality Commission (CQC) report finds that at the end of its first inspection programme of general practices 4% were rated ‘outstanding’, 86% were ‘good’, 8% were ‘requires improvement’ and 2% were ‘inadequate’.

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Image source: http://www.cqc.org.uk

The state of care in general practice 2014 to 2017 presents findings from CQCs  programme of inspections of GP practices. This detailed analysis of the quality and safety of general medical practice in England has found that nearly 90% of general practices in England have been rated as ‘good’, making this the highest performing sector CQC regulates.

Full document: The state of care in general practice 2014 to 2017

Improving quality of care through partnerships and collaboration

Partnerships for improvement: ingredients for success | The Health Foundation

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The idea of partnerships and collaboration across organisational boundaries is at the heart of NHS reforms in England. This briefing from the Health Foundation looks at what makes successful partnerships between providers at an organisational level, providing a snapshot of some of the key ingredients needed for successful partnerships.

The report looks at a range of current organisational partnerships focusing on five different partnering arrangements. It also includes interviews with national leaders, and draws learning to help inform and guide policymakers and providers.

The report finds that partnering does have potential benefits, but these are not easy or quick to achieve. To have a meaningful impact on the quality of care, the right form of partnering needs to be used in the right context and it needs to be accompanied by the right set of enabling factors – as described by the report.

Full briefing: Partnerships for improvement: ingredients for success

Related: Health Foundation blog: Is together always better? How good are NHS organisations and the wider system at achieving the potential benefits of partnering?

Practical value in the NHS

The King’s Fund has previously highlighted the fact that addressing waste and variability in clinical work can create better value in the NHS. But what does value mean to people working in the NHS – and how it is being applied in practice? | The King’s Fund Blog

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‘Value’ sounds like a familiar concept but it can mean different things to different people. One definition of value in the health and care sector is ‘health outcomes per dollar spent’, so attempts to increase value can look at either improving quality or reducing cost.

In early July we held a roundtable discussion with health service providers to better understand their approach to value improvement – initial research for a new project intended to understand the practical barriers and challenges that frontline clinical, operational and managerial leaders have encountered in pursuing better value health care. Experts who attended – including a chairman, chief executive, chief nurse, deputy chief operating officer, change leader, and representatives of national bodies – agreed that the emphasis should be on patient care. Clinicians are more likely to engage in a programme that revolves around the quality of services, and better care is typically less wasteful, so as one participant put it, ‘if you focus on quality, money will fall out’ [spending will reduce]. Consultants will often drive through successful programmes with change management teams, but we also discussed the role of junior doctors, nurses and therapists, who frequently witness low-value care and understand how to fix it. We know that substantial changes in practice can be delivered as we have seen, for example, in generic prescribing, reduced length of stay and the move towards day case surgery.

Read the full blog post here