Quality Management Systems: resources to help you get started
Draw learning and inspiration from different frameworks, tools and methods that others have used.
On this page
This resource page collates links and materials aimed at helping individuals and teams who are interested in, or tasked with developing, Quality Management Systems (QMS). Through these resources, you can draw learning and inspiration from different frameworks, tools and methods that others have used. This page builds on growing activity within the Q community – most notably a series of webinars that explored QMS and their potential in health care and our current insight project.
Quality Management Systems
QMS are not a new concept. They have been utilised in many industries over the last several decades. Many health organisations already have several elements of quality management in place, such as improvement teams and planning functions, but there is now a more sustained drive to systematically implement QMS at the whole organisation level.
There is no one single accepted definition of a QMS; they can be thought about in different ways and as functioning at different levels. Q’s work in this area, and this resource page, is primarily focused on applying QMS at the whole organisational level:
Within health care, a whole organisation Quality Management System is a consistent and coordinated approach to planning, improving, controlling and assuring high quality care. It is applied across all levels of an organisation – from team to board. It is aligned to strategy, underpinned by processes and embedded in organisational culture.
This builds on the definition in Healthcare Improvement Scotland’s Moving from Quality Improvement to Quality Management.
However, it is important to recognise that a more technical definition of QMS is well developed in specific aspects of health care delivery such as medical devices, laboratories and pathology. These forms of QMS often adopt the relevant International Organisation for Standardization (ISO) standard. Whatever form they take, most QMS are derived from the Juran trilogy of quality planning, quality control and quality improvement. Quality assurance is often added to the trilogy too.
The Juran Trilogy
Across the UK there is increasing interest in the use of the Juran trilogy as the basis for the development of QMS, with national policies and guidance utilising it as a framework for change. For example:
- In aiming to mainstream continuous improvement across the NHS in England, one of the five components of NHS IMPACT is to embed a management system that aligns assurance, improvement and planning.
- Healthcare Improvement Scotland have recognised that the delivery of high-quality care requires organisations to have a consistent and coordinated approach to managing quality that is applied from team through to board level.
- In Wales, the Health and Social Care (Quality and Engagement) (Wales) Act 2020 came into force on 1 April 2023. As part of the Act there is a requirement for the NHS to establish effective QMS that focus on learning and ensuring that planning, control, improvement, and assurance function collectively together.
While these policies and guidance all utilise the Juran trilogy, they also provide some guidance as to what else is required to effectively embed quality management.
Components of the Trilogy
Before diving into the components of quality planning, quality control, quality improvement and quality assurance, it is important to recognise:
- the components are not neatly separated in practice and should be closely linked to each other.
- the approach taken for a successful QMS will vary depending on context
- implementation requires an organisation to reframe its strategy to focus on quality and outcomes.
- implementation takes considerable time and effort across the whole organisation.
- significant changes to culture, leadership behaviour and structures are needed to effectively embed a QMS within an organisation.
Quality planning
Quality planning starts with understanding patient and service users’ needs. Then, the necessary services, along with structures and processes to support them, are developed. This may involve developing new services, making changes to current services, and stopping services where necessary. New ways to support services, or changes in how they are supported, may be required to ensure that they meet the needs of patients and service users.
With quality planning, it’s important to embed quality within an organisation’s operating system, rather than seeing quality as separate from other areas such as planning, finance and human resources.
Quality planning for impactful improvement: a mixed methods review
This research article published in BMJ Open Quality summarises the key literature and enablers to support quality planning.
Effective Quality Planning
This Healthcare Executive publication describes the elements of quality planning. While this focuses on a US context, it provides some useful insight for UK organisations.
What is a Quality Plan?
The American Society for Quality’s resource describes the parts of a quality plan and some tools to support documentation and deployment. This resource is not health care specific.
A guide to developing and assessing a quality plan
A guide for health care organisations in developing effective quality plans. While this was developed for the US health care system, it is equally useful to support NHS organisations.
Quality improvement
Quality improvement has been applied across health care for several decades. Increasingly, it is seen as part of an overall approach to quality management; when quality improvement is integrated within an organisation, it can support the prioritisation and sustainability of improvement efforts.
Quality improvement involves a systematic and coordinated approach to solving a problem using specific methods and tools with the aim of bringing about a measurable improvement. A range of different tools and methods are utilised within health care such as the IHI’s Model for Improvement or the Define, Measure, Analyse, Improve, and Control (DMAIC) process, along with tools such as cause and effect, pareto and statistical process control.
Improvement as mainstream business
A briefing by the Health Foundation outlining the need for improvement approaches to be embedded into the core strategy and operations of health care organisations.
Quality improvement into practice
An open access article published in the BMJ defining quality improvement and describing how it fits with other approaches to improving care such as audit and research.
QI made simple
A guide published by the Health Foundation in 2021, explaining some of the popular approaches and methods of quality improvement that are used in health care.
Making the case for quality improvement
A report by the King’s Fund that makes the case for quality improvement to be at the heart of local plans for redesigning NHS Services. It outlines 10 lessons for NHS leaders seeking to embed quality improvement in their work.
Quality Improvement Essentials Toolkit
A curated list of tools and templates to support and manage successful improvement projects developed by the IHI.
Quality control
Many industries have successfully implemented quality control methods, but as a term in health care it remains relatively misunderstood, often being described as similar to quality assurance. As opposed to quality assurance, quality control is owned and managed by those closest to where the work takes place to sustain improvements and produce reliable outcomes. Quality control methods frequently involve:
- Standardisation of processes and activities
- Visual management approaches to monitor key metrics
- Tiered huddles to communicate, share learning and solve problems rapidly
- A process for rapid escalation to managers and leaders when problems require additional support
Moving from Quality Improvement and into Quality Control
This YouTube video from East London Foundation Trust describes how they utilise quality control to support and sustain their improvement efforts.
Quality Control: The Misunderstood Essential for Improvement
This IHI blog describes the elements of quality control within health care and why it is important.
Visual management board guidance
This brief guide describes visual management boards, with examples, tips on their use and how to implement them.
Huddle guidance
The IHI’s brief guide providing information, examples, and a template to support the implementation of huddles.
Quality assurance: a necessary component of quality management
Quality assurance has not historically been part of the Juran trilogy. However, in health care it is well recognised, forming a crucial way to evaluate the performance of the system. It is viewed as a popular way to drive health care quality. However, it often means assessing quality retrospectively through committees, Boards or external assessments rather than supporting planning and improvement. It remains an important activity to ensure that quality control is maintained and that the system is meeting its intended aims. Quality assurance also demonstrates to leaders that the mechanisms are in place to support the planning and improvement of strategic initiatives.
Quality assurance activities frequently involve:
- Audit
- Accreditation
- Compliance with regulations and statutory guidance
Other resources to consider
An introduction to the hospital-based QMS
The American Society for Quality’s webcast introduces the hospital-based health care QMS that they developed (free registration is required).
Toyota Production System
Toyota describes how their system works and the two principles that underpin their management system: automation with a human touch, and just-in-time
High reliability organisations
The Health Foundation’s evidence scan on high reliability organisations. While different terminology is used, many of the high reliability principles are like those seen within a well-developed QMS.
Moving from Quality Improvement to Quality Management
This Healthcare Improvement Scotland resource makes the case for an organisational approach that goes beyond quality improvement to include all key components of quality management.
Factor analysis of Quality Management Systems Implementation in Healthcare
This paper investigates the views of health care researchers and professionals on the implementation of QMS. The results indicate that culture, structure and managerial training are critical to successful implementation.
10 challenges in improving quality in healthcare
This open access paper from BMJ Quality and Safety focuses on the challenges to implementing improvement. While focusing on improvement, many of the lessons are consistent with the challenges of implementing a QMS.
Scaling and Spreading a Management System
The Virginia Mason Institute’s podcast discusses the challenges, successes, and approaches to spreading a management system across a newly expanded health system.
Whole System Quality: A holistic approach to quality management
The IHI’s white paper proposes a holistic approach to quality management to help organisations close the gap between the quality that patients and service users currently receive and the quality they could be receiving. This is based on the Juran trilogy.
European Foundation for Quality Management (EFQM)
A globally recognised management framework that supports organisations in managing change and improving performance, based upon five enablers – leadership, strategy, people, partnerships and resources, and processes. While not health care specific, it has been used in health care.
ISO 9001: 2015 – Quality Management Systems
The globally recognised standard for quality management. It is, however, not specifically related to health care and there are few examples of its effective use across a whole organisation in health care. There are examples of its use within primary care, individual departments and support services such as laboratories and diagnostics.
ISO7101:2023 – Healthcare organisation management
The first international standard specifically focuses on health care quality management was developed in 2023. The publication describes the prescribed standards for a systematic approach to delivering sustainable, high quality health care systems. There are several organisations internationally that are beginning to utilise ISO7101 but evidence for its impact is yet to be collated.
Malcolm Baldridge National Quality Award
This award was developed in the late 1980s in the USA to raise the awareness for quality management and recognise companies that had successfully implemented quality management. In the late 1990s, a health care category was included. It remains specific to the US health care system, but provides a framework that is relevant to organisations outside of the US.
These resources come from a small number of examples where a QMS approach has been effectively implemented across an organisation.
East London Foundation Trust (UK)
- A quick guide to quality management systems at ELFT
- How to move beyond quality improvement projects: ELFT’s Chief Quality Officer, Amar Shah describes the components of an effective quality management system.
Jönköping (Sweden)
In 1992, Jönköping adopted a quality-based business strategy based on the Malcolm Baldridge Award under the name QUL (Quality – Development – Leadership). They continue to use this model today.
- This white paper by 1000 Lives (now Improvement Cymru) provides detail and learning from the region.
- This book chapter (available online) examines Jönköping and its application of a QMS
Greater Baltimore Medical Center (USA)
This centre was a recipient of the Malcolm Baldrige National Quality award in 2020.
- In this YouTube video, the CEO and President describe their Lean Daily Management System.
- This article describes the Center’s integrated leadership system, and how it supports its vision and aims.
Virginia Mason Medical Center (USA)
The Virginia Mason Production System was developed using the Toyota Production System
- Using a management system to drive and sustain results
A presentation by President/CEO Gary Kaplan - Virginia Mason Success Stories
These stories include improving sepsis management, pain management, transitions of care and innovative practices.
Hamad Medical Corporation (Qatar)
The IHI and NHS Scotland developed a Value Improvement methodology using a number of methodologies to combine elements of quality planning, quality improvement and quality control to demonstrate improvements in outcomes, processes and costs – aligned to strategic priorities.
- This BMJ Open Quality article focuses on engaging frontline teams in value improvement
We hope you have found these selected resources useful. This selection was developed by Q along with Emma Adams, John Boulton and Joy Furnival. If you have any questions or comments, please contact matthew.hill@health.org.uk
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