Strategic Context

This pillar emphasises the importance of actively engaging people in their care and in promoting shared decisioning making. Additionally this involves the development of robust co-design mechanisms and a systemic collection of care experience feedback (including complaints) as critical measure of quality and evidencing how this feedback has been utilised to improve care. This includes evidence of openness and transparency within and across patient/care safety issues.

The Quality Excellence Framework prioritises lived experience, ensuring effective co-production and co-design in healthcare. The framework aligns with provider organisations statutory PPI obligations. This reflected in the following domains of the framework.

• Patient & Population Needs
• Improving Population Health
• Enhancing the Safety & Experience of Care
• Advancing Health Equity

The maturity matrix requires evidence of shared decision-making process with patients, families, and communities, alongside evidence of co-production in service design. This also includes. demonstrating effective analysis and response to complaints, using insights to drive sustainable learning and improvement. The matrix also requires evidence of a systemic approach to person-centred care including the structured collection of person-centred outcomes. Finally, the framework requires evidence of "making every contact count" and evidence of the adoption of population/public health lens to care delivery.

Clinical Effectiveness focuses on the robust application of the best available evidence to inform clinical decision-making, practices and pathways. This also includes high fidelity implementation of professional and regulatory requirements and guidelines. It includes providing assurance through clinical audit, that professionals are maintaining standards and using the best available evidence and research in order to provide the best possible outcomes for people. It requires the development of robust clinical governance infrastructure for the implementation of learning, new standards and guidelines as they are developed. This also includes investing in quality improvement, simulating clinical/care system innovation and research.

The framework positions clinical effectiveness as a cornerstone of quality. It seeks evidence of both the application and generation of best practice within and across all care pathways. This is reflected across key domains, including a strategic approach to

• Professional development
• Continuous analysis and learning through accountable structures
• Quality control, & fostering a culture of shared governance
• Enhance patient safety and experience of care
• Building capability delivered by a highly skilled and competent workforce

The framework positions clinical audit through Controlling Quality through Shared Governance

The maturity requires evidence that care pathways and practices have been meticulously designed (updated), utilising the most current and robust evidence available. It also includes evidence of that staff training programmes have been aligned with evidence. The matrix also necessitates clear documentation of, an effective system of care indicators, coupled with rigorous clinical and care audits, and that learning has been optimised to improve outcomes. This also includes clear evidence of clinical audit research, development and quality improvement initiatives. Crucially, the matrix will also seek substantiating evidence that audit findings are translated into tangible action and drive improved compliance and the quality of care delivered to people.

This pillar emphasising the importance of a safety-first culture through developing robust safety systems. This involves dynamic risk management practices which proactively identify, assess, and manage risks of care to ensure the safety of patients, staff, and the broader community. It includes implementing robustly clinical guidelines/safety protocols, conducting regular risk or (re-)assessments, detecting, reporting and learning from adverse events, accidents and incidents whilst promoting a culture of continuous improvement. Fundamentally this involves preventing Risks to Patients, Risks to Practitioners and Risk to organisations by creating a safe and rewarding work environment.

The cornerstone of the five-domain framework is a commitment to ensuring safe, effective, and efficient care. It situates dynamic risk assessment within robust corporate, clinical and professional governance. This includes key learning from complaints, adverse events and accidents and the development of reliable systems and a culture of learning and continuous improvement.
This is reflective in

• Reporting Through Governance Structures
• Enhancing safety & and the Experience of Care
• Develop Culture and Build Will
• Promoting Workforce Wellbeing
• Healthful Safety Culture

The maturity matrix seeks explicit evidence regarding risk management and governance across care pathways. It sees assurance that demonstrable learning from errors, harm, and serious incidents, has resulted in concrete sustainable actions. Critically, the matrix also requires evidence of effectively mitigating risks associated with staffing challenges, ensuring patient safety remains paramount even under pressure.

This requires clinical care to be well led, with effective workplace planning and ensuring we have the right people, in the right places, with the right skills to deliver high-quality care. Crucially this includes effective recruitment, retention, and continuing professional development of staff, as well as fostering a positive, learning, nurturing and supportive work environment including performance management. It also involves creating process for ensuring staff involvement in services design/system decisioning making as well as effective mechanism for escalation of concerns.

Within the quality and excellence framework, a key domain focuses on promoting workforce well-being. This is interlinked with the development of an effective workforce strategy, aiming to build professional, and clinical skills. It also includes creating systems where staff feel ownership, and effective clinical leadership plays ensures teams are well-led. This approach is integral to cultivating a robust healthful culture, fostering an environment where staff well-being is prioritised and directly contributes to quality, safety and excellence in care.

The maturity matrix scrutinizes six key metrics. These metrics aim to identify evidence of a robust and supportive environment where staff can deliver safe, effective care. The includes evidence of a professional development strategy and assurance systems around professional practice and development. It includes clear professional reporting structures, and the utilisation of staff feedback for engagement and leadership improvement. It also includes thorough analysis regarding staffing levels, absences, and sickness, alongside a clear workforce plan. Additionally, the matrix seeks assurance of supportive safe and effective mechanisms for staff to escalate concerns to the appropriate authority levels.

This focuses on ensuring the development of robust systems of continuous training and capacity building for professionals to keep up to date with the latest skills, knowledge practice and research. It includes the systematic planning of professional development and ensuring effective systems of professional appraisal are in place.

The framework organization's commitment to staff well-being and professional development is central to delivering high-quality assurance. The framework emphasizes building capacity and equipping staff with the skills for leadership and quality improvement.

The maturity matrix evaluates professional development through several key indicators. It examines the existence of a comprehensive and sustained continuing professional development (CPD) strategy. Crucially, it seeks to validate compliance with all relevant professional and regulatory standards. The matrix looks for robust evidence of ongoing clinical skill development, as wells as mechanisms which support excellence in care, e.g. Clinical facilitators, advocate, and communities of practice.

Within the framework of clinical governance's seven pillars, performance management and quality improvement are inextricably linked to achieving optimal clinical and professional outcomes. Effective and efficient care delivery hinges on demonstrable outputs, making a robust professional performance management matrix essential. This matrix, however, cannot exist in isolation. It requires the consistent guidance of a well-defined and actively implemented quality improvement strategy. This symbiotic relationship ensures continuous assessment, and improvement of clinical practices, ultimately raising the standards of care.

Within the quality excellence framework, performance and quality improvement are intrinsically linked, focusing on ensuring value for all. This interconnectedness necessitates a robust improvement learning system, fostering continuous development and adaptation. The framework emphasises the necessity of quality management systems to achieve tangible, measurable results. By prioritising both performance metrics and a culture of continuous improvement, QEF seeks to deliver sustainable value.

The maturity matrix seeks assurance of systems and processes use to evaluated clinical and professional performance including the triangulation of patient experience, clinical outcomes, and overall cost effectiveness of care framed within the context of getting it right first time every time. This also includes providing evidence of quality improvement and it impact on performance.  This domain also requires robust evidence of the impact achieved through a quality improvement strategies and action across clinical and care pathways.

Effective assurance and governance is interdependent on the effective records systems, robust data collection, trend analysis, dissemination and the utilisation of data (often in real time). This is fundamental in informing clinical decision-making, monitoring /evaluating performance/care outcomes as well as driving learning and improvement at systems and practice levels. This requires the establishment of robust data management systems across corporate, clinical and professional functions. It includes the triangulation of variables and utilisation of enabling technologies in the delivery of safe, effective and efficient care.  

The framework, relies on meticulous data capture across all of its core domain. This specifically focused on capturing data related to care outcomes, clinical audits, as well as key care indicators. This is specifically linked to Delivering Results using Quality Management, Analysing & Learning Through Accountable Structures, Ensuring Value for all and Agreed Priority Matrix for reporting.

The maturity matrix seeks demonstrable evidence of proactive systems which capture data pertaining to patient experience, clinical outputs, care outcomes, and as data relating to staffing and staffing experiences. Critically, this will include evidence within the professional quality and governance strategies that data is triangulated to ensure a comprehensive analysis of the impact of care.