NHS Lanarkshire: Building a structure and setting a long-term strategy for Whole System Quality

Whole System Quality at NHS Lanarkshire describes the pursuit of quality through an agreed set of values and practices, structured around the four components of quality management. Their Quality Strategy 2023–29 sets out what each of these components mean, and when staff should consider using them. 

The four components of quality management have been simplified into four questions: 

1. What do we need? 
2. What is our performance? 
3. What could be better?
4. Are we meeting standards? 

A core part of their approach is a commitment to listening to service users and staff to inform each of the four areas, which is set out in a separate Learning Strategy.

The IHI model on Whole System Quality helped them to think through what their approach should look like, and it formed the basis for conversations with staff. They break down discussions into simple ideas based around the four QMS components to build understanding and address areas of misunderstanding. 

They found that staff were often confused about the difference between Quality Control and Quality Assurance. Staff found it helpful to distinguish between them as developing locally-important measures compared to compliance with external requirements, respectively. The principles of Whole System Quality have been embedded into their QI training programme (aEQUIP) and their Quality Improvement portal (LanQip), and formed the basis for an edition of their COMPASS newsletter to provide more detail on what it means for staff.

During discussions, they realised that Quality Planning – which they describe as understanding the needs of their service users and population – was the area most in need of extra attention. They developed their ​‘True North’ statements, which set out how they will achieve their quality vision, and should ​‘guide every decision relating to quality of care’. The statements have an annual action plan to determine what needs improving, and how, co-developed with the service. By working with staff on this, and focusing discussions on it:

The organisation’s quality activities are felt to be making a tangible difference. The team has worked hand-in-hand with services to address significant challenges, ranging from the set-up of COVID-19 vaccination centres to relieving pressure at the front door of their hospital emergency departments. This can be attributed to the systematic use of improvement methods, and the organisational commitment to investing in quality. 

There remains 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’:

Having people in Karon’s team who can operate at a senior level, has been an important enabler. In relation to the Improvement Advisors:

They also found that having conversations using the language of ​‘quality management systems’ has not been helpful. Staff found it too vague, and needed to discuss the practical applications of it to be helpful:

• The quality management components have been translated into four simple questions, under the banner of ​‘Whole System Quality’, to help engage frontline staff.
• Lanarkshire has a dedicated Quality Directorate, bringing together evidence, improvement and assurance teams which support services with their quality work.
• The principles of Whole System Quality are embedded at every opportunity, from corporate communications to QI training, with ​‘True North’ statements informing quality activities across the system.