Cassandra Cameron

NHS provider organisations must deliver consistently high quality care: safe, timely, effective, efficient, patient-centred, and of good value. It is a job never fully done. Unprecedented rises in demand, rapidly changing populations with more complex needs, technology, innovation in care and increasingly multi-skilled and mobile workforces all combine to create a dynamic and challenging landscape for quality.

Boards must also ensure high quality and maintain timely access to services within ever tighter financial constraints. However, the latest NHS performance figures for August reinforce a consistent trend in system-wide decline that implies the NHS simply can no longer deliver what is asked of it, within the resources at its disposal.

The CQC’s annual State of care report shows that this challenge is far beyond the NHS to solve alone. Evidence clearly shows unmet need in social care is being displaced to the NHS, with significant detrimental impacts on provider financial performance and access. There is evidence that this pressure now beginning to threaten quality and constrain improvement. Latest polling has found the NHS remains the single biggest concern amongst English voters. Change is urgently needed to delivery across the health and social care system, and the sustainable NHS envisioned in the Five year forward view relies heavily on addressing two complex delivery challenges: improving patient flow within and across providers, and reducing unwarranted variation in quality and performance.

The NHS simply can no longer deliver what is asked of it, within the resources at its disposal

Quality outcomes in clinical settings in particular rely on the efficiency of patient flow. Delaying access to the right care, in the right place, at the right time increases the risk of harm and poor quality for patients. For providers, poorly managed patient flow is also expensive, increases the burden on clinicians and damages the morale and wellbeing of staff.

Often processes in clinical settings have evolved over time to meet the needs of regulators, constraining adaptability to more modern, efficient and patient-centred care. However, to start designing better processes, clinicians at all levels need to be actively engaged to ensure that quality functions effectively as the organising principle for care. There is a wide body of research in the UK and internationally that links strong clinical leadership to enhanced organisational performance, productivity and improved care. It’s fundamental to understanding how services can be improved for patients, and for identifying where unnecessary processes impede better care.

Delivering quality improvement also takes skill at defining and analysing problems and devising and testing solutions. Trusts that most effectively improve quality and sustain the benefits exhibit strong visible leadership, with staff at all levels engaged in learning and improvement activity such that it becomes routine to their work. There’s now a much stronger national drive to foster quality improvement capability and scientific approaches to waste elimination in the UK through partnerships with the Health Foundation, AQuA, and US-based Institute for Healthcare Improvement and the Virginia Mason Institute.

Clinicians at all levels need to be actively engaged to ensure that quality functions effectively as the organising principle for care

Clinical human factors approaches that involve ‘systems thinking’ are also being used to design and deliver services and build stronger safety cultures, where the inherent risk of error is well understood and actively mitigated and staff are skilled to anticipate and prevent adverse events. These techniques and strategies will be integral to designing and delivering improvement along care pathways that cross organisational boundaries and care settings.

Whichever quality improvement approach an organisation takes, the most important message from top performing providers is that culture change and evidence of improvement take time to deliver. Through the new NHS single oversight framework, the autonomy and stability needed for improvement cultures to develop and embed are now contingent on provider performance which, as State of care has shown, is heavily influenced by systemic factors often beyond an individual organisation’s direct control. For highly challenged providers such as those in special measures or struggling with entrenched problems in particular services, allocating the resources to invest in quality improvement will be extremely difficult without additional system-level support and investment, as well as confidence among leaders that improvement will happen if given time, support and space to grow.

Despite the challenging context facing NHS foundation trusts and trusts, there are many examples of organisations and systems that are still innovating to improve the quality of care for their patients. The Delivery strand at this year’s annual conference and exhibition will feature trust leaders that are working across organisational boundaries to tackle unwarranted variation, taking bold approaches to redesigning frontline services in partnerships and within their own organisations, and have achieved remarkable improvements using quality improvement, waste reduction strategies and human factors to drive up quality. We look forward to sharing their learning and hope to see you there.

Find out more about the strand programme at this year's annual conference and exhibition, taking place in Birmingham on 29-30 November, and book your place.