Comment

• Rules of engagement

Research report

• Healthcare professionals’ views on clinician engagement in quality improvement

Case study

• Developing resources for people with insomnia

Briefing

• Measuring up: What impact are national clinical measurement schemes having on the NHS?

Feature

• Hate something, change something, make healthcare better

Rules of engagement

Wendy Buckley, Assistant Director, The Health Foundation

Prime Minister Gordon Brown was clearly serious about a new style of politics with his ‘cabinet of all the talents’. The appointment of an experienced surgeon, Professor Sir Ara Darzi, as Health Minister marks a welcome change in the government’s approach to the clinical professions, who have sometimes been viewed more as barriers to change than key partners in it.

One of Professor Darzi’s first challenges in his new role will be to re-engage clinicians disillusioned in the government’s work. It is vital that, in doing this, he does not overlook the importance of engaging clinicians in quality improvement.

The extent of the task is underlined by a literature review commissioned by The Health Foundation. The report, Healthcare professionals’ views on clinician engagement in quality improvement, concludes that the non-engagement of clinicians is a “long-standing, multifactorial and international problem”. It highlights a number of barriers, including substantial institutional barriers and scepticism that quality improvement initiatives will actually translate into improvements in practice.

The authors found that healthcare professionals generally support quality improvement as a concept. However, there is widespread concern about the amount of additional work and paperwork it generates, which is perceived as diverting effort, time and resources away from direct patient care.

In addition, the report shows that many healthcare professionals, especially doctors, believe that they are already providing excellent or above average care. Yet there is now a great body of evidence that this cannot always be the case.

We have now commissioned follow up research to move beyond healthcare professionals’ perceptions about quality to a study of what they actually do. Our next report will provide robust evidence of quality improvement activities currently being carried out by clinicians and managers and the context to help us better understand how engagement can be facilitated.

On a more practical level, we have also set up two demonstration projects, the Engaging with Quality Initiative and Engaging with Quality in Primary Care, to test out ways of engaging clinicians in quality improvement. Eighteen teams across the UK are addressing healthcare issues where there are gaps between current and best practice, such as maternity services, mental health, kidney disease, back pain, domestic violence and insomnia.

We believe that if clinicians are really to improve the quality of care that patients receive, then they need to start with the crucial first step of finding out how good the quality of their services currently is and then using that information to make improvements. We embed clinical quality measurement in all our award schemes and we are using every opportunity to argue for the national governments to ensure that a sustainable infrastructure is put in place for clinical quality and patient reported outcome measurement.

At The Health Foundation, we are doing all we can to find better ways to engage clinicians in quality improvement. If the government is serious about improving the quality of healthcare in the UK, it is vital that Professor Darzi and his colleagues also consider what the Department of Health can do to engage clinicians in quality improvement. This should include more resources for clinical measurement, more support for implementing change and a sustainable system for the future. I hope that the learning coming out of our research and demonstration projects will help Professor Darzi to do that.

Respond to author

Research report

Healthcare professionals’ views on clinician engagement in quality improvement

It is widely accepted that the active involvement of staff is an essential requirement for quality improvement, yet such initiatives in the NHS have not generally secured the full engagement of clinicians. This literature review seeks to clarify what is already known about the views of UK healthcare professionals in this area.

Case study

Developing resources for people with insomnia

Around one in ten people suffer chronic insomnia, which occurs on a regular basis or over a long period of time. This project aims to improve treatment for people with insomnia by promoting a range of treatment options beyond sleeping pills, which carry the risk of side effects and addiction.

Briefing

Measuring up: What impact are national clinical measurement schemes having on the NHS?

This briefing provides an overview of The Health Foundation’s Engaging with Quality initiative, including an in-depth case study of a project looking at improving prescribing practice for mental health. It also considers emerging policy findings from the scheme.

Feature

Hate something, change something, make healthcare better

Stephen Thornton, Chief Executive of The Health Foundation, argues that without meaningful information and good clinical measurement we cannot improve healthcare.