Information governance in local quality improvement

Information governance in local quality improvement
HQIP updated 5 November 2021

• This guide describes how information governance (IG) laws and principles apply to the use of personal data in local or regional multi-agency healthcare quality improvement studies such as clinical audit, productivity reviews, intervention testing, and service evaluation.

RCGP Quality and Outcomes Framework (QOF) QI project

Quality and Outcomes Framework (QOF) QI project
RCGP

• In 2019 the RCGP, in collaboration with NICE and the Health Foundation, were commissioned by NHS England and NHS Improvement to develop a series of quality improvement (QI) modules and guidance to form part of QOF. Ten modules were produced in this phase of work.
• In 2021 the RCGP has continued to support general practice carry out this QOF activity by producing learning material for the QOF QI module topics supporting people with learning disability and early diagnosis of cancer. 
• Additionally, guidance has been produced to support effective and sustainable QI within a primary care network (PCN).

National Quality Board - Integrated Care Systems

National Quality Board

• The National Quality Board (NQB) was formed in 2009 to champion the quality agenda, secure system alignment and drive quality improvement across the health care, social care and public health system. The NQB’s current core priorities include supporting system transformation and the integration of care and outcomes, understanding and addressing unwarranted variation and inequalities, and supporting learning and recovery from the COVID-19 pandemic.
• NQB Position Statement on Quality in Integrated Care Systems – April 2021
• Shared Commitment to Quality – Refreshed edition, April 2021
• Case Studies on Quality Oversight in ICSs – April 2021

Quality Improvement made simple

Quality improvement made simple: What everyone should know about health care quality improvement
Health Foundation updated April 2021

• A guide on quality improvement designed for health care staff leading fast and efficient service change as a result of the pandemic. It offers an explanation of some popular approaches used to improve quality, including where they have come from, their underlying principles and their efficacy and applicability within the healthcare arena. It also describes the factors that can help to ensure the successful use of these approaches and methods. to improve the quality of care processes, pathways and services.

What drives GPs in the UK to improve the quality of care? A systematic literature review

What drives general practitioners in the UK to improve the quality of care? A systematic literature review
BMJ Open Quality 2021;10:e001127. doi: 10.1136/bmjoq-2020-001127

• An examination of the evidence behind current incentive schemes available in general practice in the UK found that the majority of research examined QOF. QOF positive effects included reduced mortality rates, better data recording and improved sociodemographic inequalities. However, limitations involved decreased quality of care in non-incentivised activities, poor patient experiences due to tick-box exercises and increased pressure to meet non-specific targets. Findings surrounding competition were mixed, with limited evidence found on the use of non-financial incentives in primary care.

What influences improvement processes in healthcare? A rapid evidence review

What influences improvement processes in healthcare? A rapid evidence review
RAND Corporation 2020

• Analysis of 38 academic and 16 grey literature publications covering diverse improvement approaches. Some examples include Six Sigma, Lean, Business Process Reengineering, Plan-Do-Study-Act, clinical audits and feedback, quality improvement collaboratives and peer-learning communities, training and education interventions, and patient engagement and feedback-related interventions.

Skills for collaborative change : a map and user guide

Skills for collaborative change : a map and user guide
Q Health 29 September 2020

• A practical tool setting out the skills and attitudes needed for collaborative and creative problem-solving. It has been developed in partnership with Nesta. It draws on Q’s experience of large-scale collaborative approaches, the Health Foundation’s quality improvement expertise, and Nesta’s extensive experience of government innovation.

Information Governance in local quality improvement

Information Governance in local quality improvement
HQIP 14 June 2017 updated 8 September 2020

• This guide describes how Information Governance laws and principles apply to the use of personal data in local or regional multi-agency healthcare quality improvement studies such as clinical audit, productivity reviews, intervention testing, and service evaluation.

De-implementing wisely: developing the evidence base to reduce low-value care

De-implementing wisely: developing the evidence base to reduce low-value care
BMJ Quality & Safety 2020;29:409-417, 20 April 2020

• This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation. 
• Based on a worked example of applying CWDIF [in Canada] the paper presents a stepwise theory-based framework for de-implementing low-value care identified through Choose Wisely recommendations for reducing low-value care.

Novel Quality Improvement Method to Reduce Cost While Improving the Quality of Patient Care

Novel Quality Improvement Method to Reduce Cost While Improving the Quality of Patient Care
BMJ Quality & Safety 23 January 2020. doi: 10.1136/bmjqs-2019-009825

• NHS Scotland have developed a technical method to assist health systems to reduce operating costs, called continuous value management (CVM). 
• Derived from lean accounting and employing quality improvement (QI) methods, the approach allows for management to reduce or repurpose resources to improve efficiency. The primary outcome measure was the cost per patient admitted to the ward in British pounds (£).

Quality improvement in general practice: what do GPs and practice managers think?

Quality improvement in general practice: what do GPs and practice managers think?
Health Foundation December 2019

• A survey of over 2,300 GPs and 1,400 practice managers across the UK has found that most GPs and practice managers see quality improvement as a core aspect of their work, with 99% reporting undertaking QI activities, and many working collaboratively with neighbouring practices to improve services. However, there are many issues making it difficult to deliver improvement, including high patient demand and staff shortages; demands of other NHS agencies; lack of protected time; and level of improvement capability.

Providers deliver: better care for patients

Providers deliver: better care for patients
NHS Providers 10 October 2019

• This report is part of a new programme of work from NHS Providers - Providers Deliver - to celebrate and promote the work of NHS trusts and foundation trusts in improving care. Using 11 case studies it considers the leadership approaches and frontline initiatives that underpin improvements in quality.

Clinical service accreditation - statement of intent

Clinical service accreditation - statement of intent
BSI, HQIP, UKAS October 2019

• BSI, Healthcare Quality Improvement Partnership (HQIP) and the United Kingdom Accreditation Service (UKAS) have published a statement setting out a shared intent to improve clinical services through accreditation.
• Their statement outlines their commitment to working together to:
• improve the quality and effectiveness of healthcare by providing clinical services with an infrastructure and a set of requirements that enables a structured approach to quality improvement against which they can be assessed
• encourage further development of certification schemes in clinical services and to have the providers of those schemes accredited against national standard
• integrate these initiatives with regulatory bodies (such as the Care Quality Commission (CQC) and other inspection and improvement processes so that commissioners, service providers and service users have a mechanism that supports quality improvement and provides assurance.

Using online patient feedback to improve care

Using online patient feedback to improve care
Point of Care Foundation June 2019

• A guide supporting clinical, patient experience and quality teams to understand how to use online patient feedback to improve quality in healthcare. Product of the INQUIRE project.

Spreading and scaling up innovation and improvement

Spreading and scaling up innovation and improvement
BMJ 2019;365:l2068 10 May 2019

• There are common sense reasons why spreading an innovation across an entire health system is hard. Achieving any change takes work, and it usually also involves—in various combinations—spending money, diverting staff from their daily work, shifting deeply held cultural or professional norms, and taking risks. This rapid review discusses three common approaches in innovation spread —implementation science, complexity science, and social science.

An Introduction to Quality Improvement in General Practice

An Introduction to Quality Improvement in General Practice
NHS England 29 March 2019

• A brief introduction to quality improvement that provides a simple, practical framework to follow for practice-based quality improvement, improvement activities for practices to try out and additional support to those practices who have little experience of undertaking quality improvement activities.

Developing People - Improving Care - an update

Developing People - Improving Care
NHS Improvement, 1 December 2016 updated 13 February 2019

• An evidence-based national framework to guide action on improvement skill-building, leadership development and talent management for people in NHS-funded roles. 
• The framework guiding actions on improvement skill-building, leadership development and talent management will help create five conditions common to high quality, high performing health and care systems in every local health and care system in England. 
• The five conditions are:
• Condition 1: Leaders equipped to develop high quality local health and care systems in partnership.
• Condition 2: Compassionate, inclusive and effective leaders at all levels
• Condition 3: Knowledge of improvement methods and how to use them at all levels
• Condition 4: Support systems for learning at local, regional and national levels
• Condition 5: Enabling, supportive and aligned regulation and oversight.

Building Collaborative Teams

Building Collaborative Teams
NHS England 9 January 20198

• Building Collaborative Teams is designed as a ‘getting started’ guide for managers or facilitators who are bringing different teams together. It’s intended to be used when one or more teams plan to work in a more integrated way. It contains tools and exercises to help team members better understand each other’s roles, attitudes and values. 
• The latest resource on the NHS England Improvement Hub, a compilation of the resources which have been produced by a succession of NHS Organisations specialising in service improvement.

Glossary of terms used in improvement and implementation

KIS glossary of terms used in improvement and implementation
King's Improvement Science December 2018

• A glossary of terms used in improvement and implementation science.

Approaches to better value: improving quality and cost

Approaches to better value: improving quality and cost
Kings Fund 3 October 2018

• This report explores how three different organisations (the Royal Free London NHS Foundation Trust, Bolton NHS Foundation Trust and Bradford Teaching Hospitals NHS Foundation Trust) are attempting to improve the value of the services they offer to patients. It examines how they have developed organisation-wide strategies to improve value, and on how individual clinical services or teams have pursued value improvement. 
• Common conditions for success include fidelity to a clearly defined strategy that brings the various strands of value improvement work together; recognition that value improvement is a long-term commitment that will require considerable staff time and resources; and a new leadership approach that requires continuous engagement with frontline clinicians and managers.