S4) Improving Quality and Safety in the NHS

Question 1

What are the barriers which deter people from voicing their concerns in the NHS?

Answer 1

• Hierarchical relationships
• Lack of certainty that it will give rise to improvements
• Informal hostility in working relationships
• Lack of certainty if something is problematic

Question 2

What are the system factors which impact safety?

Answer 2

Question 3

With reference to human factors, identify six ways in which one could make the system safer?

Answer 3

• Avoid reliance on memory
• Make things visible
• Review and simplify processes
• Standardise common processes and procedures
• Routinely use checklists
• Decrease the reliance on vigilance

Question 4

What is clinical governance?

Answer 4

Clinical governance is a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish

Question 5

What are the six NHS quality improvement mechanisms?

Answer 5

• Standard setting
• Commissioning
• Financial incentives
• Disclosure
• Regulation, registration and inspection
• Clinical audit and quality improvement (local and national)

Question 6

Describe ‘standard setting’ as an NHS quality improvement mechanism

Answer 6

• NICE sets quality standards based on best available evidence
• Aim to define what high quality care should look like

Question 7

Describe ‘commissioning’ as an NHS quality improvement mechanism

Answer 7

• Commission services for their local populations
• Drive quality through contracts

Question 8

Describe ‘financial incentives’ as an NHS quality improvement mechanism

Answer 8

• Finance is increasingly linked to quality in the NHS
• Used both to reward and to penalise

Question 9

What are the aims of a national tarriff?

Answer 9

• Intended to provide consistent basis for commissioning services
• Intended to incentivise efficiency
• Intended to reward best practice

Question 10

Describe ‘disclosure’ as an NHS quality improvement mechanism

Answer 10

• Increasing emphasis on disclosing information about performance to patients and the public
• Organisational level and individual level
• Focus on safety, effectiveness, and experience of patients

Question 11

Describe ‘regulation, registration and inspection’ as an NHS quality improvement mechanism

Answer 11

• NHS trusts must be registered with the Care Quality Commission
• The CQC can impose “conditions” of registration if it is not satisfied and can issue warning notices, fines, prosecution, restrictions on activities

Question 12

What is a clinical audit?

Answer 12

A clinical audit is a process of identifying quality of care, trying to change it, then seeing whether it has changed

Question 13

What is involved in a clinical audit?

Answer 13

• Setting standards
• Measuring current practice
• Comparing results with standards (criteria)
• Changing practice
• Re-auditing to make sure practice has improved

Question 14

Illustrate an audit cycle

Answer 14