What is a Quality Management System and why are we being asked to manage quality in healthcare in this way?
By Jonathan Clarke, Clinical Lead within the NHS Wales Executive, Assistant Medical Director for QI at Aneurin Bevan University Health Board, and Ear, Nose and Throat Consultant
The Duty of Quality, published by Welsh Government, recommends that healthcare systems should operate within a Quality Management System (QMS) to deliver higher quality services. But what is a QMS and why are we being asked to manage quality in healthcare in this way?
Traditionally in healthcare, improvement towards a higher quality service revolved around research, audit and implementation. However, this approach wasn’t always delivering the results needed. So, around 20 to 30 years ago healthcare began to embrace quality improvement methodology, taken from a century of use in industry to improve services and products.
Quality improvement (QI) showed real promise but there came a realisation that QI on its own wasn’t enough to raise quality to the levels needed for healthcare all the time. We needed a new approach and a QMS based on the Juran Trilogy of quality planning, improvement and control was developed for healthcare. So, let’s take a closer look at this healthcare QMS model.
Central to the QMS model for healthcare is quality. But what is quality in healthcare? Quality can be simply defined as matching the service to the needs of the service user. In healthcare these needs have been grouped under the quality characteristics of safe, timely, efficient, effective, equitable and person-centred, affectionately known as STEEEP. However, although not officially added currently, we should add a seventh ‘E’ for eco-friendliness. Our efforts to improve should work towards improving as many of these characteristics as possible if we are to improve quality for our service users.
Wrapped around this quality central core is quality planning, quality improvement and quality control. These three disciplines must be available and work closely with each other in a connected way to guide quality management, continue to improve towards higher levels of quality and sustain any gains made. Then surrounding the whole model is quality assurance. Only when these four elements work in harmony can we achieve quality management.
You see, the problem is that without quality planning (QP) there is a risk that all the scarce quality improvement resource is wasted improving the wrong thing, resulting in lots of good work but with no impact on quality. Or, without quality control (QC) then all the work that has been done to improve a service slowly reverses back to the original state as if no improvement had been done at all. Then there needs to be some accountability and reporting through a governance structure to ensure the continued delivery of higher quality services and without this quality assurance (QA) there is a risk that the status quo could be embraced without a drive for change.
This has led us to the current situation, whereby it is recognised that a system is needed that incorporates the four quality elements of planning, improvement, control and assurance. Only when these four quality drivers are developed and interconnected with each other can we achieve a quality management system that will deliver continuous improvement and sustainability to provide our service users with the high-quality service that they need, and we strive to provide.
Through the Safe Care Partnership’s Duty of Quality Leaders workstream, the NHS Wales Executive will be supporting organisations across NHS Wales in the months ahead to embed QMS at organisational level. That will hopefully provide the next step in the right direction towards achieving consistently high quality services for those in our care.