Health Care Quality Improvement

 According to The Health Foundation (2021), 

Why need "Quality Improvement"?

- giving the people closest to issues affecting care quality the time, permission, skills, and resources they need to solve them

- It involved a systematic and coordinated approach to solving problems using specific methods and tools, with the aim of bringing about a measurable improvement. 

Dimension of Quality:

Safe, Effective, Caring, Responsive, and personalized

Health care organizations and systems are: 

Well-led, Sustainably-resourced, Equitable 

How can we improve quality? 

1. Leadership and governance

2. Improvement culture, behaviors, and skills

3. External environment 

What does quality improvement involve?

• Identify the quality issue
• Understanding the problem from a range of perspectives, with a particular emphasis on using and interpreting data
• Developing a theory of change
• Identifying and testing potential solutions; using data to measure the impact of each test and gradually refining the solution to the problem
• Implementing the solution and ensuring that the intervention is sustained as part of standard practice

Core Principles

1. Understanding the problem 

        - how, why problems arise ( interview, surveys, and process mapping)

        -eg use "cause and effect' or 'fishbone' diagram

2. Designing Improvement

        -eg use driver diagram, logic model

        -do data gathering: providing insight about what has and hs not worked in other contexts

3. Data and measurement for improvement

        -trying to assess the impact against set objectives

        -important to capture a baseline and then carry out measurement at regular interval

        - Statistical Process Control (SPC): method that examine the difference between natural variation (common cause variation) and variation that can be controlled (special cause variation)

4. Improving reliability

        -create more standardized working procedures, develop error-free processes that deliver high quality, consistent care and use resources efficiently, redesign system and clinical pathways

5. Demand, capacity, and flow

        - Understanding the variation and relationship between demand (eg the number of patients requiring access to the service), capacity (shortfall in service), flow (how and when a need for a service is met). 

6. The relationship aspects of improvement

        -Technique aspect, the team of people

7. Involving and engaging staff

8. Co-producing improvement

        -Partnership (staff, patients, carers, and wider public)

9. Buiding effective teams

10. Collaboration

Approaches and Methods

1. Model for Improvement _ PDSA (Planning, Doing, Studying, Acting)

Taken from https://www.garyrjones.com/blog/2019/1/26/the-school-research-lead-and-pdsa-cycles-whats-the-evidence-

2. Lean 

    -Emphasises the patient's central position to all activities and aims to eliminate/ reduce activities that do not add value to the patient

Lean's Operative Principles (5steps):

1. Defining what is value - adding to patients.
2. Mapping value streams (pathways that deliver the care).
3. Making value streams flow by removing waste, delay and duplication from them.
4. Allowing patients to 'pull' value, such as resources and staff, towards them, so that their care meets their needs.
5. Pursuing perfection as ongoing goal. 

3. Clinical microsystems

    -focused on 5Ps: patient, people, patterns, processes and purpose

4. Experience-based co-design

Key Questions for Planning and Delivering Quality Improvement (QI)

Q. What are the challenges to delivering QI

        Health Foundation noted 10 key challenges

• Convincing peers that there is a problem
• Convincing peers that the solutions chosen is the right one
• Getting data collection and monitoring system right
• Excess ambitions and 'projects' rather than sustained standard practice
• Organization content, culture and capacities   
• Tribalism and lack of staff engagement
• Leadership
• Balancing carrot and sticks - harnessing commitment through incentives and potential sanctions
• Securing sustainability 
• Considering side effects of change 

Q. Can quality improvement have unintended consequences? 

        QI does not always work and can have unintended consequences. 

Q. What skills do improvers need?

        -understand about QI, know how to plan, implement, measure and refine

        -negotiation skills, practical skills, reflection

Q. What role do senior leaders play in QI? 

        - Senior organizations or system leaders: ensure resources, unblock barriers, give time and space to test and refine the intervention

Q. Can QI approaches be applied across whole organizations?

        -Studies shows only 12%

        -Health foundation analysis found 4 key elements for effective organisation-wide approaches :

• Leadership and governance
• Infrastructures and resources
• Skills and workforce
• Culture and environment            

Four Interrelated Elements of Approach Taken by Health Care System (Quality Management System)

1. Quality Planning
2. Quality Control
3. Quality assurance: clinical audits, clinical incident reports, staff surveys
4. Quality Improvement

Reference

The Health Foundation (2021). Quality Improvement Made Simple. Available on https://www.health.org.uk/publications/quality-improvement-made-simple. Accessed: 20/2/2022. 

Additional Reading: 

https://aqua.nhs.uk/

https://aqua.nhs.uk/wp-content/uploads/2021/11/Case_Study_Royal_Liverpool_Serum_Lactate_in_Sepsis.pdf

https://aqua.nhs.uk/wp-content/uploads/2022/02/restrain-yourself-toolkit-BP.pdf