The responsibility for Quality and Safety lies with the entire organisation, starting with the Board and executive team who need to provide the space for the clinical staff to deliver high quality care, writes Dr. Peter Lachman.
The aim of high quality safe and effective care is the goal of many organizations. This is difficult to achieve without a framework and supporting accountability to facilitate deliver and monitor quality care. Organisations usually respond to the need to manage risk or to improve by creating risk management and quality departments. The result may be a group of professionals who may or may not be trained in Improvement Science and the theories of Patient Safety, and whose job is to improve care. Unfortunately, these approaches will not hardwire quality and safety in an organisation. It is the first step only and more is required to ensure real change.
We all have two jobs – “the one we are employed to do and then that of continual improving our performance.”
Dr W Edwards Deming said, “Quality is everyone’s business”, i.e. we all have two jobs – “the one we are employed to do and then that of continual improving our performance” (Batalden). The development of a governance framework for quality is an active decision and requires leadership at all levels. Hospital managers and clinicians must actively commit to delivering high quality care. If one considers the most successful hospitals such as Cincinnati Children Hospital
http://www.cincinnatichildrens.org/service/j/anderson-center/about/infrastructure/quality-improvement/ and Virginia Mason https://www.virginiamason.org/VMPS, one will find that these organizations have made quality and patient safety the business strategy of their organizations. The leaders provide the staff the context, time and space to improve, based on a strong governance framework with inbuilt accountability, and a theory and method. This includes the fostering of the appropriate behaviours that are required to provide high quality care; i.e. the culture of quality and safety.
One needs to go further than the current approach of specialized teams for QI and Patient Safety. Quality and safety need to be the focus of an organization and should influence every decision made. To establish a programme to improve safety and quality you need the following ingredients as a start:
- A clearly defined vision for quality and safety – e.g. Zero Harm, No Waits, No Waste
- A strategy with clearly defined aims which emphasise the need for quality to be the raison d’être for the organisation. This will require standards and operating procedures to which all will work.
- Leadership, starting at the Board, that defines its responsibility and enables leadership to be distributed to the front line staff to facilitate the delivery of the strategy.
- A safety and quality plan to implement the strategy and deliver the vision, which is the foundation of the change.
- Engagement of all the staff to deliver the plan.
- Resources to implement change with identified time, funding or equipment.
- Capacity building to allow delivery of change, by training all involved in delivery of patient care and hospital management in the theory of improvement and patient safety.
- A way of measuring performance and improvement. Statistical Control charts are the best way to display data. (This will be considered in the next article.)
- A feedback loop to clinical teams on their performance in real time as the foundation to generate and encourage continual improvement, rather then RAG ratings and KPIs.
- Continual learning which underpins the governance with learning by the teams as well as by the management.
- Involvement of patients from Board to Ward
The key is distributive leadership with clear accountability for the delivery of care. A quality and safety framework allows an organisation improve in a constructive and learning environment.
Some reading on a developing a safety plan
Dr Peter Lachman is the Quality Improvement Lead Faculty for RCPI and the National Quality Improvement Programme (HSE/RCPI). In 2005-2006, Peter became a Fellow of Quality Improvement at the Institute for Healthcare Improvement in Cambridge, Massachusetts. His current position is Deputy Medical Director (Patient Safety), Great Ormond Street Hospital for Children NHS Foundation Trust. He is also a Consultant Paediatrician at the Royal Free Hospital Hampstead NHS Foundation. His current interests are in patient safety and designing services that are safe and person friendly at the same time.