Hate something, change something, make health care better

At present, clinical measurement comes in various shapes and forms. For a number of clinical areas, practice is already being measured and compared against explicit standards.

For example, National Service Frameworks, National Institute for Health and Clinical Excellence (NICE) guidelines and the audits run by the Royal Colleges and professional societies.

Five years ago, national measurement for heart disease found that less than half of eligible patients arriving at hospital received essential treatment within 30 minutes. This finding spurred on changes to be made in how patients were treated. 83% of eligible patients now get their treatment within 30 minutes.

However, as Sir Liam said,we are still not delivering high-quality care in a consistent manner. Part of the problem is that participation rates in clinical measurement schemes are low. It can be difficult for clinicians in hospitals to submit data to national schemes when they are focused on their individual patients’ needs in a pressurised environment burdened down by financial constraints.

For some projects, participation rates don’t go over the 20% mark. Another worry is that funding for measurement has been on the decline for some years now.The Health care Commission’s support has declined and there are virtually no funds for develop development in new areas.

The Health Foundation have made our own small contribution of £4.5 million through our Engaging With Quality initiative.

We’re supporting clinicians across the UK in nine areas of secondary care, ranging from oncology to mental health.We’re collaborating with Royal Colleges and professional organisations to work with multi-disciplinary teams who aim to benchmark and close the gaps between current and best practice in their area. As well as support to set up and run their own measurement systems, the teams receive leadership training to help them change and improve services.

One project led by the Royal College of Psychiatrists is making promising progress in improving the quality of prescribing for serious mental illness. People with mental health problems who take anti-psychotic drugs for long periods can experience harmful side effects and even reduced life expectancy. Better monitoring and management of medication can help combat this. The project has developed an observatory to improve the prescribing of anti-psychotic medicines in relation to best practice.

So far, 40 mental health trusts are on board which accounts for almost one-third of the total. The lead clinicians and patient organisations involved are comparing data from different wards and services to identify where best practice guidelines are and are not being met.They are using this information to draw lessons for improving performance.

Few health care professionals would argue against the value of clinical measurement but there are a number of things that can be done to improve participation and to broaden its limited remit.

A sustainable funding mechanism needs to be put in place to cover nationally accredited schemes. Health care professionals also need more resources to take part – be they financial, access to training, support from management to free up time, and better IT systems that aid electronic data capture.

Most importantly, staff need training in improvement methodology and leadership skills to drive forward change. Like the Honda advert, I’d like to see us change something to make health care better but we can only achieve this if everyone makes measurement a priority.