Quality Improvement QUALITY IMPROVEMENT
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May 2020 A special supplement in partnership with The Health Foundation Quality improvement QUALITY IMPROVEMENT EDITOR’S CHOICE 1 A road map towards better quality improvement Raffaella Bosurgi EDITORIALS BMJ 2020 2 Prioritising quality improvement EDITORIAL OFFICES The Editor, The BMJ Joanna Bircher BMA House, Tavistock Square London, UK, WC1H 9JR Email: [email protected] Tel: + 44 (0) 20 7387 4410 3 Creating space for quality improvement Fax: + 44 (0) 20 7383 6418 Dominique Allwood, Rebecca Fisher, Will Warburton, Jennifer Dixon BMJ - Beijing A1203 Tian Yuan Gang Center East 3rd Ring North Road 5 Better healthcare must mean better for patients and carers Chaoyang District Beijing 100027 Anya de Iongh, Sibylle Erdmann China Telephone: +86 (10) 5722 7209 BMJ - Hoboken BMJ Publishing Inc ANALYSIS Two Hudson Place Hoboken, NJ 07030 Tel: 1- 855-458-0579 7 Improving together: collaboration needs to start with regulators email [email protected] BMJ - Mumbai Nicola Burgess, Graeme Currie, Bernard Crump, John Richmond, Mark Johnson 102, Navkar Chamber, A Wing Marol, Andheri - Kurla Road Andheri (East) Mumbai 400059 Tel: +91 22-40260312/13/14 10 Spreading and scaling up innovation and improvement Email: [email protected] Trisha Greenhalgh, Chrysanthi Papoutsi BMJ - Noida Mindmill Corporate Tower 6th Floor, 24 A, Film City Sector 16 A 16 Changing how we think about healthcare improvement Noida 201301 Telephone: + 91 120 4345733 - 38 Jeffrey Braithwaite Email: [email protected] BMJ - Singapore Suntec Tower Two 21 Understanding organisational culture for healthcare quality improvement 9 Temasek Boulevard, #29-01 Singapore 038989 Russell Mannion, Huw Davies Tel: +65 3157 1399 Email: [email protected] BMJ - Sydney 25 Can we import improvements from industry to healthcare? Australia Telephone: +61 (0)2 8041 7646 Carl Macrae, Kevin Stewart Email: [email protected] Twitter: Follow the editor, Fiona Godlee @fgodlee and The BMJ at twitter.com/bmj_latest 29 How organisations contribute to improving the quality of healthcare BMA Members’ Enquiries Email: [email protected],uk Naomi J Fulop, Angus I G Ramsay Tel: + 44 (0) 20 7383 6955 Advertising Email: [email protected] Tel: + 44 (0) 20 3655 5611 34 Adapting Lean methods to facilitate stakeholder engagement and Reprints co-design in healthcare Email: [email protected] Tel: + 44 (0) 7866 262 344 Iain Smith, Chris Hicks, Tom McGovern Subscriptions Email: [email protected] Tel: + 44 (0) 20 7111 1105 38 Revitalising audit and feedback to improve patient care Other resources Other contacts: http://www.bmj.com/about-bmj Robbie Foy, Mirek Skrypak, Sarah Alderson, Noah Michael Ivers, Bren McInerney, Jill Stoddart, Advice to authors: http://www.bmj.com/about-bmj/resources-authors Jane Ingham, Danny Keenan To submit an article: submit.bmj.com The BMJ is published by BMJ Publishing Group Ltd, a wholly owned subsidiary of the British Medical Association. The BMA grants editorial freedom to the Editor of The BMJ. The views ESSAYS expressed in the journal are those of the authors and may not necessarily comply with BMJ policy. The BMJ follows guidelines on editorial independence produced by the World Association of Medical Editors (www.wame. org/wamestmt.htm#independence) and the code on good 42 How to improve healthcare improvement publication practice produced by the Committee on Publication Ethics (www.publicationethics.org.uk/guidelines/). Mary Dixon-Woods The BMJ is intended for medical professionals and is provided without warranty, express or implied. Statements in the journal are the responsibility of their authors and advertisers and not authors’ 46 Getting more health from healthcare: quality improvement must acknowledge institutions, the BMJ Publishing Group, or The BMJ unless otherwise specifi ed or determined by law. Acceptance of advertising does not imply patient coproduction endorsement. To the fullest extent permitted by law, the BMJ Publishing Group shall not Paul Batalden be liable for any loss, injury, or damage resulting from the use of The BMJ or any information in it whether based on contract, tort, or otherwise. Readers are advised to verify any information they choose to rely on. 49 Why healthcare leadership should embrace quality improvement @BMJ Publishing Group Ltd 2020 All Rights Reserved. No part of this publication may be reproduced, stored John R Drew, Meghana Pandit in a retrieval system, or transmitted in any form or by any other means, electronic, mechanical, photocopying, recoding, or otherwise, without prior permission, in writing, of The BMJ. QUALITY IMPROVEMENT EDUCATION 52 How to get started in quality improvement Bryan Jones, Emma Vaux, Anna Olsson-Brown 56 Using data for improvement Amar Shah 60 Evaluating the impact of healthcare interventions using routine data Geraldine M Clarke, Stefano Conti, Arne T Wolters, Adam Steventon 65 Quality improvement into practice Adam Backhouse, Fatai Ogunlayi 71 How to improve care across boundaries Charles Coughlan, Nishma Manek, Yasmin Razak, Robert E Klaber Article provenance These articles are part of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ, including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ’s quality improvement editor post are funded by the Health Foundation. Indexing The BMJ Please do not use the page numbers given in this edition when citing or linking to content in The BMJ. Please be aware that The BMJ is an online journal, and the online version of the journal and each article at thebmj.com is the complete version. Please note that only the on- line article locator is required when indexing or citing content from The BMJ. We recommend that you use the Digital Object Identifier (doi) available online at the top of every article and printed in each article in this edition for indexing. The citation format is given on each article. EDITOR'S CHOICE A road map towards better quality improvement he BMJ and the Health Foundation’s Promoting curiosity within organisations But can the implementation of series on quality improvement is might be key. Creation of cycles around improvement approaches such as audit and T exploring the adaptive system of the projects where every single team member feedback lead to a culture of continuous NHS and what is needed to deliver a better has a sense of purpose and can ask, “Why improvement? Robbie Foy and colleagues quality of care. This booklet contains some are we doing this?” could lead to a more discuss how embedding rigorous yet of the content published since June 2019. transformative approach. A culture shift in pragmatic evaluations of improvement We hope it will help healthcare professionals attitude in order to have a better dialogue is methods within national programmes to unlock some of the challenges healthcare only possible by changing the hierarchical can deliver cumulative gains while systems face today. relationships within an organisation. simultaneously producing generalisable Quality improvement is often defined as Nicola Burgess and colleagues (p 7) point knowledge (p 38). And as Adam Backhouse a group of systematic approaches that uses out how network governance is important and Ogunlayi Fatai argue (p 65), quality specific techniques to improve delivery of care in increasing collaboration. Developing improvement should represent a valuable and bring change. But is quality improvement relational authority is a key element. opportunity for individuals to deliver change different from quality management? In their We also need to be sure quality improvement and implement leadership. essay, John Drew and Meghana Pandit (p 49) actually improves the quality of health Quality improvement remains a practice seek to understand the differences between services. Mary Dixon-Woods (p 42) calls for delivered by expert people rather than a way management and quality improvement, more evidence based research and highlights of thinking within the healthcare system. The looking at where the two can coalesce for how by using research and bringing together series will help to understand how quality organisational success. They discuss how the practice and the study of improvement, improvement can be useful and powerful if leadership, quality management, and quality we can help to improve quality improvement. applied by all within the healthcare system improvement overlap. Charles Coughlan Quality improvement has its origins in in order to deliver better care, improve and colleagues (p 71) argue that dedicated process manufacturing such as the Lean system outcomes for patients, and transform complex leadership among patients, managers, and developed for Japan’s automotive industry, but healthcare systems. clinicians seems vital to improve quality these can be a poor fit with a patient centred Raffaella Bosurgi, quality improvement editor across organisational boundaries. But where health system. Iain Smith and colleagues (p The BMJ to start? As Joanna Bircher highlights in her 34) illustrate how Lean improvement strategies Correspondence to: [email protected] editorial (p 2), deciding what to prioritise and that take customers’ values into consideration Cite this as: BMJ 2020;368:m1102 where to begin can be challenging. could be applied in healthcare. http://dx.doi.org/10.1136/bmj.m1102 the bmj | BMJ 2020;368:m1102 | doi: 10.1136/bmj.m1102 1 EDITORIAL Prioritising quality improvement QI is a team sport, best