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Quality Management Systems
This page has been developed by the National Clinical Director for Improvement, Dr Amar Shah.
Quality improvement, by itself, does not represent a holistic approach to managing quality.
Quality improvement needs to be used alongside quality planning, quality assurance, and quality control to create a single, consistent management system.
A quality management system consists of four aspects:
Key features
Examples of tools
1. Quality planning
identify the needs of the customer and population
develop service models to meet the need
put in place structures and process to manage the service
commissioning process
contracts and service specification
service model or pathway
team structure
job roles
measures (outcome, structure and process)
2. Quality control
identify clear measures of quality for the service, and monitor these over time
take corrective action when appropriate
internal vigilance to hold gains made through improvement
team huddles
clear escalation process
visual display of key measures for the service (presented as data over time)
3. Quality assurance
periodic checks to ensure the service is meeting the needs of the customer and population
actions to address gaps identified
audit
inspection
implementation of best practice (e.g. NICE guidance)
gap analysis
action trackers
cause and effect diagrams
4. Quality improvement
identify what matters most
design project and bring together a diverse team
discover solutions through involving those closest to the work, test ideas, implement, and scale up
cause and effect diagrams
pareto charts
flow charts
driver diagram
project charter
model for improvement
divergent and convergent thinking tools
PDSA cycles of testing
statistical Process Control (SPC) charts
A key challenge in healthcare is to balance energy and activity across these four domains: planning ought to be an annual activity; improvement should be used in short bursts to achieve new levels of performance; assurance ought to be used occasionally to check whether standards are maintained; and control should be the way daily work is managed in a team.
One of the main responsibilities leaders have within teams and organisations is to ensure the four different features of quality management are balanced and that the appropriate approach for a particular type of opportunity is deployed. In order to support our teams and people managing quality, it will be important to understand how different members of the team can contribute to each of the four aspects of quality management. Everyone in the team, including patients, should play an active part in a robust quality management system.
Roles of team members within each aspect of the quality management system:
Quality Planning
Quality Control
Quality Assurance
Quality Improvement
Team leader
contribute to service planning and commissioning
put in place the structures and processes for service delivery
be transparent about how the team is performing and take corrective action when needed
empower the team to share and solve small problems on a daily basis
stay attuned to hard and soft intelligence to ensure gains are achieved and sustained
share assurance data with the team and help make sense of the different types of data
proactively take action to address gaps against agreed standards
support regular time for team reflection and help the team and service users identify the priority area for improvement
bring together a diverse project team and help it find the time to improve the service and to remove barriers
support the team to share their learning
Team member
____________
monitor how the team is performing
listen to the feedback from service users, customers and carers
proactively raise and solve problems on a daily basis
ensure that daily practice meets agreed standards, or justify when practice departs from these
participate in assurance activities such as audit, inspection, learning lessons.
share views with the team about biggest opportunity to improve
contribute to change ideas to the area that the team is currently working on
using the tools of Quality Improvement to develop a strategy, test ideas and implement these into daily practice
Consultant or senior clinician
identify the best service model to meet the needs of the population, using clinical expertise and knowledge
monitor how the team is performing
listen to the feedback from service users, customers and carers
proactively raise and solve problems on a daily basis
ensure that daily practice meets agreed standards, or justify when practice departs from these
help identify and set the standards against which the team is measured
participate in assurance activities
contribute views about the team’s biggest area of opportunity
use clinical expertise and research knowledge to bring ideas to the team
support the team to involve a diverse range of people in improvement work
help the team find time to improve the service and remove barriers to this
Service user
be able to contribute to identifying the needs within the population and what types of service might be best to meet them
be able to feed back experiences of the service through a variety of ways
help set standards against which services are measured
be involved in auditing or inspecting services
help the team determine the big issues the need improving
be able to help inform how the service improves
be able to contribute to the improvement work as much as desired
be able to feed back whether changes have made a difference
Senior leader
contribute to developing the organisation’s vision, mission and strategic plan
communicate these to the teams
help teams align their work to the organisation’s mission and strategic plan
work with external stakeholders and partners in developing goals and priorities across the system
monitor how the system is performing
use data to inform decision-making
empower and support teams to solve complex problems
regularly listen to the experience of staff and service users
ensure systems are in place to check that high quality care is being provided
ensure that assurance activities add value and are meaningful.
play a sponsor role for improvement work
help identify priority areas for improvement
helps teams see how their work fits to strategic priorities
help teams find space and time to improve
link regularly with projects to help unblock barriers and celebrate their work
The activities in the management system should not be considered as isolated entities, but as being interconnected and sequential.
The highest performing teams reduce assurance activity, create an intentional annual planning or redesign process, build a real-time quality control system and use quality improvement for the right type of problem in short bursts of rapid-cycle testing and learning.
