Matthew Mezey's activity
In group: Quality Management in Healthcare
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Matthew Mezey posted an update in the group Quality Management in Healthcare 2 months, 3 weeks ago
HSJ article claims to identify key reason continuous quality improvement doesn’t deliver
The article ‘Time for our ICSs to embrace continuous improvement’, by KPMG’s Russell Jewell, warns that a key ‘stumbling block’ to continuous quality improvement (CQI) is that it is “still not particularly well understood”.
You can read the article here: https://www.hsj.co.uk/quality-and-performance/time-for-our-icss-to-embrace-continuous-improvement/7036412.article
What do you think?
“For too many people, CQI… is something that clinicians do through small-scale, discrete, tactical projects, delivering minor, highly localised improvements to how they deliver patient care”, he explains.
“That’s no bad thing”, he adds – but means it won’t “be seen as fundamental to how a CEO runs their health and care system”.
“That’s why this traditional form of CQI rarely delivers sustainable long-term outcomes or further improvements – because it’s not embedded into the fabric of how a system operates. It’s not seen as being able to deliver major financial benefits, solve debilitating workforce issues or provide a response to the latest existential crisis. The reality is that – done properly – CQI can absolutely deliver all those benefits.”
For inspiration on how to make CQI work at the system level, he looks to the example of the 20-year journey of UMass Memorial Health system.
“They have incredibly tightly defined standard work processes that determine how the health and care system operates. But their staff are also empowered (and encouraged) to make improvements in their particular area.”
“This is how ICSs will address and resolve their biggest challenges – financial, workforce or otherwise. It’s how they’ll cope with emerging crises; by trusting in the process and not reverting to old ways of working. And with all this embedded into the system’s culture, they’ll benefit from a highly sustainable, repeatable, improvement process.”
Have a read of the whole article, is Russell Jewell right in his analysis? And his proposed solution?
How does this differ from what you’ve proposed in your various Zooms and articles etc, Tom?
The recommendation is ‘incredibly tightly defined standard work processes that determine how the health and care system operates’. I don’t think we need to look to America and UMass Memorial Health to know that! I’ve bee preaching it for the last & years – not that most people listen. Just scroll down the page and look for a comment on any of my posts. I don’t entirely agree with Russell. Incredibly tightly defined standard work processes are not the answer for healthcare. There is too much variability in patients for this. I prefer Standard Process. I separate the clinical and operational procedures in the process. It’s the operational procedures that are tightly defined and a degree of flexibility is provided for (most) clinical procedures.
How this standard process is documented is key to the success of implementation. I favour a simple task flow charting technique with hyperlink access to more detailed procedures and guidance. Certainly not the NHSE examples or swim lane type techniques.
I do agree with Russell that this is most certainly a ‘must do’ step towards true quality management.
Whilst I believe that the NHS and patient safety can benefit from taking significant steps towards standardisaiton to improve relibility … the description of ‘incredibly tightly defined standard work processes’ is frankly out of keeping and out of step with the reality and challenge of delivering healthcare in many settings with the system constraints that ar ethere at every turn.
As a pharmacist by training, I know that this is a challenge even in the relatively controlled environment of a hospital pharmacy, but go beyond the boundaries of that space and interact with the system to deliver medicines safety we are entering a totally different realm’. It is important that we respect the reality and not operate in a bubble that is idealised beyond recognition of work in the real world.
I have responded to other elements within Russell’s article in linkedin https://www.linkedin.com/posts/nicola-davey-87442116_time-for-our-icss-to-embrace-continuous-improvement-activity-7159137957805760513-BYpk?utm_source=share&utm_medium=member_desktop
My response here
https://www.linkedin.com/posts/nicola-davey-87442116_time-for-our-icss-to-embrace-continuous-improvement-activity-7159137957805760513-BYpk?utm_source=share&utm_medium=member_desktop
I liked your poster and am still studying it. I use a simpler version of process mapping based around a simple flow carting method. As a first step to a degree of standardisation, certainly not ‘incredibly tightly defined standard work processes that determine how the health and care system operates’, I promote just documenting WAD. This is my first step towards an improvement project. Defining each process would be a start. This fits in well with the 5th clause in NHS Impact.