Quality Management Systems

Quality improvement, by itself, does not represent a holistic approach to managing quality.

Quality improvement needs to be used alongside quality planning, quality assurance, and quality control to create a single, consistent management system.

A quality management system consists of four aspects:

Key features Examples of tools
1. Quality planning
  • identify the needs of the customer and population
  • develop service models to meet the need
  • put in place structures and process to manage the service
  • commissioning process
  • contracts and service specification
  • service model or pathway
  • team structure
  • job roles
  • measures (outcome, structure and process)
2. Quality control
  • identify clear measures of quality for the service, and monitor these over time
  • take corrective action when appropriate
  • internal vigilance to hold gains made through improvement
  • team huddles
  • clear escalation process
  • visual display of key measures for the service (presented as data over time)
3. Quality assurance
  • periodic checks to ensure the service is meeting the needs of the customer and population
  • actions to address gaps identified
  • audit
  • inspection
  • implementation of best practice (e.g. NICE guidance)
  • gap analysis
  • action trackers
  • cause and effect diagrams
4. Quality improvement
  • identify what matters most
  • design project and bring together a diverse team
  • discover solutions through involving those closest to the work, test ideas, implement, and scale up
  • cause and effect diagrams
  • pareto charts
  • flow charts
  • driver diagram
  • project charter
  • model for improvement
  • divergent and convergent thinking tools
  • PDSA cycles of testing
  • statistical Process Control (SPC) charts

A key challenge in healthcare is to balance energy and activity across these four domains: planning ought to be an annual activity; improvement should be used in short bursts to achieve new levels of performance; assurance ought to be used occasionally to check whether standards are maintained; and control should be the way daily work is managed in a team.

One of the main responsibilities leaders have within teams and organisations is to ensure the four different features of quality management are balanced and that the appropriate approach for a particular type of opportunity is deployed. In order to support our teams and people managing quality, it will be important to understand how different members of the team can contribute to each of the four aspects of quality management. Everyone in the team, including patients, should play an active part in a robust quality management system.

Roles of team members within each aspect of the quality management system:

Quality Planning Quality Control Quality Assurance Quality Improvement
Team leader
  • contribute to service planning and commissioning
  • put in place the structures and processes for service delivery
  • be transparent about how the team is performing and take corrective action when needed
  • empower the team to share and solve small problems on a daily basis
  • stay attuned to hard and soft intelligence to ensure gains are achieved and sustained
  • share assurance data with the team and help make sense of the different types of data
  • proactively take action to address gaps against agreed standards
  • support regular time for team reflection and help the team and service users identify the priority area for improvement
  • bring together a diverse project team and help it find the time to improve the service and to remove barriers
  • support the team to share their learning
Team member ____________
  • monitor how the team is performing
  • listen to the feedback from service users, customers and carers
  • proactively raise and solve problems on a daily basis
  • ensure that daily practice meets agreed standards, or justify when practice departs from these
  • participate in assurance activities such as audit, inspection, learning lessons.
  • share views with the team about biggest opportunity to improve
  • contribute to change ideas to the area that the team is currently working on
  • using the tools of Quality Improvement to develop a strategy, test ideas and implement these into daily practice
Consultant or senior clinician
  • identify the best service model to meet the needs of the population, using clinical expertise and knowledge
  • monitor how the team is performing
  • listen to the feedback from service users, customers and carers
  • proactively raise and solve problems on a daily basis
  • ensure that daily practice meets agreed standards, or justify when practice departs from these
  • help identify and set the standards against which the team is measured
  • participate in assurance activities
  • contribute views about the team’s biggest area of opportunity
  • use clinical expertise and research knowledge to bring ideas to the team
  • support the team to involve a diverse range of people in improvement work
  • help the team find time to improve the service and remove barriers to this
Service user
  • be able to contribute to identifying the needs within the population and what types of service might be best to meet them
  • be able to feed back experiences of the service through a variety of ways
  • help set standards against which services are measured
  • be involved in auditing or inspecting services
  • help the team determine the big issues the need improving
  • be able to help inform how the service improves
  • be able to contribute to the improvement work as much as desired
  • be able to feed back whether changes have made a difference
Senior leader
  • contribute to developing the organisation’s vision, mission and strategic plan
  • communicate these to the teams
  • help teams align their work to the organisation’s mission and strategic plan
  • work with external stakeholders and partners in developing goals and priorities across the system
  • monitor how the system is performing
  • use data to inform decision-making
  • empower and support teams to solve complex problems
  • regularly listen to the experience of staff and service users
  • ensure systems are in place to check that high quality care is being provided
  • ensure that assurance activities add value and are meaningful.
  • play a sponsor role for improvement work
  • help identify priority areas for improvement
  • helps teams see how their work fits to strategic priorities
  • help teams find space and time to improve
  • link regularly with projects to help unblock barriers and celebrate their work

 

The activities in the management system should not be considered as isolated entities, but as being interconnected and sequential.

The highest performing teams reduce assurance activity, create an intentional annual planning or redesign process, build a real-time quality control system and use quality improvement for the right type of problem in short bursts of rapid-cycle testing and learning.

Read the full report: How to move beyond quality improvement projects.