Wednesday 8 July 2009

Meaningful measurement - time to turn words into actions

Measuring quality - the fundamental first-step in improving quality
The majority of NHS organisations (and individuals) have no accurate and timely way to measure their performance, nor to compare it with other providers.
In contrast to organisations in the commercial sector, whether at board level (exec and non-exec), through management to clinical, front-line staff there is no rigorous, valid way to allow direct, continuous assessment of the quality of care delivered.

The need to measure quality is more urgent than ever before, due to the reorganisation of services that will be required as a result of budgetary pressures post 2011. To be sure that quality is maintained requires it to be measured before, during and after any changes. Without this organisations are deluding themselves if they think they can be confident about quality of service.

Warning - Merely collecting data on clinical outcomes alone is inadequate:
a. In the majority of clinical areas the quality data required is simply unavailable
b. The Mid-Staffordshire disaster shows that current data sets collected are wholly inadequate to accurately monitor service provision with the granularity or timeliness required - Mid-Staffs data was insufficient for the Chief Exec, non-execs, clinical staff, Monitor or the HCC to have visibility of reality
c. Clinical outcomes alone are only half of the equation (quality = outcomes X experience). The NHS cannot understand or assess quality until patient experience is approached with the same seriousness and importance as is monitoring and response to hospital-acquired infection. This requires new thinkning and innovative use of IT driven systems to collect and visualise the data
d. Data itself has little or no value - impact on organisational performance and quality are only realised when the information is accessible, understood and integrated in the systems and processes of the organisation, e.g. enables culture-change. When this is achieved it is proven to deliver improved outcomes, decreased litigation and decreased staff-turnover - all massive clinical and financial benefits to the NHS and patients.

Thus the challenge (and opportunity) is how to provide every NHS (and private-sector) organisation with the insight and understanding required to measure and improve quality. Successfully enabling this will reveal areas of quality excellence, as well as rapidly and accurately identifying areas for improvement.

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