Quality management systems: a way for health care leaders to address pressing challenges in health care

Staff shortages, outdated facilities, financial constraints, quality concerns and loss of productivity all feature in the oft-repeated catalogue of issues facing the health care sector in the UK and Ireland. Grappling with these issues alongside long-term system transformation and an evolving regulatory and policy environment can make it challenging for health care leaders to prioritise improving quality of care.

Senior leaders of health care organisations need strategic tools that are flexible, enabling them to mobilise their organisations to support short-term priorities and systemic long-term change. This is where a Quality Management System (QMS) approach can help.

A Quality Management System connects an organisation's strategy to front-line teams' day-to-day work. It can build shared purpose, reduce quality and safety defects, align quality initiatives with organisational goals, equip boards with a systemic means to track progress and, ultimately, improve performance, productivity and patient outcomes.

Growing interest in Quality Management Systems

QMS isn’t something new. This approach builds on what organisations are already doing to improve the delivery of care, the engagement of staff and the experience of patients and service users. QMS have gathered momentum in the UK through growing policy attention including national commitments in Scotland and Wales and as a core part of England’s NHS IMPACT framework – where it features as one of five pillars essential for the embedding and adoption of continuous quality improvement.

Support for QMS is widespread:

Q’s work to build understanding of QMS in health care

The Q community collaboratively accelerates the improvement of care in the UK and Ireland through sharing insights to address health system challenges. Building on years of convening on QMS, our recent work highlights how health care leaders can set clear vision, direction and culture for their organisation through a QMS approach.

Despite wide interest in QMS, most health care organisations are at the early stages of a fully developed QMS, with relatively little shared evidence on progress. In this context, Q set out to better understand QMS as part of a long-term quality journey. We reviewed the literature, spoke with 15 leaders and developed seven case studies of provider organisations who have made progress on QMS. These case studies include:

• Aneurin Bevan University Health Board
• East London NHS Foundation Trust
• NHS Lanarkshire

The seven case studies show how QMS are being adopted in reality, showcasing the different journeys organisations have taken. They demonstrate that embedding a QMS is not a one-size-fits-all approach, but depends on different starting points, available resources, and the challenges that each organisation need to navigate. 

Recommendations for local NHS leaders

Through engagement with a wider group of experts and leaders, we co-developed nine recommendations. These cover:

• the importance of leadership (in setting the vision, direction and culture for QMS)
• building strong foundations (with meaningful shared language and positioning)
• the need to involve patients and invest in good data infrastructure
• developing the QMS evidence base for ongoing learning.

You can download a postcard setting out the nine recommendations for senior leaders.

The role that national leaders can play in QMS

National leaders have a clear interest in helping providers mature their approach to managing quality. They can support by: 

• adopting a clear and consistent definition of whole-organisation QMS, ensuring guidance balances technical clarity and necessary flexibility
• developing a national support offer for QMS, with tools, resources and opportunities for peer learning (building on the work of Q and others)
• offering a supportive regulatory approach – including in the face of multiple strategic demands.

For instance, the recent Dash review (into the operational effectiveness of the Care Quality Commission) concluded that, ‘A greater focus on how organisations are approaching and delivering improvement, rather than looking at input metrics, could enable more significant improvements in quality of care.’

There is also a need for national bodies to set out how QMS can function at different levels of the system. This should involve modelling the interconnected approach to quality management in national policies and planning guidance – including as part of the proposed quality strategy for the NHS in England.

Q’s insight work shows the promise of QMS in supporting the delivery of high-quality care, but sustained and concerted effort at all levels will be required to realise the full potential of QMS.