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.
- 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.
- 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.