Quality improvement

What is quality improvement?

Quality improvement is an important element of the quality agenda. It aims to improve patient experience and outcomes by taking a systematic approach that uses specific techniques to improve quality. These approaches are often known as ‘organisational’ and ‘industrial’ methods, as their origins are in the manufacturing industries.

The approaches help organisations to analyse performance and make systematic changes in order to improve quality. At the Health Foundation, we work with the health service to apply quality improvement approaches to healthcare to ultimately deliver better quality care to patients.

Quality improvement methods

There are many methods for formal quality improvement. Many of these methods originally gained popularity in Japan and were adapted for use in Western manufacturing industries, but are now widely used to support quality improvement in healthcare and other sectors.

Quality improvement draws on a wide variety of methodologies, approaches and tools. Many of these share some simple underlying principles, including a focus on:

• understanding the problem with a particular emphasis on what the data tell you
• understanding the processes and systems within the organisation – particularly the patient pathway and whether these can be simplified
• analysing the demand, capacity and flows of the service
• choosing the tools to bring about change, including leadership and clinical engagement, plus staff and patient participation
• evaluating and measuring the impact of a change.

These methods include:

• Business process re-engineering. Fundamental rethinking of how processes are designed, with change driven from the top by a visionary leader, and organisations set up around key processes rather than specialist functions.
• Collaboratives. Groups of hospitals or health economies addressing the same problems as each other, and learning from each other’s experience.
• Lean. A quality management system developed by the Japanese car manufacturer Toyota, focusing  on value, flow and waste reduction.
• Plan, Do, Study, Act (PDSA). An approach to continuous improvement where changes are tested in small cycles.
• Six Sigma. A process or product improvement approach that focuses on reducing what customers would define as ‘defects’.
• Statistical process control. Examines the difference between natural variation (common cause) and special cause variation, and enables data to be collected over time to show whether a process is within control limits.
• Total quality management (TQM). Also known as continuous quality improvement. Emphasises the need for leadership and management involvement to understand work processes.

Others include: ISO standards, Kaizen methods, Kansei engineering, object oriented quality management, quality circles, Taguchi methods, TRIZ, zero defect programme.

What does quality improvement mean for the NHS?

In the NHS there are three main priorities for using quality improvement methods:

• applying existing methods to help improve organisations and services
• developing new tools and resources specific to the NHS
• developing indicators and tools to measure quality improvement.

A number of organisations are applying methods such as lean, six sigma, PDSA cycles, continuous improvement and statistical process control in their day-to-day work. For example, the Patient Safety First campaign in England encouraged all trusts to use PDSA cycles to roll out improvements in patient safety and to map progress using statistical charts.

Various guides, such as the Department of Health’s ‘Improving quality in primary care’ have been issued to help clinicians and managers apply these concepts in the NHS. In addition, NHS Improvement has been set up to disseminate good practice regarding the QIPP (quality, innovation, productivity and prevention) agenda and key national clinical priorities. The NHS Improvement System is an online tool to support NHS staff share quality improvement resources and success stories.

New tools and techniques are also being developed, For instance, the NHS Institute for Innovation and Improvement’s ‘productive series’ of toolkits combines new and existing quality improvement approaches to drive up quality and productivity. The series includes toolkits for use on hospital wards, in community hospitals and services, operating theatres, mental health wards and leadership teams.

Measuring the benefit of quality improvement initiatives is a priority. The NHS Information Centre and the Department of Health have identified an evolving set of quality improvement indicators, known as the Indicators for Quality Improvement (IQI). Their purpose is to bring validated indicators together to help organisations benchmark and measure quality and to encourage local teams to improve services.