Whole System: Quality ​A Unified Approach to Building Responsive, Resilient Health Care Systems

Whole System Quality: ​A Unified Approach to Building Responsive, Resilient Health Care Systems
IHI White Paper 18 August 2021

• This IHI White Paper proposes a holistic approach to quality management — whole system quality — that enables organizations to close the gap between the quality that customers are currently receiving and the quality that they could be receiving by integrating quality planning, quality control, and quality improvement activities across multiple levels of the system.

How to sustainably build capacity in quality improvement within a healthcare organisation

How to sustainably build capacity in quality improvement within a healthcare organisation: a deep-dive, focused qualitative analysis.
BMC Health Serv Res 21, 588 (2021). https://doi.org/10.1186/s12913-021-06598-8

• An Australian study of existing QI projects found that four interacting components lead to successful implementation of quality improvement projects and the overall program that facilitates or support these: an agreed and robust quality improvement methodology, a skilled faculty to assist improvement teams, active involvement of leadership and management, and a deep understanding that teams matter.

Abstract

Whole system quality: a unified approach to building responsive, resilient health care systems - IHI White Paper

Whole system quality: a unified approach to building responsive, resilient health care systems
Institute for Healthcare Improvement White Paper June 2021

• This paper describes a more holistic approach to quality management. Through a process of rigorous learning, health care organizations can design resilient and responsive management systems to continuously deliver services that reliably and sustainably meet the evolving needs of patients, populations and communities – in times of both stability and crisis. 
• Free registration is required to access this paper.

Quality improvement in general practice: what do GPs and practice managers think?

Quality improvement in general practice: what do GPs and practice managers think? Results from a nationally representative survey of UK GPs and practice managers
BMJ Open Quality 2021;10:e001309. doi: 10.1136/bmjoq-2020-001309

• Results of the first UK-wide survey of NHS GPs (n=2377) and practice managers (n=1424) designed to explore the service improvement activities being undertaken in practices, and the factors that facilitated or obstructed that work. Ninety-nine per cent reported having planned or undertaken improvement activities in the previous 12 months. 
• The most frequent related to prescribing and access. Key facilitators of improvement included ‘good clinical leadership’. The two main barriers were ‘too many demands from external stakeholders’ and a lack of protected time. Audit and significant event audit were the most common improvement tools used, but respondents were interested in training on other quality improvement tools.

"Enjoying work takes work"

“Enjoying Work Takes Work” [blog]
IHI 12 May 2021

• An overview of the quality improvement work at East London NHS FT including their use of the IHI Framework for Improving Joy in Work to support their Enjoying Work programme.

Quality Improvement made simple

Quality improvement made simple: What everyone should know about health care quality improvement
Health Foundation updated April 2021

• A guide on quality improvement designed for health care staff leading fast and efficient service change as a result of the pandemic. The guide offers an explanation of some popular approaches used to improve quality, including where they have come from, their underlying principles and their efficacy and applicability within the healthcare arena. It also describes the factors that can help to ensure the successful use of these approaches and methods. to improve the quality of care processes, pathways and services.

Special measures for quality: a Q&A on the impact of improvement interventions in NHS trusts

Special measures for quality: a Q&A on the impact of improvement interventions in NHS trusts
Nuffield Trust 21 April 2021

• Conversation with Naomi Fulop and Chris Sherlaw-Johnson about their work evaluating improvement interventions in NHS trusts who were in special measures for quality.

How to make good group decisions: Simple tips to help organisations become more collectively intelligent

How to make good group decisions: Simple tips to help organisations become more collectively intelligent
NESTA 9 April 2021

• This report brings together simple, accessible tips to help organisations become more collectively intelligent and make better group decisions. From idea generation to evaluation, it describes how each stage of the decision making process can be optimised to make the most of the skills in the team and beyond.

What drives GPs in the UK to improve the quality of care? A systematic literature review

What drives general practitioners in the UK to improve the quality of care? A systematic literature review
BMJ Open Quality 2021;10:e001127. doi: 10.1136/bmjoq-2020-001127

• An examination of the evidence behind current incentive schemes available in general practice in the UK found that the majority of research examined QOF. QOF positive effects included reduced mortality rates, better data recording and improved sociodemographic inequalities. However, limitations involved decreased quality of care in non-incentivised activities, poor patient experiences due to tick-box exercises and increased pressure to meet non-specific targets. Findings surrounding competition were mixed, with limited evidence found on the use of non-financial incentives in primary care.

Equity, health inequality and quality improvement

Equity, health inequality and quality improvement Discussion Paper
Healthcare Improvement Scotland December 2020

• This paper was developed as an internal working document to inform discussions around QI planning and measurement within Healthcare Improvement Scotland.
• See Equity, health inequality and quality improvement [blog] Health Foundation 3 February 2021
Q member, Sharon Wiener-Ogilvie shares Healthcare Improvement Scotland's recent work around incorporating inequalities into QI work.

Guide to evaluation design: principles and practice.

Guide to Evaluation Design, Principles and Practice
Midlands Decision Support Centre [December 2020]

• This guide has been produced to take you through the evaluation process, and considerations, in designing and delivering a high quality service evaluation. It begins with an introduction to evaluation and how it should be used, followed by sections on: who to involve in developing the evaluation design; governance and ethics; resourcing; the main qualitative and quantitative approaches; and how to report your findings.

Patient safety BMJ Improvement Hub

Patient Safety 
BMJ Improvement Hub

• A collection of quality assessed resources to help you improve patient safety. 
• Other topics in the BMJ Improvement hub are on Mental health, leadership, and patient centred care.

CQC regulation and quality of health and care services

CQC regulation and quality of health and care services, September 2020

• Three pieces of research have been carried out to look into areas where CQC’s regulation has contributed to improving the quality of health and care services, and how it can be improved.
• CQC’s impact on the quality of care
• Rapid literature review on effective regulation: Implications for the Care Quality Commission
• Evaluation of the healthcare services well-led framework

What influences improvement processes in healthcare? A rapid evidence review

What influences improvement processes in healthcare? A rapid evidence review
RAND 15 September 2020

• The Healthcare Improvement Studies (THIS) Institute commissioned RAND Europe to conduct a rapid evidence review of the academic and grey literature, to draw out initial learning about what influences quality improvement processes in healthcare, and to inform potential themes to explore in future research.
• The reviewers identified and reviewed 38 academic and 16 grey literature publications covering diverse improvement approaches. Some examples include Six Sigma, Lean, Business Process Reengineering, Plan-Do-Study-Act, clinical audits and feedback, quality improvement collaboratives and peer-learning communities, training and education interventions, and patient engagement and feedback-related interventions.
• Based on the reviewed literature, six key factors influence the implementation of improvement efforts: 
• Leadership; 
• Relationships and interactions that support an improvement culture; 
• Skills and competencies; 
• Use of data;
• Patient and public involvement, engagement and participation; and 
• Working as an interconnected system of individuals and organisations, influenced by internal and external contexts

A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches

A Guide to Patient Safety Improvement: Integrating Knowledge Translation & Quality Improvement Approaches
Canadian Patient Safety Institute 2020

• This Guide is intended to accompany current best available evidence change ideas, and tools and resources for your specific project. It includes ideal practice changes “the what” and strategies “the how” that creates the evidence-based intervention.

How to design, implement and evaluate organizational interventions for maximum impact: the Sigtuna Principles

How to design, implement and evaluate organizational interventions for maximum impact: the Sigtuna Principles
European Journal of Work and Organizational Psychology, DOI: 10.1080/1359432X.2020.1803960 

• This discussion paper aims to offer a set of principles, grounded in knowledge from various disciplines that can guide researchers in designing, implementing, and evaluating organizational interventions. 

ABSTRACT

How to move beyond quality improvement projects

How to move beyond quality improvement projects
BMJ 2020; 370:m2319 doi: https://doi.org/10.1136/bmj.m2319 (Published 27 July 2020)

• A practice note by Amar Shah, chief quality officer, East London NHS Foundation Trust; national improvement lead for the Mental Health Safety Improvement Programme, NHS Improvement and RCPsych; quality improvement lead and chair of QI faculty, Royal College of Psychiatrists.
• Key points:
• Quality improvement, by itself, does not represent a holistic approach to managing quality
• Quality improvement needs to be used alongside quality planning, quality assurance, and quality control to create a single, consistent management system
• Knowing when and how to use each of these four approaches, and creating an appropriate balance across all four, is the gold standard

Demonstrating the value of postgraduate fellowships for physicians in quality improvement and patient safety

Demonstrating the value of postgraduate fellowships for physicians in quality improvement and patient safety
BMJ Quality & Safety 2020;29:645-654.

• Graduates and mentors of two postgraduate quality improvement (QI) and patient safety (PS) (QIPS) fellowship programmes for physicians embedded within two US academic medical centres were interviewed using newly developed interview instruments.The conceptual framework developed may be useful to other academic medical centres seeking to develop fellowships for postgraduate physician training programmes in QIPS.

Abstract

The barriers and facilitators influencing the sustainability of hospital-based interventions

The barriers and facilitators influencing the sustainability of hospital-based interventions: a systematic review.
BMC Health Serv Res 20, 588 (2020). https://doi.org/10.1186/s12913-020-05434-9

• This study aimed to identify, appraise and synthesise the barriers and facilitators that influenced the delivery of sustained healthcare interventions in a hospital-based setting. A systematic review identified 32 interventions or programmes all of which were multicomponent with the majority aimed at improving the quality of patient care and/ or safety. Key facilitators included clear accountability of roles, strong leadership , support at organisational level. The most frequently reported barrier to sustainability was inadequate staff resourcing.

An evaluation of the clinical microsystems approach in general practice quality improvement

An evaluation of the clinical microsystems approach in general practice quality improvement
Primary Health Care Research & Development volume 21, 23 June 2020. doi.org/10.1017/S1463423620000158

• A clinical microsystem (CMS) is defined as a ‘small group of people who work together on a regular basis to provide care to discrete subpopulation of patients". This study was commissioned by a CCG in South East England that introduced CMS within its member practices in 2013 and supported a funding stream to enable this. 
• This evaluation explored the experiences of GP staff participating in a CMS and suggest that CMS relies on: establishing a contract between coach and GP to promote buy-in; a flexible approach; identifying a champion at the outset; the use of outcome measures that demonstrate not only the impact on process and systems but also the wider benefits for staff and patients; and follow-up after completion of a project to boost motivation, review progress and refresh skills.

Abstract