QI Introduction

Quality of Care and Quality Improvement - from personal skills to systems wide resilience

An introduction:

1. Best patient care arises from the application of the knowledge, skills and behaviours of excellent clinicians working with patients and families.

2. Quality improvement methods and approaches support and enable healthcare professionals to meet their duty to make the care of the patient their first concern, design and deliver safer care and work in or lead high performing teams. Quality of care, experience and outcome is a team responsibility more than ever before.

3. More complex healthcare systems and the changing patterns of disease and public expectation have led to greater emphasis on the need for systems thinking and designed systems to connect and reduce risk does not increase it through poor connections, handovers, IT failures or simply not taking ownership of what happens the person on their journey through the system.

4. All clinical professionals should be able to participate in and develop the competences and confidence to apply quality improvement methods to their work and be part of a supported continuous learning organisation.

The healthcare professional practices in a complex system where learning and continuous improvement should be supported by everyone.

All healthcare professionals are expected to have and maintain the necessary knowledge, personal skills, ethical and behavioural frameworks that ensure patients are always cared for effectively and compassionately. These expectations are described in the codes of practice and they have adapted to meet new and changing contexts as well as the developments in medical science. This has been embedded in continuous professional development systems, the publication of research and the promotion of ever higher standards of care.

While medical advances have created tremendous opportunity for improved treatment and survival, they have also created new challenges for professionals. Better outcomes for patients come from constant professional development, excellent individual performance and behaviour but also require improved’ whole system’ performance. In 2007, Batalden and Davidoff described the necessary knowledge systems involved in healthcare improvement as being; scientific knowledge, particular context awareness, performance measurement, plans for change, execution of those planned changes. They observe that ‘everyone in healthcare really has two jobs when they come to work every day: to do their work and to improve it’. The list five knowledge systems that are involved in improvement. This is far more and requires a different approach than simply addressing one personal development goals for appraisal and or in due course revalidation.

(Batalden and Davidoff in Quality and Safety BMJ 14th February 2007)

Batalden and Davidoff's article including the above table can be found here

Professional codes of practice for medical, nursing of allied healthcare professionals require individuals to maintain their skills, take prompt action if there are safety concerns and work in teams and with patients to maintain trust at all times. However, healthcare professionals all work within healthcare organisations and systems alongside managers and other staff who may also have project management skills and operational knowledge that are needed to make change that is an improvement. All staff have a role to play in ensuring patients are safe and receive high quality care at all times.
Quality Improvement methods provide a common language, a shared approach within and between teams to systematically understand what should happen, what does happen and what needs to change to ensure higher quality outcomes for all patients. Quality Improvement approaches also provide a well-tested approach to using data to measure progress and develops leadership skills to manage barriers and challenges along the way. Change is never easy and changing complex system can be extremely difficult leading to all sorts of unintended consequences that can put patients and professionals at risk and wary of change at all. Quality Improvement Methods provide a flexible, adaptable, consistent approach that will lead to effective change, improved team working and more likely led to sustainable ongoing improvement as science and expectations change over time.

 

 

What drivers have there been to improve quality in Healthcare?

• QI into Practice - a valuable short paper from the BMJ
• Learning from other industries is harder than you might think - an insight article by the BMJ

 

How does Quality Improvement activity fit with professional practice and training?

Why does a systematic approach to improvement matter more than ever?

All healthcare professionals are expected to have and maintain the necessary knowledge, personal skills, ethical and behavioural frameworks that ensure patients are always cared for effectively and compassionately. These expectations are described in the codes of practice and they have adapted to meet new and changing contexts as well as the developments in medical science.
While medical advances have created tremendous opportunity for improved treatment and survival, they have also created new challenges for professionals. Better outcomes for patients come from constant professional development, excellent individual performance and behaviour but also require improved’ whole system’ performance. In 2007 Batalden and Davidoff described the necessary knowledge systems involved in healthcare improvement as being; scientific knowledge, particular context awareness, performance measurement, plans for change, execution of those planned changes. They observe that ‘everyone in healthcare really has two jobs when they come to work every day: to do their work and to improve it’.
Professional codes of practice for medical, nursing of allied healthcare professionals require individuals to maintain their skills, take prompt action if there are safety concerns and work in teams and with patients to maintain trust at all times. However, healthcare professionals all work within healthcare organisations and systems alongside managers and other staff who may also have project management skills and operational knowledge that are needed to make change that is an improvement. All staff have a role to play in ensuring patients are safe and receive high quality care at all times.

Quality is everyone’s responsibility but a learning organisation creates the right environment to improve:
Increasingly in the last 20 years it has been recognised that healthcare organisations require a deliberate approach to systems wide quality and safety to enable a culture of continuous improvement and staff are encouraged to participate at all levels and stages of their career. The consequence of failure to do this was clearly described by Don Berwick in 2013 in his report on the learning from Mid Staffs and summarised is in table 3. The wider commitment to his report has meant that new and more extensive efforts have been made across the NHS and healthcare systems internationally to ensure that the quality and safety of patient care is both an individual’s responsibility but is always within and supported by a whole system ‘learning environment’. 

Quality Improvement techniques and competences are now seen as core to healthcare professional training and the practice of medicine:
Quality improvement approaches have been significant in making this transition. Healthcare organisations have developed multi-disciplinary improvement teams and these have provided the opportunity for medical foundation and specialist trainees to participate and in some cases leave positive changes. The Health Foundations report in 2012 and Training for Better Outcomes by the Academy of Medical Royal Colleges in 2016 describe the critical part quality improvement knowledge and competence plays in the development of healthcare professionals and their ability to continuously improve their medical practice and patient care.

The context in which healthcare services are now delivered requires us to continuously review and rethink how we provide care:
Technical advances and rapidly advancing medical knowledge have accelerated the changes needed in healthcare in recent decades.  In addition, there have been two significant national and global influences that have required us to think differently about improvement of care at every level. Long-term conditions have increased in prevalence creating new challenges for systems and professionals. When ill health is more likely to be a long-term condition than a single event the need for excellent communication over time with all those involved becomes crucial. Working closely with the patient and their family as partners in co -producing the best outcome is increasingly important for both effective care but also the efficient use of resources by staff, the system and the patient.

Quality improvement approaches require systems thinking and collaboration:
Safe, effective, timely, efficient, equitable and person centeredness care is a ‘whole system’ property. Quality Improvement methods enable healthcare professionals to successfully improve quality of care by using systems thinking and methods that have been developed to enable change in complex environments. Using quality improvement approaches ensures that all healthcare staff, whether or not they have professional qualifications can share and understand a common language when discussing improvement. It has also enabled patients, families and the public to participate and share that language, the data and contribute the ideas for change that matter to them. In the last 5 years there have been many examples of system wide collaboration building will, working with patients, coaching teams, improving data collection and its use, integrating pathways for patients, putting local ideas for improvement into practice and then sharing these more widely. The principles of quality improvement; ‘all share all learn’ and that Improvement is a team sport, are evident in the aims and the design of such collaboratives.

References/Documents of interest:

• https://www.aomrc.org.uk/wp-content/uploads/2019/06/Developing_QI_into_practice_0619.pdf
• Batalden, P, and F Davidoff. 2007. “What is quality improvement and how can it transform healthcare?” 
• Berwick, D. 2013. A promise to learn- a commitment to act: improving the safety of patients in England. London : Department of Health and Social Care. Accessed 12 20, 2018. 
• England, NHS. 2019. 16 01.

Quality Improvement methods in a nutshell?

• Principles of QI and getting started are described here. 

 

What difference does it make for patients, systems and professionals?

• A simple guide from the Health Foundation on why QI matters to us all.

 

The Person previously known as the Patient- changing our perspectives of what improvement is needed

• Co-production and new lens of patient-centred care
• We must rethink how we involve and learn from patients so as to build better approaches to caring

  

A wider understanding of quality improvement in a global arena

1. USA - Examples of how QI is being supported across healthcare providers (Federal, State and Private).
2. USA - QI in the United States Healthcare System.
3. WHO - How the World Health Organisation is supporting and encouraging QI.
4. IHI - Signing on for access to the Institute for Healthcare Improvement is free and though US bases IHI work across the world including in the NHS.
5. ISQUA - International Society for Quality in Healthcare shares from fellows from around the world who blog their experience in healthcare QI.
6. UK - Defining quality

This page was last updated August 9th 2024 (3 months ago)