Helen Carson, Product Manager for BMJ Quality
BMJ Quality was at the Arab Health Congress in Dubai last month. This event played host to 85,000 delegates, over 2,000 exhibitors and 19 conferences, which included topics such as quality management and diabetes. Talking to delegates was a good way to learn about the myriad uses for the term “Quality”; Accreditation, safety, performance standards, risk mitigation, innovation, process improvement and patient centred care were just a few of the phrases that were regularly used by delegates to talk about quality in their organisations. This blog is brought to you by BMJ Quality. For more quality improvement resources go to quality.bmj.com
One of the contrasts to the UK was the sense that in the Middle East, “Quality” is very structured; delegates from the Middle East tended to talk about a very organised quality manager at their organisation who worked to devise and implement quality strategies and practical resources, whilst working to ensure that everyone adhered to the frameworks necessary for accreditation by the likes of Joint Commission International (JCI). These healthcare professionals saw their role as implementing quality controls to reduce risk, and to ensure that clinical practices are safe and consistent. Perhaps it was due to the nature of the events, but when I think back to the ‘quality themed’ conferences I attended in the UK in the summer, there was a contrast: Senior NHS figures were calling for frontline staff to take responsibility for quality improvement through critical appraisal and innovation. Many spoke of the redesigning of processes and services, due to the continued complexity and bureaucracy of many organisations, and the ability of those at the frontline to see a clearer path to improve services. This is of course in addition to adhering to the guidelines given by government and other healthcare bodies such as CQC and NICE.
Perhaps a sweeping generalisation but these are examples of a “top down” and “bottom up” approaches in action. Two very different approaches to the notion of Quality but, hopefully, both with patients as a central focus.
And this is where things (in the era of patients as customers) get complicated. For many patients high quality healthcare has strong links to service elements; speed at which they get to see a doctor, the manner in which they are treated.
While a healthcare professional or a hospital can appreciate the importance of these things their emphasis will likely be on clinical quality and the flow of services and processes. All of these elements need to be measured, improved and managed by empowering healthcare professionals and patients to contribute to the cycle of improvement.
So do we need to agree on a consistent meaning of the term “Quality” to move forward? Or do we need to be flexible and responsive to the needs of patients and organisations in order to give a notion of quality that is important to them?
I suspect that it is the latter.
But one thing that is for sure is that people working at the front line are unsure of their role and authority in Quality Improvement and innovation, so in this respect, clarity, support, and education are an important part in moving forward. And for all these phrases or interpretations of quality; change is essentially what is needed.
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