Read Standard 2: quality management and continuous improvement

Rationale

Implementing a whole-system approach to quality means the organisation learns how to continually, reliably and sustainably meet the changing needs of staff, service users and communities.^{3, 4, 23} A coordinated and consistent way of managing quality ensures an interconnected approach to planning, improving, maintaining and assuring high-quality care. Whole-system quality management requires commitment and capacity to drive continuous improvement.²⁴ Proactive management of quality requires organisations to identify and plan improvement before issues arise.

An effective quality management infrastructure is essential for the delivery of high-quality care. Organisations benefit from, and share expertise through, continuous learning and planned improvement. This enables learning, sharing of data and identification of ‘bright spots.’ A learning system, with data and intelligence from different sources, allows services and systems to understand and plan more effectively, be responsive to the needs of their local populations and share good practice.²⁵ See also Standard 7 on data and information.

References

Criteria

2.1

Organisations demonstrate a robust governance and oversight process for monitoring the quality and safety outcomes of clinical services.

2.2

Organisations implement a systematic and evidence-based whole-system quality management approach that covers all clinical services.

2.3

Clinical services demonstrate participation in the collection and monitoring of relevant data to inform planning and improvement.

2.4

Organisations have processes to monitor service and system data to identify and respond to:

signals of safety or quality issues
areas of learning and good practice.

2.5

Organisations have systems and processes in place to improve the quality and safety of clinical services across the whole system by:

participating in local improvement work, national datasets and research
sharing intelligence and learning
embedding and sustaining good practice.

2.6

Organisations collect anonymised demographic data in their population and use this data to reduce health inequalities in:

clinical and health outcomes
quality of care.

2.7

Clinical services use local data and intelligence, including people’s experiences of services, to:

understand their service or system
identify issues with quality or safety
address gaps or inconsistencies in data collection
develop intelligence-led improvement plans
monitor the impact of improvement plans on quality or safety.

2.8

Staff use appropriate evidence-based tools and improvement approaches to undertake tests of change and demonstrate innovation in their clinical teams and services.

2.9

Organisations have processes in place to support tests of change in clinical services within an agreed quality management system.

What does this standard mean for...

What does the standard mean for people?

You can be confident that organisations and services are always learning to make your healthcare better and more equitable.
Organisations monitor their own clinical services so they can understand where improvements are needed.
You can be confident that services will share their learning with other clinical services.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

manage quality and safety in a coordinated and interconnected way to plan, improve, maintain and assure high-quality and safe care
continuously improve care and treatment
undertake local improvement work and tests of change
understand their role in improving quality across the whole system
implement innovative practice and share learning.

What does the standard mean for the organisation?

Organisations, in line with their respective governance and delivery structures:

actively monitor the quality of clinical care they deliver through established governance and oversight frameworks
have a system to receive applications for tests of change
use data and intelligence to monitor and improve the safety and quality of their clinical services
work collaboratively with other organisations to share learning and improve safety and quality of care
implement a whole-system evidence-based quality management system.

Benchmarking and measuring performance: Examples of what meeting this standard might look like [linked criteria]

Examples may vary according to the size and scale of the service, NHS board, organisation.

Identification of GP practice quality lead to prioritise quality improvement activity. [2.1]
Implementation of a quality management system for all clinical services at all levels of the organisation. [2.2, 2.9]
Individual GP practice quality audit. [2.3, 2.4]
Participation in national audits, self-assessment, benchmarking and registries. [2.3, 2.4]
Evidence of improved outcomes as a result of quality improvement activity. [2.5]
Locality improvement work though primary care partnerships or clusters. [2.5]
Participation in national forums and informal intelligence sharing networks. [2.5]
Evidence of intelligence-led improvement plans. [2.6, 2.7]
Use of accessible data dashboards, including progress against key indicators for quality reporting at board level or equivalent. [2.4, 2.7]
Provision and uptake of staff education and training in quality improvement methodology relevant to their role and responsibilities. [2.8, 2.9]
Minutes and actions from governance and oversight forums evidencing discussion and scrutiny of service and system data to identify signals of safety or quality issues. [2.1, 2.4, 2.7]