Sharing learning from hospital trusts on a journey of quality improvement

BMJ Leader ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. 24-26 ◽  
Author(s):  
Iona Thorne ◽  
Jeremy Cox ◽  
Edward Baker
Keyword(s):  
Quality Improvement ◽  
Systematic Approach ◽  
Healthcare Providers ◽  
Care Quality ◽  
Magic Bullet ◽  
Frontline Staff ◽  
Positive Effects ◽  
Consistent Model ◽  
Care Quality Commission ◽  
And Control

BackgroundQuality improvement (QI) has been shown to deliver better patient outcomes, and improved operational, organisational and financial performance when led effectively and supported by organisational systems and training. Surveys of staff and patient satisfaction also show positive effects. In many trusts that Care Quality Commission (CQC) has rated as outstanding, a culture of QI has been embedded throughout the organisation.ObjectivesWe wanted to hear trusts’ experiences of using QI as a systematic approach to improving service quality, efficiency and morale, and share learning from these organisations to drive further improvement to quality of care.MethodsUsing CQC’s comprehensive inspection programme of all healthcare providers nationally, we identified 19 trusts for inclusion and carried out an in-depth review of their improvement journeys.ResultsWe found that commitment from the board and senior leadership is crucial to ensuring success on the QI journey, modelling effective leadership behaviours that enable all staff to deliver improvement. These organisations have a systematic approach to QI, using a consistent model, anchored in a systems perspective, and often across a health system. The model of improvement requires leaders of all backgrounds and frontline staff to work together in improvement, and can help to break down barriers between managers and clinicians, and providers and patients, so there is a shared purpose to deliver better care to patients.ConclusionsQI is not a magic bullet, but is an important factor in the evolution of an organisation from a traditional ‘command and control’ form of management towards higher performing approaches to the design and management of work.

scholarly journals Determining the skills needed by frontline NHS staff to deliver quality improvement: findings from six case studies

2021 ◽  
pp. bmjqs-2021-013065
Author(s):  
David Wright ◽  
John Gabbay ◽  
Andrée Le May
Keyword(s):  
Quality Improvement ◽  
Case Studies ◽  
Care Quality ◽  
Snowball Sampling ◽  
Healthcare Staff ◽  
Frontline Staff ◽  
Care Quality Commission ◽  
Nuanced Understanding ◽  
Practice Knowledge ◽  
The Right

BackgroundPrevious studies have detailed the technical, learning and soft skills healthcare staff deploy to deliver quality improvement (QI). However, research has mainly focused on management and leadership skills, overlooking the skills frontline staff use to improve care. Our research explored which skills mattered to frontline health practitioners delivering QI projects.Study designWe used a theory-driven approach, informed by communities of practice, knowledge-in-practice-in-context and positive deviance theory. We used case studies to examine skill use in three pseudonymised English hospital Trusts, selected on the basis of Care Quality Commission rating. Seventy-three senior staff orientation interviews led to the selection of two QI projects at each site. Snowball sampling obtained a maximally varied range of 87 staff with whom we held 122 semistructured interviews at different stages of QI delivery, analysed thematically.ResultsSix overarching ‘Socio-Organisational Functional and Facilitative Tasks’ (SOFFTs) were deployed by frontline staff. Several of these had to be enacted to address challenges faced. The SOFFTs included: (1) adopting and promulgating the appropriate organisational environment; (2) managing the QI rollercoaster; (3) getting the problem right; (4) getting the right message to the right people; (5) enabling learning to occur; and (6) contextualising experience. Each task had its own inherent skills.ConclusionOur case studies provide a nuanced understanding of the skills used by healthcare staff. While technical skills are important, the ability to judge when and how to use wider skills was paramount. The provision of QI training and fidelity to the improvement programme may be less of a priority than the deployment of SOFFT skills used to overcome barriers. QI projects will fail if such skills and resources are not accessed.

How do explicitly stated hospital trust values relate to their CQC ratings?

BMJ Leader ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 68-70
Author(s):  
Nathan Hamnett ◽  
Naomi Patel ◽  
Kathryn Nelson ◽  
Tom Harrison ◽  
Nicholas White
Keyword(s):  
Quality Improvement ◽  
National Health Service ◽  
Health Service ◽  
Service Delivery ◽  
National Health ◽  
Care Quality ◽  
A Value ◽  
Care Quality Commission ◽  
Organisational Values ◽  
Range Of Values

IntroductionFor National Health Service(NHS) Trusts in the process of setting internal organisational values, it would be useful to see if there was a correlation between certain organisational values and Care Quality Commission (CQC) ratings to enable quality improvement.MethodsTo examine this, we identified the CQC ratings of the NHS England provider trusts and identified and listed the trust’s values. These values were then categorised and a comparison made of well-performing and underperforming trusts.ResultsA total of 43 different values were identified, with a total of 800 values being used across all 188 trusts. In the reviewed hospitals, a broad range of values were found with some not meeting common definitions of what a value is. All trusts included some aspect of behaviour in their values.ConclusionWell-performing hospitals are more likely to be open and honest with aspirational values, whereas those which are not are more likely to be focused on day to day service delivery with operational or proscriptive values. There was considerable variation from the published NHS constitution values with outstanding and good trusts having more variance from the values in the NHS constitution than trusts rated requiring improvement or inadequate.

Creating a Quality-Improvement Dialogue: Utilizing Knowledge From Frontline Staff, Managers, and Experts to Foster Health Care Quality Improvement

2008 ◽  
Vol 19 (2) ◽  
pp. 229-242 ◽  
Author(s):  
Louise E. Parker ◽  
JoAnn E. Kirchner ◽  
Laura M. Bonner ◽  
Jacqueline J. Fickel ◽  
Mona J. Ritchie ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Care Quality ◽  
Care Quality ◽  
Frontline Staff ◽  
Health Care Quality Improvement

scholarly journals What Does a Systems Approach to Quality Improvement Look Like in Practice?

2022 ◽  
Vol 19 (2) ◽  
pp. 747
Author(s):  
Sharon J. Williams ◽  
Stephanie Best
Keyword(s):  
Quality Improvement ◽  
Systems Approach ◽  
Secondary Data ◽  
Healthcare Systems ◽  
Care Quality ◽  
Secondary Case ◽  
Care Quality Commission ◽  
Leadership Structure ◽  
The Uk

Universally improving healthcare systems is difficult to achieve in practice with organisations implementing a range of quality improvement (QI) approaches, in varying and changing contexts, and efforts ranging from project-based improvements to whole system change. This study aimed to identify how organisations overcome the challenges to improving the quality of the services they deliver. Drawing on the eight challenges from the ‘Quality and Safety in Europe by Research (QUASER) hospital guide, we assessed eight cases reported by the UK-based regulator Care Quality Commission as improving their performance. A thematic analysis of these secondary data established that all eight challenges had been addressed or considered in varying degrees. Education and physical and technological challenges seemed less prominent than developments made to address other challenges such as developing leadership, structure, and culture to support improving quality. This paper relies on the analysis of secondary case data and one framework to assess improvement efforts. Further research is required to consider other models and frameworks and to collate longitudinal data to capture the dynamics and increasing the maturity of improving healthcare systems in practice.

scholarly journals How do frontline staff use patient experience data for service improvement? Findings from an ethnographic case study evaluation

2020 ◽  
Vol 25 (3) ◽  
pp. 151-161 ◽  
Author(s):  
Louise Locock ◽  
Catherine Montgomery ◽  
Stephen Parkin ◽  
Alison Chisholm ◽  
Jennifer Bostock ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Patient Experience ◽  
Care Quality ◽  
Service Improvement ◽  
Ethnographic Case Study ◽  
Frontline Staff ◽  
Diverse Range ◽  
Study Evaluation

Objectives Improving patient experience is widely regarded as a key component of health care quality. However, while a considerable amount of data are collected about patient experience, there are concerns this information is not always used to improve care. This study explored whether and how frontline staff use patient experience data for service improvement. Methods We conducted a year-long ethnographic case study evaluation, including 299 hours of observations and 95 interviews, of how frontline staff in six medical wards at different hospital sites in the United Kingdom used patient experience data for improvement. Results In every site, staff undertook quality improvement projects using a range of data sources. Teams of health care practitioners and ancillary staff engaged collectively in a process of sense-making using formal and informal sources of patient experience data. While survey data were popular, ‘soft’ intelligence – such as patients’ stories, informal comments and observations – also informed staff’s improvement plans, without always being recognized as data. Teams with staff from different professional backgrounds and grades tended to make more progress than less diverse teams, being able to draw on a wider net of practical, organizational and social resources, support and skills, which we describe as team-based capital. Conclusions Organizational recognition, or rejection, of specific forms of patient experience intelligence as ‘data’ affects whether staff feel the data are actionable. Teams combining a diverse range of staff generated higher levels of ‘team-based capital’ for quality improvement than those adopting a single disciplinary approach. This may be a key mechanism for achieving person-centred improvement in health care.

Tools in Infection Prevention and Control

2019 ◽  
Author(s):  
Stephanie J. Smith ◽  
Martina N. Cummins
Keyword(s):  
Infection Control ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Care Quality ◽  
Care Bundle ◽  
Code Of Practice ◽  
Care Services ◽  
The Board Of Directors ◽  
Care Quality Commission ◽  
And Control

The Health Act (2008) Code of Practice on the Prevention and Control of Infections and Related Guidance provides a legal statutory requirement to which all hospital trusts in England should abide to ensure the safety of patients and healthcare workers. There are similar laws in both Scotland and Wales. Prevention and control of healthcare- associated infections (HCAI) remains integral to provide safe, quality patient care and requires an effective management team to implement the Act. In July 2015, a revised Code of Practice was introduced for the prevention and control of HCAI. The Code of Practice is also referred to as the ‘Hygiene Code’ and is regulated by the Care Quality Commission (CQC). A requirement of this Act is that the board of directors receive an annual report from the Director of Infection Prevention & Control (DIPC), with acknowledgement of the report and approval of a proposed programme of delivery prior to public release and implementation. All trusts must register with the CQC, whose role is to regulate and inspect care services in the public, private, and voluntary sectors in England. Part of the CQC assessment against the Act includes Outcome 8: Cleanliness and Infection Control. Under this outcome the trust is required to demonstrate compliance. The DIPC within an organization will assume responsibility to provide assurances that criteria are met by ensuring regular committee meetings to discuss compliance with standards, monitoring of trends, and provide strategies to reduce HCAI. The trust has to be made accountable for any infection control issues for their staff and patients and have evidence of a clear framework to provide assurances that safety has been met. The IPC Team will implement a plan across their trust that requires quarterly and annual reports to ensure implementation and remedial actions listed and acted on as appropriate. A care bundle is a set of evidence-based interventions that are grouped together to ensure that patients receive optimal management consistently. Ideally, each part of the bundle should be based on evidence from at least one systematic review composed of multiple randomized control trials. Care bundles have been implemented in England since June 2005.

Practice management

2020 ◽  
pp. 739-777
Keyword(s):  
Vocational Training ◽  
Care Quality ◽  
Ionising Radiation ◽  
Practice Management ◽  
Dental Practice ◽  
Care Quality Commission ◽  
Medical Exposure ◽  
Core Training ◽  
Key Aspects ◽  
And Control

This chapter outlines the fundamental principles of dental practice management including relevant legislation and guidelines. The key aspects of a safe and successful dental practice are covered such as the appropriate implementation of Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) and Control of Substances Hazardous to Health (COSHH) Regulations. In addition, the roles of the Care Quality Commission (CQC) and General Dental Council (GDC) are discussed. Postgraduate vocational training posts now known as Dental Foundation Training and Dental Core Training are explained. The chapter summarizes important considerations for managing a dental team effectively and ways to successfully motivate, train and reward staff are revealed.

Clinical outcomes, quality improvement and professional recertification: lessons from UK cardiac surgery

2010 ◽  
Vol 92 (5) ◽  
pp. 168-169
Author(s):  
Ben Bridgewater ◽  
Owen Nicholas ◽  
Leslie Hamilton ◽  
Graham Cooper
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Clinical Outcomes ◽  
Healthcare Professionals ◽  
Care Quality ◽  
Published Data ◽  
Form Part ◽  
Care Quality Commission ◽  
The Uk ◽  
Cardiac Surgeons

At the time of writing this paper, mortality outcomes for cardiac surgeons in the UK are being updated on the Care Quality Commission (CQC) website. The initial clamour for results to become available followed events in paediatric cardiac surgery at Bristol and recommendations from the subsequent inquiry (see http://www.bristol-inquiry.org.uk/). A decade later these published data remain unique in British medicine. More recently legislation was introduced to regulate healthcare professionals and outcomes data will form part of the evidence required. What are the lessons from cardiac surgery?

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