Assurance and quality

It is vital that any organization can give assurance to the owners (in the case of the NHS, the government and the voters), the users or patients, and the staff, that the quality of care is high. The Francis report following the exposure of poor quality care at the Mid Staffordshire Hospital Trust resulted in every member of every Board of any NHS organization being reminded of his or her personal responsibility for quality. This created a step change. Where previously people might have been happy to hear a report of ‘no problems’, now the organization is required recurrently to prove that quality is good. The challenge is to determine what we can measure to do this. This area of ‘Ward to Board assurance’ is a dynamic one and the list of topics is evolving.

No one number captures the whole picture. It is important to measure a number of different parameters and to ensure both internal and external perspectives are included. Wherever possible, data needs to be benchmarked and trended over time. The measures need to look at the inputs to the clinical process, such as numbers of trained staff. The effectiveness of the clinical process needs also to be measured by its adherence to best practice. It is of course also vital to examine the outcomes, both good and bad, in terms of clinical quality and patient experience.