Our approach to improving health care quality in the UK is based on an analysis of the challenges facing the UK health care system. The large scale, complexity and rising cost of the UK health care system creates significant challenges to achieving high quality care consistently everywhere.
We think that the following factors make achieving consistent high quality care difficult:
- the belief that the most important investment to improve quality is the development of new cures
- there is often failure to translate quickly research findings into practice and many tried and tested interventions have not been implemented
- clinical autonomy can result in a lack of accountability to managers and peers and tolerance of behaviours that add to waste and inefficiencies
- there are many operational deficits, which mean staff have to recover from latent errors within the system
- clinicians only see a snapshot of the patient’s care yet the quality of care is determined by many different process steps provided by many different people.
- the unintended consequences of methods of financing, performance assessment, regulation and organizational structures
- weak workforce design and planning.
Potential solutions
We believe that there can be lasting and widespread improvements to health care quality in the UK. To do this requires:
A sustained focus on continuous improvement in the quality of health services
As well as identifying new cures, demonstrating the clinical effectiveness of new interventions and addressing the underlying determinants of health, better health outcomes can also be achieved by improving the quality of health services. This has been a neglected area and why health systems need to focus on closing the gap between best and current practice. To achieve this, leaders need to know about and be competent in leading for improvement.
An emphasis on the importance of internal (intrinsic) motivators, alongside external (extrinsic) ones
There has been a dominant focus on external drivers to change (e.g. regulation, economic incentives, performance management) when internal drivers of behavioural change (professionalism, skills development, organisational development, leadership) can be a stronger motivator. Both are needed but there needs to be a strong emphasis on finding ways to support and channel the motivations of professionals for greater health gain. Good leadership is critical to achieving the right blend of drivers and in particular appealing to the internal motivators of staff and peers.
Action at all levels of the health care system to ensure they are aligned for quality
To achieve high quality care for every patient every time, there is a need to work across the whole health care system and to ensure the different parts of the system relate to each other in support of quality:
- one to one interactions between a patient and a clinician
- the clinical micro system
- the delivery systems
- interventions designed to achieve change at the national level.
Redefinition of the nature of the relationship between patients and those who provide care
One critical determinant of quality of care is the interaction between patients and their clinical team. To achieve the best outcomes, patients need to be equipped to play an active role in their care and for their care to be personalised. This demands a different approach to the way clinicians and the wider healthcare system engage with patients and local communities.
Building of the knowledge about new techniques/skills and new practices to improve quality
New skills and knowledge need to be developed, for example developing ways to test and analyse what is known about effective care, how to make changes across the system and supporting self-management. In doing so it is important that the organisational factors and human factors that impact on how the NHS system works are taken into account.
