Quality planning, control and improvement

To help create a coordinated and consistent approach to managing quality EiC promotes the use of the principles of Healthcare Improvement Scotland’s QMS. The EiC framework incorporates the elements of the QMS to ensure a consistent approach to quality improvement. Quality planning, quality improvement and quality control are key components of the EiC framework and fundamental to maintaining and improving the consistent delivery of high-quality care.

To support local teams to access quality data a core function of the EiC national programme has been the development of the CAIR dashboard.

Quality planning

Joseph Juran famously described quality planning within manufacturing as 'a systematic process for developing services and processes that ensure customer needs are met' (31). Over the last 30 years Juran’s process has been adapted within healthcare to deliver improved patient experience through understanding the unmet needs of the service user (31) with quality planning being a key component of this process. Quality planning relies on mechanisms which help teams and services to identify their priorities for improvement and then design the right interventions to deliver improvements. The three main sources of discovery which should feed quality planning processes are:

quality control and/or quality assurance mechanisms
work to understand the population/customers’ needs and assets
government strategies and targets

Quality control

Understanding, monitoring and controlling variation in clinical variables is an integral part of clinical practice (32). Quality control covers the processes that are in place to monitor performance in real time and then take action when results don’t match the agreed performance standards. Ideally quality control processes should be owned by those directly providing the service. This means care delivery teams understand what good looks like, have real time data (quantitative and qualitative) to know if they are meeting those performance standards, have the skills and permission to address the quality/performance problems within their control, and know who else to involve in addressing the ones beyond their control.

The development of nationally agreed measures of quality for nursing and midwifery and the development of the CAIR dashboard supports local teams to access quality measurement data that will help them identify and plan improvements within their own area of practice. These developments are a core component of the EiC National Programme.

Quality improvement

The term ‘quality improvement’ refers to the systematic use of methods and tools to try to continuously improve quality of care and outcomes for patients (33). There are various methods and tools, but they enable some common principles:

knowing why there is a need to improve
being able to interpret if improvement is happening through measurement
developing an effective change theory which will result in improvement
testing a change before moving to implementation
knowing when and how to implement a change