Delivering results relies on maintaining a strong focus on what is important and setting and managing priorities. There must be a structured approach to managing quality both at a local level but also at scale, where needed, to improve the health and wellbeing for the local population. There are 3 core quality functions that need to be delivered as described in the Juran Trilogy, Quality Planning, Quality Control and Quality Improvement,. The functions are not neatly separated in practice and should be closely linked to each other. Central to this is a need to align to operating models and reframe strategic focus on quality and outcomes along with a commitment for openness and shared learning.
Create vision & plan for quality
The case for quality needs to be at the heart of the planning cycle ensuring there is an understanding of the patient and service users’ needs and expectations and systematic approaches for improvement are adopted to accelerate results. There should be a clear vision for quality across the organisation that is understood by everyone. Effective quality planning helps teams and services identify their priorities and enables testing of interventions to deliver improvements. Setting quality priorities should be guide by insights from staff, service users and organisational intelligence ensuring a proactive approach to future challenges.
Leverage existing knowledge across organisations to identify aligned opportunities for improvement
Leveraging existing knowledge and insights helps teams and organisations understand what matters most. The ability to pull together data and information from multiple sources creates knowledge management and informed decision making. Knowledge management involves identifying, capturing, and utilizing both explicit knowledge (formalized and documented) and tacit knowledge (personal insights and expertise) possessed by individuals, teams patients and service users. The main goal of this approach is to create a learning environment in which new knowledge is continually generated, shared, used and improved. Planning needs to consider the organisational and professional vision to align clear goals for improvement with a focus on those issues which will have the biggest impact. Data should be used to plan internal strategic and local improvement priorities through the local operating cycle based on evidence based practice.
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Ensure Quality control through shared governance
Controlling quality through shared governance engages front line teams in the role of leading quality excellence creating the structure for staff to participate in the decision making process. Measuring and monitoring agreed metrics is complex and multi-faceted, yet vitally important if we hope to establish learning systems with a focus on improvement within and across professions. The integration of information and data must be carried out at different levels of the organisation and across the wider regional system. Some issues are primarily relevant to a particular ward/team or department and should be resolved at that level, only escalating when they prove intractable. This enables good quality control where the people closest to the work have the knowledge, tools and procedures in place to review, reflect and more importantly react, with immediacy, to discrepancies between observed – and agreed – improved levels of performance. Boards need more generic information that has been previously analysed to reflect higher level trends and patterns while regional leaders also need information to inform policy, strategic decisions and forward planning.
Promote professional accountability and assurance
Professional accountability is a commitment that you make to yourself and your career when you become a nurse, midwife or AHP to advance, grow, improve, and adapt to your work. Organisations have a duty to provide safe, high quality care underpinned by accountability and ensuring transparency is included as a critical principle of good governance. People need to be confident about the quality of care they receive from organisations who are providing health and social care. They want services that are readily accessible, are safe, and are provided by competent and confident staff who will always work in their best interests. In order to deliver this nurses, midwives and AHP’s need to have control of their data providing oversight of how their system is performing. Daily visual management of data combined with the empowerment and involvement of staff in decision-making will ensure professional accountability and assurance.
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Develop and improvement learning system
Developing an Improvement Learning System is about coming together around a common challenge, testing new ideas that can make a difference, reflecting and learning to make things better. The foundation of a learning system is a community that connects and influences people and develops their understanding leading to better outcomes for populations. It requires a culture that values curiosity, continuous learning, improvement, and innovation. Achieving and sustaining learning systems requires commitment across organisations and people along with a supporting infrastructure to bring individuals and teams together.
Focus on local and regional improvement priorities enabling participation, collaboration & learning
In almost every part of our lives we are inundated with information and often find difficulty in identifying our priorities and focusing on what is most important. Improvement won’t happen unless people take action using local knowledge along with data to create a sense of purpose and intent. Generating priorities for improvement that resonate with people and are connected to the strategic organisational vision are those that will deliver the best outcomes. Bringing teams together to enable knowledge sharing is critical to enable the scale of best practices across (and up and down) organizations.
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