This paper argues that the NHS in England cannot meet the health care needs of the population without a sustained and comprehensive commitment to quality improvement as its principal strategy.
Despite a succession of well-meaning policy initiatives over the past two decades, the paper argues that the NHS in England has lacked a coherent approach to improving quality of care. It describes key features of a quality improvement strategy and the role of organisations at different levels in realising it, offering 10 design principles to guide its development. A quality improvement strategy of this kind has never been implemented at such a scale and the challenge in doing so is immense – yet the paper argues that the NHS has no real alternative.
Key findings
Successive governments have pursued policies to improve the quality of care in the NHS, but the many and varied initiatives failed through a lack of consistency and the distraction of other reforms.
Efforts to improve quality of care have been hampered by competing beliefs about how improvements are best achieved.
More than ever, the NHS must focus on delivering better value to the public. This means tackling unwarranted variations in clinical care, reducing waste, becoming more patient- and carer-focused, and ensuring that quality and safety are at the top of the health policy agenda.
This is best done by supporting clinical leaders through education and training in quality improvement methods, and developing organisational cultures where leaders and staff focus on better value as a primary goal.
Clarity about the role of inspection in a quality improvement system is vital. Done well, inspection has a part to pay in quality assurance – but this should not be confused with quality improvement.
Policy implications
A quality improvement strategy that defines the roles of organisations at different levels in supporting improvements in care is needed for the NHS in England.
Politicians and leaders of national bodies must reduce the burden of regulation, inspection and performance management to free up clinicians and organisational leaders to work on improvement.
More emphasis is needed on developing cultures committed to improvement and learning from within the NHS – building in-house capability for improvement – rather than complying with external standards.
To transform the NHS into a learning and high-performing organisation will require resources and expertise, alongside an openness to learn from organisations around the world that have reformed from within.
A pragmatic, real-time evaluation of the quality improvement strategy and its implementation is essential.
I agree with the need for better value for money and reducing waste but there is a great need to focus on priorities and this means educating the public on what is realistically possible for the NHS to provide in these days of austerity. There has to be a cultural switch from being mere technicians of care to being warm and empathetic care providers at times of real crisis in people's lives when they are scared. It is that that lives in the memory of people and it is that which appears to be disappearing from many wards and care settings. Perhaps innovation should be encouraged from the bottom up and not top down. People need to be cared for by people with a true vocation.
I agree with the need for better value for money and reducing waste but there is a great need to focus on priorities and this means educating the public on what is realistically possible for the NHS to provide in these days of austerity. There has to be a cultural switch from being mere technicians of care to being warm and empathetic care providers at times of real crisis in people's lives when they are scared. It is that that lives in the memory of people and it is that which appears to be disappearing from many wards and care settings. Perhaps innovation should be encouraged from the bottom up and not top down. People need to be cared for by people with a true vocation.
I couldn't agree more - an excellent paper! I worked with John Oldham on the Primary Care Collaborative, then moved to the Modernisation Agency, then the NHS Institute for Innovation and Improvement - I am one of those clinicians referred to in the paper that has extensive training in QI (including the IHI). In recent years I have been focussing on building capacity and capability of frontline staff in QI tools and techniques and supporting leaders with developing a culture for QI. I have been working with an Acute Trust for the past year - leading a QI programme that supports staff to lead improvement in their own areas. The evaluation has been stunning - the staff that have taken part in the programme to date (circa 60) have felt empowered to make changes and now have the knowledge and skills to lead other improvements locally. A key part of the design of the programme was to create a community of practice - peer support is more likely to ensure sustainability. The programme was loosely based on the model adopted by Wrightington Wigan and Leigh who have found it to be a sustained success. Sadly, in relation to the challenge of stabilising finance and performance the Trust has decided to stop the Programme. Consequently, despite the success of such Programmes, unless the receptive context is right, they will not succeed longer term. I feel that the Centre could do more to support Trusts who are in difficulty to nurture a QI approach even in the face of extremely challenging conditions. More scrutiny is not the answer!
I think the opening lines of para 2 sum this up quite well for me
'Despite a succession of well meaning.......etc'
I was diagnosed with a terminal illness just over a year ago and have recently, once again, been placed in the 3-6 months bracket. I'm still around and pleased to say, still fighting
Difficult to say without seeming disingenuous to carers and the medical profession but please please listen to us and make a real effort to respect our thoughts, needs and desires
Doctor doesn't always know best. I've had some great treatment and advice but also about as much BS as I can cope with. I'd like to take a BS holiday now, perhaps some BS respite care for a short while?
Whilst the assisted dying debate continues, there are many of us who have only two wishes - make the most of the time we have left and die with as much dignity that I can muster.
No apologies for being (perhaps more than) a little non PC but EoL is something I speak (preach?) to others about quite a lot and know that whilst many of us don't share the same views, we all feel strongly enough to 'get off the fence'
I am sorry that the previous commentator has had below-par experiences. I have never had anything but excellent care, delivered with warmth and great kindness. I am deeply suspicious that 'improved care' and prevention of 'waste' are simply excuses to cut back on funding, make us accept long travel times to distant places of excellence (our own having been removed), and ultimately twist our arms and wallets to pay for private healthcare. According to many friends and relatives I have in the US and in Australia, Medicare, and Medicaid is almost worse than nothing, and they have repeatedly warned me off accepting it.
Comments
'Despite a succession of well meaning.......etc'
I was diagnosed with a terminal illness just over a year ago and have recently, once again, been placed in the 3-6 months bracket. I'm still around and pleased to say, still fighting
Difficult to say without seeming disingenuous to carers and the medical profession but please please listen to us and make a real effort to respect our thoughts, needs and desires
Doctor doesn't always know best. I've had some great treatment and advice but also about as much BS as I can cope with. I'd like to take a BS holiday now, perhaps some BS respite care for a short while?
Whilst the assisted dying debate continues, there are many of us who have only two wishes - make the most of the time we have left and die with as much dignity that I can muster.
No apologies for being (perhaps more than) a little non PC but EoL is something I speak (preach?) to others about quite a lot and know that whilst many of us don't share the same views, we all feel strongly enough to 'get off the fence'
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