Identify the key drivers to bring about change, including leadership and clinical engagement, skills development, and staff and patient participation

Being a doctor in the 21^st century is not just about diagnosing and treating patients, but a commitment to improve the quality of care provided. Improving quality is about making health-care safe, effective, patient-centered, timely, efficient, and equitable. The terms used around ‘quality improvement’ can be confusing, and this section will provide details of these terms, and an overview of the processes involved in quality improvement.

What is quality?

 

Within healthcare, there is no universally accepted definition of ‘quality’. The United States (US) Institute of Medicine defines quality as ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (US Institute of Medicine, 2001). The Institute of Medicine has identified six dimensions of healthcare quality:

 

 

1.	Safe – Avoiding harm to patients from care that is intended to help them.
2.	Effective – Providing services based on evidence and which produce a clear benefit.
3.	Person-centered – Establishing a partnership between practitioners and patients to ensure care respects patients’ needs and preferences.
4.	Timely – Reducing waits and sometimes harmful delays.
5.	Efficient – Avoiding waste.
6.	Equitable – Providing care that does not vary in quality because of a person’s characteristics

 

 

What is Quality Improvement?

 

There is no single definition of quality improvement. However a number of definitions describe it as an evidence-based systematic approach that uses specific techniques to improve the quality of processes of care for measurably better outcomes. All good organisations continually review and modify their processes to improve the quality and outcomes of patient care.

 

These techniques share some simple underlying principles:

 

• Understanding the problem with a particular emphasis on what the data tells you
• Understanding the processes and systems within the organisation, particularly the patient pathway, and whether these can be simplified
• Analysing the demand, capacity and flow of the service
• Identifying the key drivers to bring about change, including leadership and clinical engagement, skills development, and staff and patient participation
• Evaluating and measuring the impact of a change