Unit Six

Key benefits

This unit will explore:

• organisations that play a role in quality improvement
• ways to monitor and improve quality in general practice
• how to conduct evaluations from a variety of perspectives.

The following organisations play a key role in quality improvement:

• National Patient Safety Agency (NPSA) – explores how to make the NHS safer for patients and encourages examination of sources of error (www.npsa.nhs.uk)
• National Institute for Clinical Excellence (NICE) – evaluates disease treatment and management to establish the most cost-effective care (www.nice.org.uk)
• Healthcare Commission – an independent watchdog that reports to Parliament on the performance of trusts in England and Wales (www.healthcarecommission.org.uk)
• NHS Institute for Innovation and Improvement – has expertise in service transformation, technology and product innovation, leadership development and learning. Many of the learning programmes and outputs from previous organisations, such as the Modernisation Agency, the NHS University (NHSU) and the National PCT Development Team (NatPaCT), have been subsumed within this organisation (www.institute.nhs.uk)
• Clinical Governance Support Team – supports developments in clinical governance (www.cgsupport.nhs.uk)
• National Primary Care Development Team – works nationally and regionally to improve care, including access and coronary heart disease care (www.npdt.org)
• National Audit Office (NAO) – scrutinises public spending on behalf of Parliament; currently reviewing the implementation of clinical governance within primary care trusts (PCTs) (www.nao.org.uk)
• Audit Commission – an independent public body responsible for ensuring that public money is spent economically, efficiently and effectively in health and other areas. Their mission is to be a driving force in the improvement of public services, promoting good practice and helping to achieve better outcomes (www.audit-commission.gov.uk).

The Healthcare Commission’s Standards for Better Health (ref 2) document may be useful when reviewing practice standards. These are based on seven pillars of clinical governance, including:

• safety – risk management, in order to understand, monitor and minimise the risks to patients and staff, and to learn from mistakes
• clinical care and cost-effectiveness – to ensure that the approaches and treatments used are based on the best available evidence
• governance arrangements – to make sure that systems and audits are in place to collect and interpret clinical information, and to monitor the quality of patient care
• patient-focused services – to enable patients and patient organisations to have a say in their own treatment and in the way that services are provided
• accessible and responsive care – delivery of care by the right person at the right time
• care environment and amenities – adequate resources, including the recruitment, management and development of staff, including the promotion of good working conditions and effective methods of working
• public health – emphasis on health care that is linked to population needs in order to benefit whole communities.

Evaluation is a vital component of quality assurance – effective evaluation should be based on the following principles:

• efficient, effective and economical – taking account of the costs and effectiveness of what is being evaluated as well as the evaluation process itself
• valid – measuring what it is intended to measure
• reliable – producing accurate findings
• flexible and practical – not burdensome
• fair – not favouring any particular person or group, either directly or indirectly; including all elements of care
• in proportion – to the specific issues or elements of care
• accountable – linked into any internal or external reports that are part of the accountability structure for individuals, in the practice or PCT
• coordinated – with the practice or PCT development or review processes.2