Embedding and sustaining Quality Management Systems

The next phase of work is focused on putting the ambitions around a QMS into practice. They are creating a delivery plan, and hope to use a QMS approach primarily to identify risks and issues, and demonstrate actions are being taken to address them. 

They will implement a structure for reporting from the ward to the Board, and envision it will be used at accountability meetings – with a view to discussing how it can be incorporated into their planning process.

• Extensive discussions with staff found the original language of quality management to be ​“too theoretical”, leading to the development of four questions to use for service planning and delivery.
• Discussions have illuminated challenges in understanding where best to apply their approach, from the micro (service or problem) level to the macro (organisational) level.

Improvement is evident in staff survey scores on questions around people’s ability to improve work, and being listened to by managers. 

Their Quality Account cites how the LIM approach was applied in a range of clinical value streams in the past year, demonstrating improvement in quality while reducing waste. This included:

• a 28% reduction in children’s cardiac surgery cancellations
• 51% improvement in the correct recycling of medicines. 

• Leeds has shifted the balance of activity from quality assurance to quality improvement work, moving from tackling discrete quality problems to a pan-organisation approach.
• Adopting Lean as a management system ensures quality and value is seen from the patient’s perspective, enabling improvement work to consider issues that impact quality, including cost, efficiency and sustainability.
• Improvement is led by those closest to the front line. They have worked with staff to demystify the improvement concepts while retaining fidelity to their principles.

The Quality team has worked closely with services to address significant challenges, from the set-up of Covid-19 vaccination centres to relieving pressure at the front door of their emergency departments. This can be attributed to the systematic use of improvement methods, and the organisational commitment to investing in quality. 

There’s a longer-term ambition to recognise how their Whole System Quality approach is contributing to this, but they consider that the impact is already being ​‘felt’.

• Team members who can operate a senior level has been an important enabler.
• Translating quality management components into four simple questions to help engage frontline staff.
• A dedicated Quality Directorate, bringing together evidence, improvement and assurance teams which support services with their quality work.
• Describing and embedding the principles of Whole System Quality at every opportunity, from corporate communications to QI training to help staff engagement. 

Taking a QMS approach has helped to link finance, performance and quality. For example: 

• examining the costs associated with harm when assessing whether services are effective. 
• asking for quality impact assessments associated with service changes, 
• using information on the impact of performance issues to better target resources. 

Board reports will change from a separate quality report to an integrated report ​“which will be important to join the dots”. 

• The approach has been led by the executive team, placing an emphasis on patient engagement and ensuring ​“softer intelligence” from staff and service users is captured routinely. 
• Taking an integrated approach aligns the Wales Duty of Quality with the components of quality management, makes the link between finance, performance and quality, and applies equally to the commissioning and provision of care. 
• They have engaged staff in developing their approach and brought staff in quality-related roles into a single directorate. 

Pilot feedback from a directorate indicated that the framework is easy to understand and facilitates effective implementation. The approach fosters a culture of continuous enhancement in patient care and supports a unified response to regulatory requirements, ultimately keeping patient needs at the centre. 

The process, when fully implemented, will form a self-assessment exercise. Services will upload evidence (eg service feedback or performance data) to an online portal, which is pulled into a central repository to feed into a system-wide dashboard.

• The importance of empowering teams at the service level rather than just the Directorate level. 
• Engaging key internal stakeholders yielded valuable insights
• Consolidating 183 external standards into 55 clarified expectations and reduced duplication.
• A user-friendly approach fosters understanding and collaboration, ultimately enhancing patient care through a consistent and systematic quality management system.

The impact of their improvement journey has been evident in gains across many areas of organisational performance from reductions in instances of physical violence to increased levels of staff satisfaction. Although it is too early to assess the impact of their work to bring together the components of their management system, there is potential to see how they could, for example, understand how effective their work on Quality Control had been in due course. 

• Strengths in quality improvement and quality assurance provided the foundation for their management system, working with clinical directorates to develop their quality planning and quality control approaches. 
• They have socialised the approach with staff based around work already taking place, and how that can be improved, to avoid it being seen as a new system to be implemented.