Surely we’ve always been working to improve the quality of our services, and there is so much evidence of improvements made over the years? What does Quality Improvement (QI) add to this?

A different way to go further

There are many ways to improve quality, including performance management, CQUIN targets, audit, robust governance and controls and so on. QI builds on these approaches, but utilises and leverages skills and experience in a different way to go further.

Traditional management, target-setting, policy making, performance and assurance all rely on people in senior positions making decisions about what to do, and how to do it. This is important, but only gets us so far. These approaches also rely on us understanding the problem, and knowing the answer, having the skills to solve it, and not needing to address attitudes, behaviour or culture.

Tackling complex problems

QI goes beyond this, and is best applied when tackling problems in complex systems, where the problem isn’t completely understood and where the answer isn’t known – for example how to reduce frequency of community suicides, or how to reduce frequency of violence on inpatient mental health wards. QI utilises the subject matter expertise of people closest to the issue – staff and service users – to identify potential solutions and test them.

Releasing creativity and innovation

Done well, this can release great creativity and innovation in tackling complex issues which services have struggled to solve for many years. The type of problems that we should be using quality improvement to tackle, are those that require not only changes in behaviours or preferences, but also hearts and minds, where we choose to work together towards a shared purpose.

Thanks to Dr Amar Shah, Associate Medical Director (Quality Improvement) & Consultant Forensic Psychiatrist, East London NHS Foundation Trust –

The Improvement Journey >

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