Danny Keenan and Kieran Mullan: Making quality improvement easier

If we want clinical leaders to act on data for quality improvement, we need to make easy access a priority

The question of how to drive engagement in quality improvement has been studied, picked apart, and analysed as much as the different aspects of clinical care we are trying to improve.

There are some key themes that are well understood, such as the role of clinical audit in hospital governance, the involvement of patients in such processes, and how continuing attention to safety is fundamental to hospital improvement. We know that national clinical audits help colleagues not just to think about measurement, but to deliver improvements as well.

Yet we also know that one of the main challenges clinical leaders face is obtaining information that clearly indicates where they need to concentrate their activities to improve the quality of their services. We need to simplify access to this information and make sure that it is meaningful.

You might argue that it is the responsibility of clinical leaders to make the time to look at the data no matter how difficult the process is, but you need to be mindful of the reality on the ground if you want to make progress.  There are so many competing pressures for clinical leads’ time that presenting important data in easily understood and speedy formats should be a priority.

Medical and clinical directors are very busy people. They have an endless list of data and reports they must look at. These are followed by things they should look at. Finally, there are the things they could look at. If clinical leaders are to have the time to examine and act on data for improvement, we need to make life easier for them.

In behavioural science what we are talking about acting on are known as situational factors. A simple but effective experiment run by the economics department of the University of Tilburg found that staff were almost four times more likely to steal from a communal fridge if they did not have easy access to a pen to write down what they were taking. Those working in medical education have long known that the easiest way to get trainees to attend educational seminars is to give them lunch, even though a formal survey might point to a whole range of much more complex factors as to why they don’t attend.

So how do we give the equivalent of easy access to a pen to our colleagues leading in quality improvement?

Countries around the world use national clinical audits and registries to drive improvement (Scandinavia and Australia, for example). But the challenge is to make these audit results readily available. If the E-commerce giants are fighting battles over allowing customers to buy things in “one click,” we in the world of quality improvement should take notice.

Some organisations are already starting to do this. In the US the American College of Surgeons National Surgical Quality Improvement Program provides daily reports to surgeons on 30 day morbidity and mortality data, with comparisons against national averages. There is no waiting around for the publication of big reports on set days. Every day there are new data to look at when it suits you.

In Ontario the MyPractice programme provides primary care practices with six monthly performance reports on opioid prescribing, cancer screening, and diabetes management, which include at the start summaries that capture the best and worst performing measures across all these domains. If you are time pressed just looking at this page is going to tell you where to focus your quality improvement efforts. To make it even easier, these reports also contain within them key ideas for delivering quality improvement as well.

To try and tackle this in England, we are bringing the results from our national audits and registries onto a one page format called National Clinical Audit Benchmarking (NCAB). The Model Hospital programme is also sharing visual benchmarking data for a whole host of cost productivity and efficiency metrics with NHS Trusts—data that are ordinarily hard to find in one place.

With NCAB, the data are emailed so within just one click you can see a summary of key metrics that have been chosen as the most important by the clinical leads of these audits, benchmarked with easy to understand visuals.

Measurement in healthcare can be difficult and has many pitfalls. It is up to us to simplify these measures, their visualisation, and their interpretation. The easier it is for medical and clinical directors to access national clinical audit data, the more likely they will be to act on it—and act on it often.

Businesses are continually making user journeys easier for customers so that they follow through with actions that will benefit their companies. In business that equals getting money. In healthcare that means working to improve services to deliver the best care to patients. Let’s have that same relentless focus on making things easier when it comes to quality improvement.

Danny KeenanDanny Keenan is an associate medical director of the Manchester University NHS Foundation Trust and is seconded as the medical director of the Healthcare Quality Improvement Partnership. 

Competing interests: I have no conflicts of interest to declare other than the fact that I work for the English National Health Service.

Kieran MullanKieran Mullan is the clinical lead of clinical audit for improvement at the Healthcare Quality Improvement Partnership.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None.