Great Ormond Street Hospital: sustained quality improvement and enhanced patient outcomes

Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) has undertaken a transformative initiative to implement a Quality Governance Framework aimed at unifying quality standards, improving patient care and equipping teams with a clear understanding of what constitutes ​“good quality.” 

Led by Jit Olk, Head of Quality, the initiative resulted in the development of a Quality Governance Blueprint, consolidating the numerous external standards governing quality governance. Over nine months, Jit systematically reviewed and synthesised 183 external standards—spanning ISO 9001, 7101, 31000, Care Quality Commission (CQC) requirements and NHS IMPACT self-assessment principles—into a streamlined framework of 55 core standards across seven domains. 

Each standard within the framework outlines expected outputs, behaviours and outcomes to provide clarity and consistency in quality expectations across services. The overarching goal is to foster active governance, ensuring that blind spots are identified and mitigated through clear accountability structures and data-driven decision-making. 

The framework enables a standardised approach to measuring quality across services, fostering alignment while preserving the individualised nature of patient interactions: 

While senior leaders at GOSH were supportive of a new approach, the challenge was to develop and integrate an operational Quality Management System (QMS) by the end of 2025. The goal was to unify quality-related activities, such as clinical audits, improvement initiatives and assurance processes, to eliminate duplication and enhance efficiency: 

A comprehensive stakeholder consultation—including board members, clinical and non-clinical staff—guided the development process. A pilot was conducted with a single directorate in June 2024, receiving positive feedback on its clarity and usability. 

The final framework prioritises risk-based decision-making, assigning a risk rating to each standard based on impact severity and frequency. These insights are then integrated into an improvement tracker, allowing services to proactively address gaps and drive meaningful enhancements. 

Once fully deployed, the framework will function as a self-assessment tool, where services will upload evidence (e.g., service feedback, performance data) into an online portal. This data will be consolidated into a central repository, feeding into a system-wide dashboard that offers real-time insights into service performance. 

Beyond regulatory compliance, the framework is designed as a collaborative learning platform, enabling services to identify and address quality gaps proactively: 

• Empowerment at the Service Level: Initially considered for Directorate-level application, the framework was ultimately designed to empower services to take ownership of improvement plans. 
• Stakeholder Engagement: Active involvement of internal stakeholders ensured that the framework was both practical and aligned with organisational goals. 
• Reducing Complexity: The consolidation of 183 external standards into 55 key requirements clarified expectations, minimised duplication, and streamlined compliance. 
• User-Friendly Design: Traditional corporate QMS language was intentionally avoided to create an accessible, intuitive framework that enhances engagement and collaboration. 

GOSH’s Quality Governance Framework represents a progressive shift in quality management, balancing standardisation with flexibility to accommodate patient-centred care. By integrating governance, risk and compliance into a cohesive system, the initiative lays the foundation for sustained quality improvement and enhanced patient outcomes.