Hi Tom,

You say that ‘No NHS Trust has a quality management system other than in specific, regulated, areas‘ – meaning that full-blown (ISO-compliant?) type management systems with audit trails just don’t exist outside those specific narrow areas, right?

Yet all round the UK organisations says they have a QMS. I guess you’re suggesting that the ‘QMS’ label gets used in a looser, more generic, way much of the time?

Is the kind of formal Management System for Quality seen in the regulated areas something that you think should spread to all other parts of a hospital, for example?

And, if so, why?

I did see that a first hospital (in Mexico) was very recently certified in last year’s ISO standard for healthcare quality management (7101).

Are you suggesting that every healthcare org should at least be beginning the journey to 7101? Or maybe it’s more appropriate often to just be inspired by its principles, rather than actually going for certification? Or are there areas where it really doesn’t make sense to apply it at all, or is best to just apply parts of it?

You shared a great BSI graphic on all the 50 or so ‘Hospital Standards’ that exist in your illuminating recent Zoom with Jem: https://www.catmalvern.co.uk/Lectures/Lecture10/bsi-hospital-standards-infographic.pdf

What I’d love to see is what the rough reach is of them all. Which standards are popular, and which are ignored? Where should ISO 7101 appear on that BSI graphic? (Though it sounds like no NHS Trusts are actually implementing 7101).

However, won’t some people say that the more formal Management Systems for Quality are so focused on the compliance, control and the audit trail aspects that there ends up being a lack of robust iterative improvement in such a QMS process? Meaning they end up too weak on the QI arm of the Juran Trilogy, I presume….?

It sounds like the QI-orientated improvement frameworks of ELFT or Healthcare Improvement Scotland ought best to be built on to cover the full Juran Trilogy more completely?