Aneurin Bevan University Health Board: managing the total quality system

Quality management at Aneurin Bevan means managing ​‘the total quality system’, extending to both the provision and commissioning of health and care. Their Quality Strategy is structured around the six STEEEP pillars (care that is Safe, Timely, Effective, Efficient, Equitable, and Person-centred) as set out in the Welsh Duty of Quality. 

In practice, however, they ​‘wrap the quality management system around’ the work they do within each of those pillars, using the four components of quality management as their guiding framework.

Jennifer has been a Director of Nursing for 15 years, moving to Aneurin Bevan two years ago as Executive Director of Nursing. One of her first tasks was to update the Quality Strategy. This was done ​‘rapidly’, within six months, before the national Duty of Quality came out ​‘because we needed something strategic to hang our hat on’. This was followed by several other strategic actions.

They were the first organisation in Wales to develop a quality outcomes framework, focused on the data and metrics needed to judge their performance. They developed a Listening and Learning Framework to draw in the ​“softer intelligence” from the perspective of staff and service users. They developed a Patient Experience and Involvement Strategy around the same time, ​‘to be really clear about how we triangulate our data with the experience of service users and our staff’. Most recently, they have developed a commissioning quality framework:

A lot of work went on behind the scenes, with staff and with the Board, to operationalise the strategies and ​‘to work out exactly how to deliver an effective quality management system’. This included, for example, thinking more systematically about Quality Planning and Redesign as an important first principle, asking themselves, ​’What is it we want to change? What is it we want to do? What are we ambitious about for quality?’.

To better understand Quality Control, they explored what their systems and processes should look like, what the data flows and standards should be, who needs to be involved, and what this should look like within each divisional care group. For Quality Assurance, they provided clarity on reporting arrangements to the Board, the Executive Committee and the Quality Committee. A particularly strong emphasis was then put on the Quality Improvement component: 

There have been challenges, for example, with engaging operational colleagues, given the pressures they are facing. It has been helpful in conversations to illustrate how the approach can support them in their role. Working closely with the Director of Planning and Director of Workforce has been an important part of this.

Taking a quality management system approach has helped to make the link between finance, performance and quality. For example, they now specifically examine the costs associated with harm when making assessments about whether services are effective. The Finance Director routinely asks for quality impact assessments associated with service changes, and the Director of Planning uses qualitative information on the impact of performance issues to influence outcomes. In future, board reports will change from being a separate quality report to an integrated report ​‘which will be important to join the dots’:

This work has been done alongside an Organisational Change Programme. This brought together around 40 people, who were already undertaking quality-related activities, into Jennifer’s directorate. While acknowledging that this work doesn’t necessitate structural change, ​‘in order for me to get the quality control and the planning right, I’ve needed to bring that resource in-house in my directorate’.

Aneurin Bevan is developing an integrated quality management approach aligned with the Wales Duty of Quality and led by its executive team. They focus on patient engagement and aligning quality with finance and performance. Key initiatives include a Quality Strategy based on the STEEEP pillars, and frameworks for quality outcomes, listening, and patient experience. The organisation aims to create a tailored quality management system that extends to both the provision and commissioning of health and care.

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.