Necessary measures

All clinicians want to provide patients with the best possible standard of care. Many believe that they can do this by focusing on the individual patient in front of them. Whilst true in itself, the only way clinicians can be certain about the quality of care they provide is by measuring what actually happens and comparing this to established best practice. Only then will clinicians be able to know what action to take to improve the care they provide.

Measuring practice locally against established standards is critical to informing clinicians’ views about the quality of care they provide. Research funded by The Health Foundation has found that national evidence and policy statements about problems in healthcare provision are on their own unlikely to lead to changes in care at the local level(1). For example, fewer than 20 per cent of organisations assessed by the Healthcare Commission met all the audit criteria for heart failure set by The National Institute for Clinical Excellence (NICE) and the National Service Framework in 2005/6(2).

“Although many clinicians know what they would like to improve about their service organisation, sometimes they may need a lot of evidence to persuade them that their individual practice needs to change,” Wendy Buckley, Assistant Director at The Health Foundation, explains. “The only way to really understand whether the care patients are actually receiving is the best possible is to measure and compare individual practice and services with established standards. This is the best way to convince clinicians that practice can improve.” Of course, every clinician is also part of a multi-disciplinary team, in which all members’ actions affect the patient’s outcome. Another purpose of clinical measurement is therefore to understand the impact of the whole team on standards of care, in a way that may not always be apparent to individual clinicians.

Cycles of change 

The clinical audit cycle is a well established way for clinicians to take forward quality improvement work. Using this model, clinicians measure their own practice against established national standards. Once they have data about their own performance, they take action to improve it, and measure again to see if this has been successful.

Making these changes can be hard. Sometimes clinicians do not know how to respond to the results of an audit or do not have access to the support they need. In some cases, results are disputed because of concerns about data reliability or because clinicians fear that managers will use the data to justify cost cutting activities.

Clinicians have reported other barriers to their involvement in quality improvement projects. These include insufficient time or resources, lack of expertise or advice and problems within organisations that make change difficult to achieve. The national context also makes a difference. Recent changes in the NHS structure and continuing reorganisation of services can make it harder for clinicians to engage in quality improvement work, because of disruption to organisations(3).

1. Healthcare professionals’ views on clinician engagement in quality improvement, Huw Davies, Alison Powell and Rosemary Rushmer, The Health Foundation, April 2007.
2. Pushing the Boundaries, Improving Care for People with Heart Failure, Healthcare Commission, July 2007.
3. The Health Foundation, April 2007.