Recruit a chief quality officer to be systematic on quality

The appointment of a chief quality officer at Medway Foundation Trust has cemented quality as a key priority for the trust.

The move comes after Medway, which was placed in special measures in July 2013, was rated “inadequate” by the Care Quality Commission in November last year.

‘Appointing a chief quality officer is a significant change in direction for quality management’

In England the way that the NHS looks at quality is changing, with increasing evidence that trusts are adopting a systemic approach to quality improvement.

By appointing Trisha Bain as one of the first chief quality officers in England is a significant change in direction for quality management in the NHS - moving from mere compliance with regulations and standards to building practical improvement capability.

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Recruit at every trust

Over the last few years, Nick Black, professor of the health services research for the London School of Hygiene and Tropical Medicine, has been advocating the creation of the chief quality officer role at every trust in England.

Writing in October 2014 for HSJ, Professor Black argued that, to attain the radical changes that it needs to improve, the NHS needs “chief quality officers with vision to lead, inspire staff and facilitate rigorous assessment and improvement of quality throughout their trust”.

Speaking last month on Dr Bain’s appointment, Professor Black said: “Medway is exceptional in making this appointment. They are trailblazers. Hopefully, gradually, Medway is the start of a sea change in trusts across the country.”

The creation and fulfilment of the role within the NHS could have significant benefits for patients and staff, for trusts and for quality management as a profession.

Shifting focus

Having a chief quality officer on the board of each hospital could address concerns within the quality profession over the expertise available to the NHS and ensure its understanding of quality can keep pace with that in other sectors.

In the past, as in many industrial domains, quality management in the NHS has been shaped by regulators and based on empirical experience. With this move by Medway, the profession seems to be shifting its focus to building practical improvement capability.

However, the rate of socio-technical change brings with it new problems to solve, particularly in the proliferation of data generated by information systems, in which the limitations of current tools and techniques are starting to show.

‘It could reflect an organisational shift to a more systemic approach to managing quality that integrates quality compliance’

Furthermore, Medway’s appointment of a board member who understands quality systems and processes could be the first indication of an organisational shift to a more systemic approach to managing quality that integrates quality compliance and nursing quality.

While the medical director and chief nurse will retain overall responsibility for quality, the chief quality officer will work with them and other staff to identify the underlying causes of longstanding issues and to implement preventive actions and improvement initiatives to address them.

The role’s additional responsibility for information systems also highlights the importance of data management in addressing the challenges facing the NHS, including the increasing complexity of care and the need to improve productivity.

Focus for best practice

This blend of experience of quality management with expertise with information systems can help establish a framework of integrated processes, supported and augmented by appropriate technology that can provide robust data and evidence to identify improvements.

While the activities that trusts currently carry out seek to improve the quality of care, learning can very quickly become diffuse as a result of a lack of structure and coordination, with many of the same lessons learned repeatedly and not always shared.

But with a dedicated focus on quality improvement, an understanding of how quality can improve patient experience and outcomes, as well as productivity, should ensure that insights derived from intelligence and information can be spread in order to achieve and sustain good practice.

‘The role can help trusts establish a systematic approach to organising for quality at all levels’

The creation of the chief quality officer role is reflective of an increasing understanding that, rather than establishing many small quality initiatives, establishing a framework for initiatives in which they can then thrive and spread instead, enables trusts to organise for quality.

By ensuring that quality initiatives are part of a larger, fundamental framework in which they can be structured and coordinated, the role can help trusts establish a systematic approach to organising for quality at all levels.

In addition, by providing leadership in quality improvement, the role can promote continuity and consistency in quality activities throughout a trust. It can make a tangible, durable difference to quality processes, the care pathways that they underpin and, ultimately, patient care.

Other trusts must now be watching Medway’s performance closely, as will many quality professionals who may see in the role of chief quality officer the prospect of a seat on the board and the chance to show leadership through quality.

Andrew O’Hara is strategic research analyst for healthcare at Ideagen Gael Ltd