- Date published
- April 2007
- Pages
- 3
- Download publication [35kb PDF]
1. Thank you for the opportunity to comment on the Healthcare Commission’s proposals for the annual health check in 2007/8.
2. The Health Foundation is an independent charitable foundation working to improve the quality of healthcare across the UK. Our endowment enables us to spend at least £20 million each year to make UK healthcare the best it can be. Our programmes include leadership development, demonstration projects in healthcare organisations involving clinicians, managers and patients, commissioned research, and evaluation studies.
3. We agree with the Healthcare Commission that some of the Standards for Better Health are too detailed and could be simplified. We therefore support the Department of Health’s intention to review the standards as part of the alignment of standards for the independent sector and NHS providers. As part of this review, we would welcome the opportunity to share what we have learnt so far about how an organisation can best achieve continuous quality improvement.
4. With regard to the specific proposals for the health check in 2007/8, our response focuses on three areas: patient safety, development of staff and measuring the quality of patient care across care pathways.
Patient Safety
5. We are very pleased that the 2007/8 health check will focus on patient safety. It is important that we work together to broaden the focus of patient safety to go beyond compliance with infection control measures. Ensuring the safety of everyone who uses health services is one of the most important challenges facing healthcare today. That is why through our Safer Patients Initiative we are supporting 24 hospitals across the UK to test ways to reduce adverse patient safety incidents by 30% and patient mortality rates by 15%. This initiative is showing that with the right skills and focus, patient safety can be significantly improved.
6. In our view, the most important safety standard is Developmental Standard D1. This is because it is the only standard which expects healthcare providers to work proactively to improve patient safety. The other core standards assess how providers respond to harm once it has already occurred. These are essential, but the hospitals involved in the Safer Patients Initiative report that the biggest improvements in patient safety occur when they proactively seek out harm. This means that they put in place measures to reduce the likelihood of harm occurring as well as having systems in place to learn from and act on adverse incidents.
7. We believe that there are many ways to assess whether hospitals are proactively working to improve safety. Evidence could include hospitals having in place systems for monitoring and acting on key patient safety indicators. Most UK hospitals do not have these systems in place. They do not measure and/or act on critical data like hand hygiene compliance, outcomes from emergency “crash” calls, or infection rates following surgery. One of the Chief Executives involved in the Safer Patients Initiative told us that measuring adverse events to get a baseline for the initiative is new work for many hospitals like his own. This data has been critical for the hospitals involved to understand the current situation, to work out where change is needed and when implemented to understand if the change led to improvements in safety. The involvement of the senior leadership team in reviewing information on patient safety has also proved to be key in making sustainable improvements.
8. We would welcome the opportunity to share with the Healthcare Commission other learning from the Safer Patients Initiative to help develop the standards further. Other examples of the types of action the hospitals are taking to proactively improve safety include linking the complaints database with the organisation’s risk register and creating processes to elicit clinical views on areas of patient risk. We think such work should be recognised by the developmental standards.
Development of Staff
9. The consultation asks for suggested indicators to assess the quality of management of human resources by NHS providers. From what we have learnt about the importance of leadership in quality improvement, we think that the way providers identify and develop future clinical and management leaders should be a key indicator. This is important because the increasing complexity of the healthcare system requires competent and engaged leaders, particularly clinicians, if changes in clinical practice are to be systematic and sustained.
10. Providers should for example:
- Have strategies to develop clinical leaders throughout the organisation, with an explicit aim of developing leadership skill in quality improvement.
- Proactively identify potential clinical and managerial leaders and support them through leadership development, including action learning sets as a mechanism to spread good practice
- Support staff through work-based and multidisciplinary development programmes that focus on quality improvement and developing leadership across teams.
Measuring the quality of patient care across care pathways
11. We are pleased that the Healthcare Commission is developing methods to measure the quality of patient care across care pathways and we welcome the proposal to use patient reported outcomes. This is becoming increasingly important as many different organisations may be involved in the care of the patient and NHS reform is likely to increase this.
12. Funded through our programme, Quest for Quality and Improved Performance (QQUIP), researchers are investigating ways to bring together clinical and financial information on cardiac care and stroke care to assess quality. This work will lead to the development of a small number of indicators of quality. We would be most willing to work with the Healthcare Commission in this area and to share our findings with you.
13. We think that clinical measurement has an important role to play in this area. We are funding a number of clinical audits which examine the degree to which current practice is in line with best practice. The annual health check should continue to place an expectation on hospitals and clinical teams to participate in these audits and to use them as a mechanism for improving quality. It is critically important to ensure that hospitals measure the effectiveness of their care and how it compares over time and against the highest performing clinical services. In particular we think that the Healthcare Commission should ensure sufficient resources are allocated to funding clinical measurement.
Conclusion
5. At a time when there is ongoing debate about the need to reduce the costs of regulation we believe that the role of the Healthcare Commission in improving quality is critical. The evidence shows that regulation and standards can lead to quality improvement.
6. Finally, we think the Healthcare Commission’s standards should focus on assuring the public and patients that healthcare providers have systems, processes, training and clinician engagement necessary to underpin a strategy for the continuous improvement of quality of care.
For further information please contact:
Zoe Ward Public Affairs Adviser
Telephone: 020 7 257 8051
Email: Zoe Ward
Reference
1. Sutherland, K, and Leatherman, S, 2006, Regulation and quality improvement: a review of the evidence, Sept 2006, The Health Foundation
