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Five key themes

This diagram illustrates the 5 interconnected key themes that form a framework to look closely at how to improve the quality of care

Five key themes appear repeatedly in policy documents about healthcare quality: 

  • Patient focus - how services are based on patient needs
  • Information focus - how information is used
  • Quality improvement - how standards are reviewed and attained
  • Staff focus- how staff are developed
  • Leadership - how improvement efforts are planned.

These five themes are interconnected. Together they provide a framework to look more closely at those things that make the difference to quality of care.

Public inquiries and investigations into poor care quality usually show that multiple dimensions of care are involved.

Sir Robert Francis, author of the Mid Staffordshire Inquiry report (Francis 2013), described the breakdown of fundamental clinical governance practices:
  • No systems in place for systemic appraisals of clinical quality or of staff
  • Information gathering was “inept” and coding “dreadful”
  • Staff were not “gripped” by the importance of clinical governance
  • No culture of self analysis
  • Little analysis of complaints or incidents
  • The risk register was not kept up to date.

The RCN has developed this resource to support those wanting a deeper understanding of these themes and what can be done to make a positive impact on patient care. 


Francis R (2013). Mid Staffordshire NHS Trust Public Inquiry 

Page last updated - 03/08/2019