Sir John Oldham and Dr Johnny Marshall on how it's time for the NHS to raise the bar on quality
Quality is at the heart of healthcare. It is a word that binds the ambition of all of us who work in the NHS, yet optimal quality is achieved rarely and a culture of ‘good enough' pervades. When challenged with variation in quality a common response from those who underachieve is to blame a lack of resources. Unwarranted variation in clinical practice usually exists as a result of a system failure rather than a failing clinician. Sharing information on clinical performance with clinicians drives quality improvement.
The reality is that poor quality costs – both the patient and the health economy. Waste is rife in our health care systems; duplicated investigations, wasted drugs, lost results, cancelled appointments, unnecessary appointments, multiple steps in process, care fragmented between silos of specialist knowledge; each of us can create a list. On the other hand, the lesson from organisations, both here and abroad who demonstrate excellence in clinical outcomes, is that they also have the lowest costs i.e. good quality costs less.
A further analysis of these healthcare organisations also reveals a deep cultural and leadership commitment to quality. Quality defined by what one of us called [ Oldham J 1996 IHI Forum New Orleans] the quality trinity; maximising clinical outcome, maximising patient experience and maximising use of resources both human and financial. This commitment to quality in these organisations pervades everything they do especially the clinicians. It goes way beyond the illumination provided by the narrow beam of traditional clinical audit. It is about systems and process implementation and people. It is the way they do things, the expectations, the rigour and discipline of their corporate being.
Clinicians in these organisations view it as much their moral duty to maximise system effectiveness and efficiency as it is their moral duty to maximise the care for an individual patient, for they know the two are inextricably linked. The year 2011 offers the NHS not only challenges, but also the opportunity for clinicians to renew their focus on wishing to deliver high quality healthcare as something that unites us all. Clinicians will not only be formerly (or ‘formally') responsible for the care of individual patients, but the use of resources that maximise that care. We submit that the principles of quality improvement should underpin the structure and operation of GP commissioning consortia from the outset. Further, knowledge and understanding of the tools and techniques of quality improvement will be an essential part of the armour of leading clinicians and senior staff in consortia. It is the experience of best performing organisations that leaders can only drive quality if they themselves understand it deeply. And it is only by creating GP Commissioning consortia organisations that are focused on quality root and branch, that sustainability will be achievable.
However we intend to go beyond this proposition and make an offer. Already over 1000 of the next generation of potential clinical leaders, including medical students, junior doctors and newly qualified consultants and GPs, are actively learning and developing skills in quality improvement as an on-line community with an interest in clinical leadership and medical management (The Network–www.the-network.org.uk). It is our intent to provide a modular learning environment for present and future leaders covering the principles of quality improvement, how to create organisations rooting in quality, commissioning for quality, organisational behaviour and many other topics designed to help create as many quality driven consortia as possible. This is at the same time as developing skills in current and future leaders, and placing them alongside each other in that learning environment.
Quality is not just central to the care of an individual patient, it is mission critical right now for the NHS and for GP consortia within that. We urge consortia leaders to join with us now in making that a reality for their practices and their patients.
Sir John Oldham is managing director of Quest4Quality and Dr Johnny Marshall is chair of the NAPC
