How can trusts measure quality well?

Measuring quality was rightly put at the forefront of quality improvement by the NHS Next Stage Review. But we need to get better at thinking about why we want to measure something and how we will use that information to improve care if we are going to develop a truly sophisticated and intelligent approach to quality measurement in the NHS.

For some purposes, such as quality accounts, we need clearly comparable data over time, to compare organisations' performance and see how they improve.

But for day-to-day monitoring of care in a clinical setting, we need more real-time measures collected at the point of care. And whatever the purpose, we need to provide contextual information so that the users of the data understand what it is – and isn't – telling them about the real quality of care.

Last week we held a workshop to stimulate discussion and get feedback on the proposed content of a discussion paper on quality measurement, due to be published in early 2010.

The speakers gave a range of perspectives – government, provider, commissioner, GP and patient – which was useful in unpacking what measuring quality means to different parts of the system.

Support was unanimous for using quality measurement as a tool for improvement, particularly highlighting the need for clinical engagement, clarity of aims, good quality data and rigorous analysis, and for indicators that cover patient pathways across organisational boundaries.

There was also an endorsement for 'less is more' in terms of indicators, and for linking quality measurement to productivity and efficiency measures. Views were less consistent about how quality should be defined and measured, and about the number and complexity of indicators.

What do you think is the key to measuring quality well? Let us know by adding your comments below.

Comments

The most important aspect of measuring quality is that the people responsible for key areas of performance can debate their own subject well, providing answers when things are going wrong. Choose & Book is a key area to look at!! poor performance seriously effects patients,therefore it is essential key players are ready to address issues of poor performance and slot availability.Sadly most have just walked away leaving a large void.Patients know best if systems work or not yet, for the most part are excluded from the debate.Dictate from above rules the day.Very little will change this being the case.

A good example of the difference from the patients perspective and that of say the Strategic Health Authority is highlighted in a reply I received to a question I asked in Dec 08 "Is the Choose & Book system currently fit for purpose"? Reply The national target for Choose&Book which is 90% of referrals our communitys recorded uptake at the time was 29% SHAs explanation, these programmes appeared NOT to be on the TOP of the PCTs agendas!!!!!!! therefore rated HIGH RISK on the SHAs risk register. These facts acknowledged by the powers that be have also effected our communitys ability to implement WORLD CLASS COMMISSIONING and more community based services. Therefore the baseline needed to ensure QIIP is a success in our area has been lost. We are at the back of the queue.

I have a story to share about the road throught the system and within myself that I found to good health. This story recorded in a journal includes the methods that helped and what did not. Unfortunately I have not been able to find a way to 'give back' this work. I had hoped that it may in some small way help to further understanding and improve the treatment of those who find themselves with similar problems to the ones I had both in themselves and in the system. Surely the voice of the people like me who are prepared to share their journey to health needs welcoming to improve patient care? Where are the research centres to collect work like mine to further understanding and to fed it back into the system?

For me the most important measure of quality remains the patient experience. Capturing the voice of the patient is the most powerful tool to use with clinicians and commissioners to bring about change. Audits that produce statistical information are useful but should be used in conjunction with the patient experience of the service given. Capturing, measuring and improving this is the challenge for clinical staff.

I completed my full pathway of care as an ophthamology patient, it was over 100 pages long and makes for very interesting reading. We are an ageing population who are in urgent need of these services being up and available, my experience shows just how far we need to improve to meet demand. The patient experience is essential for improvements to happen on the ground. This is after all or so we are told a patient lead NHS.