Quality is a complex notion and means different things to different people. So before we challenge ourselves to improve quality, we need to define exactly what it means. The definition of quality is essentially very simple; we see it as the ‘degree of excellence’ in healthcare. Excellence has many dimensions. But within the healthcare sector it is widely accepted that excellent healthcare should have the following six characteristics1:
• Safe – avoiding harm to patients from care that is intended to help them.
• Effective – providing services based on scientific knowledge and which produce a clear benefit.
• Person-centred – providing care that is respectful or responsive to individuals’ needs and values.
• Timely – reducing waits and sometimes harmful delays.
• Efficient – avoiding waste.
• Equitable – providing care that does not vary in quality because of a person’s characteristics.
However, there are tensions among them that need to be balanced – for example, person-centeredness may not always go hand-in-hand with efficiency.A number of solutions that have the greatest potential to make lasting and widespread improvement to health services are:
• A sustained focus on continuous improvement in the quality of health services is needed.
• Emphasise the importance of internal motivators (for example, professionalism, skills development, organisational development and leadership), alongside external ones (for example, regulation, economic incentives and performance management).
• Align quality at every level to make sure that all levels of the system relate to each other in supporting quality.
• Redefine the nature of the relationship between people who use services and those who provide them.
• Build knowledge, skills and new practices, including learning from other sectors that have improved their performance and reliability in highly complex areas.
Most important ingredient to improve quality and achieve sustained improvement. The way in which the change is introduced and implemented. Best outcomes achieved through utilising a combination of change behaviour and systematic change methods and structures
The Key Principles of Leadership and Quality Improvement are the following:
• Vision of what the organisation should look like and agreed strategy
• Agreed role responsibilities for Quality Improvement
• System changes (data collection, rewards, incentives)
• Training and development
• Communication and commitment (Ovretveit 2005)
• Aims of improvement and Board commitment
• Systems alignment ( strategy, projects, leadership learning)
• Channel leadership to system level improvement
• Right people
• Financial support
• Clinicians engagement
• Build improvement capability (Reinersten et al. 2005, IHI 2008)
We should be aware too about the Key Principles to Quality Improvement which are:
• Governance, leadership and management (as opposed to policies and procedures alone)
• In-built quality and safety measures (rewards, penalties for breaches)
• Self-assessment of culture and values (expressive behaviour) –of the organisation are expressed in behaviour of quality improvement approaches, commissioners will be better placed to ask the right questions about providers’ focus on improvement and the progress
• Performance management (setting standards, measurement, corrective action: feedback loop)
• Dialogue and communication with key stakeholders: interaction loop
Focusing on your Service Improvement goals with the organisations strategic goals is needed to achieve those goals which serve the common organisation objective of Improving Quality and Services Improvement.
Adapted from Reinerstein J.The work of pursuing perfection. Cited by NHS Institute for Innovation and Improvement (2005) Improvement leaders Guide: Leading Improvement, Personal and Organisational Development
Challenge to organisations is to implement the change. Change is a necessary condition for survival and in organisations and individuals is a never ending search for improvements to gain competitive advantage. Change is a necessary condition of survival. In fast changing environments not to change is to lose. Change in terms of clinical leadership is to devolve power to frontline staff- to innovate locally. Use the softer term of innovation as it has less connotations to that of the term change. Innovation- term combined with change and progress.
In Core Principles change management for the purpose of patient and service improvement are Diagnosis or assessment, Planning, Implementation and Evaluation.
Innovation in Quality Improvement:
In Finding the Important characteristics of an innovation it will include the following:
• Relative advantage (the degree to which it is perceived to be better than what it supersedes);
• Compatibility (consistency with existing values, past experiences and needs);
• Complexity (difficulty of understanding and use);
• Ability (the degree to which it can be experimented with on a limited basis);
• Observability (the visibility of its results).
The important roles in the innovation process include:
• Opinion leaders (who have relatively frequent informal influence over the behaviour of others);
• Change agents (who positively influence innovation decisions, by mediating between the change agency and the relevant social system);
• Change aides (who complement the change agent, by having more intensive contact with clients, and who have less competence credibility but more safety or trustworthiness credibility
About the Author:
Dr.Hisham M Safadi (Hisham Safadi ) BDS & MSc Leadership and Management in Health Care Practice form the University of Salford where his Master dissertation was in the effect of Emotional Intelligence on improving Dentistry care in Middle East. He was born and raised in the Emirates of Ras Al Khaimah, United Arab Emirates. Dr.Safadi had start his professional career as a dentist then turn to the field of managing medical facilities and investment management. His main interest is business start-up, leadership and mentoring. Currently he is leading several projects in Manchester that is related to enhance patient experience and improving leadership style through education.
– Foundation, H. 2015. What is quality? – Health Foundation. Health Foundation. http://www.health.org.uk/about-us/what-is-quality/, June 12, 2015.
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