Achieving High Quality Care

List of Contributors xi
Foreword xiii
Preface xv
Acknowledgements xvii
1 Introduction 1
Gillian Leng
Introduction 1
What is the role of evidence? 2
How can guidance be used to track improvement? 4
What are the challenges to achieving quality improvement? 5
How does NICE support implementation? 6
Raising awareness 7
Motivating change 7
Practical support 8
Monitoring impact 8
Summary overview 8
Learning from practice 8
References 9
Further reading 9
Example in Practice: Using clinical leaders to improve patient care 10
NICE guidance highlights room for improvement 10
Audit reveals areas where care can be improved 11
Increased compliance with NICE guidance 11
Learning from practice 12
2 Practical actions for health care providers 13
Val Moore
Introduction 13
Why take a systematic approach to guidance implementation in a health care provider organisation? 15
Legal and regulatory context 15
Cost pressures and quality improvement 15
Public and patient involvement 16
Staff training and continuing professional development 16
What defines quality improvement for health care providers? 16
What practical advice do health care providers require? 18
Why board support and clear leadership for achieving high-quality care is important? 19
Who should be the day-to-day lead for quality? 19
Do you have an effective multidisciplinary forum for strategic decision-making on the use of best practice guidance? 20
Why a lead for each new development should be nominated? 21
Why take a systematic approach to financial planning for service change? 22
Developing an action plan 22
Evaluate uptake, provide high-level assurance and share your success story 23
Summary 23
Learning from practice 24
References 24
Further reading 24
Example in Practice: A hospital-wide approach to reduce mortality among acutely ill patients 25
Promptly escalating care for deteriorating patients 25
How did the hospital carry out the project? 26
Improving rates for mortality and cardiac arrest 26
Learning from practice 26
3 Identifying a high-quality evidence base 27
Paul Chrisp and Sara Twaddle
Introduction 27
Why it is important to seek high-quality evidence 27
How does guidance support evidence-based medicine? 28
How can the standard of guidance development be checked? 28
How does guidance perform against these standards? 29
Can the ability of guidance to improve patient outcomes be checked? 31
How can high-quality evidence be found? 31
What is NICE accreditation? 32
What does NICE accreditation say about guidance quality? 35
What if there is no relevant high-quality guidance? 36
How to get high-quality evidence into practice? 36
Learning from practice 36
References 40
Further reading 40
Example in Practice: Finding a way through guidance on pre-hospital care across South West England 41
Finding a way through guidance 41
Smart access on the move 42
Monitoring improvement in outcomes 42
Learning from practice 43
4 Key challenges to implementation and effective interventions 45
Elaine Whitby and Julie Royce
Introduction 45
What are the main factors that will influence an implementation project? 46
What are the context and resource issues to consider? 46
What have others done? 48
Is there a recognised need for change? 48
How to engage and influence? 49
How to move forward? 50
How to assess current barriers and facilitators? 51
How to find out more about behaviours and barriers? 51
How to prioritise action? 52
What interventions should be used in the implementation plan? 53
How to design the implementation project and evaluation? 57
Summary overview 58
Learning from practice 58
References 58
Further reading 59
Example in Practice: Changing behaviour in primary care to improve the management of children with feverish illness 60
Four key components not being measured 60
Provide prompts to change current practice following education 61
Measuring improvement 61
5 Using financial systems to support improved care 63
Jennifer Field
Introduction 63
Why is good financial management important? 64
Can financial systems and levers help drive improvements in the provision of health care? 65
How is quality incentivised in the English NHS? 66
What is the QOF? 66
What are PbR and BPT? 66
What is CQUIN? 67
How can funding arrangements incorporate NICE and other evidence-based guidance? 68
What are the components of a good business case? 69
Why should finance be considered across a health economy? 70
Summary 71
Learning from practice 72
References 72
Further reading 73
Example in Practice: Building a business case: to redesign diabetes services 74
Remodelling services for type 2 diabetes 74
Using savings from implementing NICE guidance to redesign services 75
Multidisciplinary team brought several improvements 75
Learning from practice 76
6 Using measurement to support change and improvements in health care 77
Nick Baillie
Introduction 77
How can measurement be used to support change? 79
Developing measures and indicators: lessons from the national experience 79
Developing measures and indicators: issues for local consideration 81
What is the best way to report and communicate data? 82
Involving the team 82
Reporting to the board 83
Engaging patients through reporting of data 83
Formats for reporting to each audience 83
How to provide leadership for change? 85
Acknowledging the structure and context of service provision 85
Identifying the individual or groups to provide feedback 86
Summary overview 87
Learning from practice 87
References 88
Further reading 88
Example in Practice: Setting up a service for peripheral arterial disease in the North West of England 89
Using NICE guidance to redesign services 89
Benefits of managing PAD in the community 90
Learning from practice 90
7 Conclusion and reflections 91
Danny Keenan and Sasha Abraham
Introduction 91
Why we think high-quality evidence should be sought? 92
Review of the chapters in this book 93
What constitutes clinical quality and what is quality improvement? 93
How does guidance support evidence-based medicine? 93
What are the barriers to the use of guidance? 95
Reflections on service improvement 96
How is clinical quality defined and how is it measured? 97
Clinical audit 99
How is a clinical audit performed? 99
Whose responsibility is the achievement of high-quality care? 100
Summary overview 100
Learning from practice 100
References 101
Further reading 101
Index 103