Professor Chris Ham has recently authored a report entitled Improving quality in the English NHS with Dr Jennifer Dixon and Professor Don Berwick. The report highlights the need for a coherent strategy for quality improvement (QI) across the NHS, and sets out some recommendations for a “system of support”. Below is a selection of some of their recommendations:
– Organisations need to build capacity and capability for QI (as has been done in trusts such as Salford Royal and East London)
– There needs to be shared learning and the provision of regional support for QI through the academic health science networks, for example
– A centre of expertise for QI should be established
– Frontline clinicians, leaders of NHS organisations, patients, and the public should be involved in designing and implementing the strategy.
Dr Jen Perry, clinical lead for BMJ Quality, met with Chris to ask him about his paper and what it means for clinicians working on the frontline.
What do you think the most important message from your report is?
I think the key message is that there needs to be a strong and consistent focus from national leaders and ministers on QI. In politics, there is always the risk that other priorities can get in the way.
How do we keep the national focus on QI?
QI isn’t just the right thing to do; it helps the NHS to use its resources better, to hit targets, and improve financial performance. These issues are important to politicians and so we need to keep this at the forefront.
What will your report mean for frontline clinical staff?
It will mean that healthcare teams will be able to develop skills in and knowledge in QI. They will be supported to undertake projects which will improve quality and make better use of resources.
What about cost?
This is something that you can’t do without money. There needs to be a strong commitment from trust boards and money will need to be found from somewhere (for example through reserves and charitable trusts) or tough decisions will be made. The money invested for QI programmes will pay off in the long run through other savings. For example, at Tees, Esk and Wear, a mental health trust in the North of England, they have been able to close 100 inpatient beds and focus more of their psychiatric care in the community.
What are the barriers to rolling out QI across the UK?
Workload pressures are the obvious one. At present, teams are already working flat out and they will struggle to find the time to do QI; it really needs to become part of everyday practice. They have a saying at Jönköping: “People are employed not only to do a job, but also to improve upon it.”
There is also the issue of board commitment. Board members are often from different walks of life and are new to the concept of QI. As a result, they often need more convincing of it as a concept. What we really need is to have a document which makes the case for QI that we can present to trust boards.
How do we engage people in QI?
I’ve visited lots of organisations which are doing great QI work and what often happens is that QI starts with the enthusiasts, such as on a few wards. The rest of the staff in the hospital then start to hear about their great successes and want to get involved; it can have a ripple effect. This needs to be supported by leadership from the top and clinical champions.
What about top down strategy vs bottom up QI?
We need both. The top-down strategy is needed to provide the framework and resources, but all of this would be nothing without the teams on the ground actually doing the QI work.
Why should frontline staff get involved in QI?
The evidence is clear: QI improves patient outcomes, increases efficiency, and decreases waste. Staff members are able to develop a wide range of skills through doing QI such as leadership skills. Junior doctors are particularly well placed to get involved in QI because they see things through fresh eyes, they question and they challenge.