The Q that makes the difference...

05 November 2012

The traditional message – that quality begins with the people working and using services – is at variance with the idea that compliance with standards leads to better quality, says Janet Davies, head of the Healthcare Quality Improvement Partnership, who will chair Public Service Events' NHS Quality of Care 2012 conference. We have to find a way to deal with the tension between efficiency and quality, she says

Delivering sustainable improvement should be the key aim of quality initiatives and activity in the NHS.

The keynote address – Putting the Q in QIPP – at the NHS Quality of Care conference will highlight tensions within the current QIPP (Quality, Improvement, Productivity and Prevention) agenda.

This agenda has become synonymous with the P for productivity and the Nicholson challenge to find £20bn in efficiency savings, focusing on cost-saving activities that release real cash savings quickly.

This often involves cuts or process changes in the name of efficiency, new ways of working with little built-in evaluation or development of evidence and sometimes ignoring evidence already available. This approach neglects the real long-term gains that can be achieved through true, dynamic quality improvement – the Q that can make a real difference.

The conference will also hear about NICE quality standards, which are as central to supporting the government's vision for an NHS focused on delivering the best possible outcomes for patients, being aspirational but achievable.

The standards, like the guidelines, are based on the best possible evidence and will assist practitioners and organisations in delivering care which has been shown by others to be both high quality and cost effective.

Doing what works and not what doesn't, as indicated by evidence, is widely accepted as the most efficient way of providing a service. The challenge of ensuring that the evidence is constantly reviewed and updated, as well as gaining ownership and adoption of externally generated standards, is far from insignificant even when practitioners themselves are auditing compliance.

The panel session will debate "ensuring quality of care". Ensuring quality and improving quality are different and the debate should be interesting.

The focus on compliance, which is, of course, essential for quality assurance and patient safety, does not always engage practitioners, especially in identification of standards and evidence, reducing ownership of the process.

Without regular review involving those delivering and receiving the care, the potential for innovation and continuous improvement may not be realised. The growing number of quality assurance systems, measures, and dashboards which are reactive and imposed can be confusing and difficult to implement, at times translating into a tick-box exercise.

This takes practitioner time away from direct care delivery. And without an understanding of the process and the results, they are unable to use these to change practice, improve quality and increase efficiency.

The traditional message – that quality begins with the people working and using services – is at variance with the idea that compliance with standards leads to better quality.

While key as a safety check, the processes can become static and limit innovation. By involving service users and providers, enabling them to think together about what makes a difference, and designing solutions together by innovating and designing those solutions that unlock value, it may be possible to deal with the tension between efficiency and quality.

Innovation includes using what is known to work for one scenario in a new one, or trying something out and observing the results of a new idea, so that the process does not stop at compliance or assurance. Audit of the outcome of innovations and actions is needed to develop further solutions and innovations, thus creating a dynamic process.

Quality improvement as a continuous process can achieve efficiency, so is not only about compliance. The conference will hear how, with different approaches, this might be achieved.

This article first appeared in Public Servant magazine