NHS Education for Scotland

Defining A Quality Improvement

FrameworkFor

A Coordinated Service Model

Workshop 27th May 2003Dr Ann Wales

NHS Scotland Library Service Development Coordinator

Ann.wales@nes.scot.nhs.uk

Quality management systems

• Wave of performance assessment:– Inspection– Reporting– League tables

• Culture of comparison– Shared learning– Attribution of

blame

• Absence of resources for implementation

• Vulnerability of public sector to change

• Top down approach

Temptations

• Measure those things that are easy to quantify

• Pursue statutory or regulatory targets only

• Focus on short-term outputs rather than long-term outcomes

• Example: use of “efficiency episodes” rather than clinical outcomes

Defining performance indicators

• Performance Management: the managerial work needed to ensure that the system’s top-level aims (“Vision and Mission”) and objectives are attained.

• Requires Performance Measurement – one part of the management

process – should lead to actions

“E’s” of Performance

Measurement

• Effectiveness

• Efficiency

• (Economy)

• Equity

What makes a good performance indicator?

• Clarifies the organisation’s objectives• Evaluates final outcomes• Enables customers to make informed choices• Enables monitoring of contracted services• Indicates contribution of different specialties• Supports managerial action to improve quality• Supports determination of cost-effective

approaches• Provides feedback to staff to enable personal

learning and improvement of practice

• (Mayston, 1985; Pollitt, 1987)

From Conformance to Performance

• Original definition of quality:• “Conformance to requirements”

• New definition of quality (TQM):• “delighting the customer by

continually meeting and improving upon agreed requirements”

Guidance or Steering via Continuous Quality Improvement• Purpose of the system needs to be agreed• Desired outcomes need to be defined and

measured• Mechanisms set in place to achieve

desired outcomes• Managers within system need to be –

– Committed to outcomes – Able to organise themselves to achieve

outcomes

“Coordinated system” Approach to Quality Improvement

• Quality improvement intrinsic to all levels of the organisation

• Primary responsibility lies with direct service providers

• Continuous Quality Improvement based on Self-Assessment against “Whole Systems” Model of Quality

• Guides development for the whole organisation

• Encourages innovation

Audit (standards) approachVs

Self Assessment (CQI)

• Audit against Standards• Independent, systematic,

objective evaluation against standard’s minimum requirements

• Professional and statistically sound judgement

• Episodic approach• Narrow focus• Lack of connection to

strategic planning

• Self Assessment against Quality Model

• Incremental performance improvement

• Ownership across all levels of organisation

• Flexible: Responsive to environmental change

• Direct link to strategic planning cycle

• Supports Continuous Quality Improvement

EFQM Excellence Model

• Comprehensive framework

• Self-assessment:– strengths – areas for improvement – across all activities

• Based on experience of over half public sector organisations in UK

EFQM Criteria: Processes and Outcomes

• Enablers (How)

• How the organisation is led

• How it manages staff• How it manages

resources• How it manages

partnerships• How it plans strategy• How it sets policy• How it fosters innovation

and learning

• Results (What)

• Satisfaction among customers and

stakeholders• Satisfaction among

employees• Impact on wider

community• Key performance

indicators

EFQM Excellence Model

© EFQM. The EFQM Excellence Model is a registered trademark of the European Foundation for Quality Management.

Benefits of Self-Assessment against an Excellence Model• Identifies strengths and areas for

improvement• Identifies priority areas to address• Provides regular assessment of

performance throughout the organisation against a recognised model

• Provides a framework which makes sense of all quality and improvement activities

• Generates fresh motivation for improvement

• Provides a basis for ongoing strategic and business planning

Summary: Conformance to

Performance • Limitations of Audit and Standards Approach• Continuous Quality Improvement based on

Self-Assessment against “Whole Systems” Model of Quality

• Responsibility lies with direct service providers

• Guide development of organisation through identification of purpose, outcomes, mechanisms

• Performance measurement should be linked to strategic planning and actions.

• Performance Indicators– Support organisation’s objectives– Based on outcomes– Facilitate learning

Service Vision

• “NHS Scotland Library and Knowledge Services transformed in the light of new technology, operating as a network of proactive, skilled information practitioners and managers, empowered to deliver centrally funded resources to point of need on an equitable, integrated, nation-wide basis”.

Guidance or Steering via Continuous Quality Improvement• Purpose of the system

needs to be agreed

• Desired outcomes need to be defined and measured

• Mechanisms set in place to achieve desired outcomes

• Managers within system need to be – Committed to

outcomes– Able to organise

themselves to achieve outcomes