What is Quality Improvement? Starting the conversation with your team

In the first of a new RCVS Knowledge series of features on patient safety, clinical human factors, and the principles and associated themes of Quality Improvement (QI), Angela Rayner and Chris Gush explore what the terms quality healthcare and Quality Improvement mean within a veterinary context.

Delivering quality care has always been at the heart of what it means to be a veterinary professional. To understand what it means to provide quality care, we must first define what we mean in terms of quality.

Defining quality isn’t easy, but we know it when we see it. It is one of those words full of nuance and often depends on the point of view of the person defining it. It’s a word often associated with high reliability, meeting a standard or exceeding people’s expectations. When we start to look at defining quality when delivering healthcare, it adds even more layers of complexity.

Human healthcare has been studying quality for a long time, so often we turn to organisations such as the NHS for a model that we can adapt to our work. But when you start looking for a definition, you find that there are many.

What is quality?

Let’s start with just two definitions of quality:

“Care that is effective, safe and provides as positive an experience as possible…” 

NHS, 2008

“Quality is the degree to which care services influence the probability of optimal patient outcomes…” 

American Medical Association, 1991

The Institute of Medicine (1) has described this even further by putting forth the 6 Domains of Health Care Quality, which includes the aims that healthcare is safe, effective, person-centred, timely, efficient and equitable. If we view these aims from a veterinary perspective, it starts to look like this:

• Safe: minimising harm to staff and patients from the care that is intended to help them.
• Effective: based on evidence-based principles, reliably delivered to all who benefit from it and refraining from actions to those not likely to benefit.
• Patient-centred: care that is respectful of and responsive to the needs and values of the owner but prioritises the health and welfare of the patient. Care should be coordinated, and care decisions made in partnership between professionals and owners.
• Timely: reducing waits and harmful delays for both those who receive and who give care.
• Efficient: minimising waste and maximising benefits of resources, including skills, equipment, finance, ideas, environment, and energy.
• Equitable: care that does not vary in quality of delivery or outcome because of personal characteristics, geographic location, time of the day/week.
• Care-giver experience:  providing care which supports a sense of fulfilment and pride for the caregiver.  (An extra one to make 7!)

In the delivery of healthcare, quality is about understanding what you are doing, how this relates to others in your team and how to work with everyone involved to continually improve. It also means thinking about what you may need to change to make sure you are meeting the needs of your patients, their owners and your team members.

Defining Quality Improvement

Quality Improvement (QI) is the term used to cover specific activities designed to make the delivery of healthcare better. That might be safer (less errors or infections), more effective (delivering care that is evidence-based), more efficient (less waste), more patient-centred (compassionate, with owner collaboration), equitable or timely (improving access to care) or improving the care-giver experience (professional development). 

Quality Improvement can be defined as: “The combined and unceasing efforts of everyone…to make changes that will lead to better patient outcomes, better system performance, and better professional development.”

Batalden P, Davidoff F. Qual. Saf. Health Care, 2007

“The combined and unceasing efforts of everyone…to make changes that will lead to better patient outcomes, better system performance, and better professional development.”

 

Quality Improvement involves everyone

Quality Improvement is not just a programme or a project. It isn’t the responsibility of one person or even those working in the quality department of an organisation. Quality Improvement involves people, teams and organisations coming together, to look at how making changes to the way they work can contribute to improving patient care. (3)

To do this, a range of tools and techniques are used to make sure that the changes are effective and sustainable. These tools and techniques recognise that a small change in one aspect of a service may require changes in other areas of the service for it to work. 

Using quality improvement methods and tools helps you look at change in a systematic way, but it is more than just the result of an audit. Quality of care flows through your actions, and improvement begins with intention; it all starts with you.

Discussion points

What does quality mean to you and your team? 

Checklist - what you can do next

• Join 5000 other colleagues, follow us on our Facebook page: @RCVSKnowledge
• Visit RCVS Knowledge’s Quality Improvement hub to start taking advantage of our free templates, courses and resources (over 20 hours of free CPD)
• Take a strategic approach to supporting QI in your area of work
• Find out how EBVM and QI fits together in our article: Doing the right things right 
• Listen to our QI Advisors, Pam Mosedale and Lizzie Whiting, with Nicky Paull, talk about why QI is more important than ever 
• Passionate about QI? Why not submit an application to win our next Champion Award

 

References:

1. Institute of Medicine (US) Committee on Quality of Health Care in America (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press (US): Washington (DC).

Available from: https://psnet.ahrq.gov/issue/crossing-quality-chasm-new-health-system-21st-century [Accessed 1 October 2020]

2.  Introduction to quality and quality improvement, eLearning [NHS Education for Scotland] [online].

Available from: https://learn.nes.nhs.scot  [Accessed 1 October 2020]

3.  Lloyd, R. Improvement stories. Improvement tip: “Quality” is not a department [Institute for Healthcare Improvement] [online]. Available from:

http://www.ihi.org/resources/Pages/ImprovementStories/ImprovementTipQualityIsNotaDepartment.aspx 

[Accessed 1 October 2020]

 

About the authors

Angela Rayner PGDip PS&CHF MRCVS

Angela is Quality Improvement Advisor for RCVS Knowledge, Director of Quality Improvement for CVS, and is an RCVS Knowledge Champion for her role in improving CVS’ systems for controlled drugs auditing.

In 2018, Angela began an MSc in Patient Safety and Clinical Human Factors at the University of Edinburgh. The programme supports healthcare professionals in using evidence-based tools and techniques to improve the reliability and safety of healthcare systems.

It includes how good teamwork influences patient outcomes, key concepts around learning from adverse events and teaching safety, understanding the speciality of clinical human factors, as well as the concept of implementing, observing and measuring change, monitoring for safety, and it focusses on quality improvement research and methodologies.   

 

Chris Gush BSc MSc

Chris is the Executive Director of RCVS Knowledge. Chris began his career as a microbiologist working on a clinical hygiene monitoring system to measure hygiene standards in hospital wards. Having left the laboratory, a move to the Department of Health saw him co-develop the Showcase Hospitals Programme. The programme led on the evaluation and adoption of new technologies and protocols that improved hospital infection control and reduced hospital-acquired infections in seven hospitals around the country.

Later, at the Health Protection Agency, Chris managed investigations into microbiology testing within hospital laboratories leading to improved clinical standards and offering re-testing where appropriate.

In his previous role as Assistant Director of Clinical Innovation and Research at the Royal College of General Practitioners, Chris led on the development of tools and resources which were instrumental in the reduction of inappropriate antibiotic prescribing in General Practice.