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Quality Management Systems: resources to help you get started

Draw learning and inspiration from different frameworks, tools and methods that others have used.

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 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.

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

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

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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