The content for this half-day Learning Event was designed to address three key questions:

Question 1: What is the difference between a Commissioning process that is focused on QA and one that is focused on QI?  How do we strike a balance between assurance and improvement?

• What is quality?
• The messiness of life
• Old Way versus New Way – Quality Assurance (QA) vs Quality Improvement(QI)
• Overview of the Science of Improvement
• The IHI Model for Improvement as a roadmap for QI

Question 2: How do analyse data from a QI perspective and what questions should we ask about the results?

• By understanding variation conceptually
• By understanding variation statistically
• By displaying data for QI rather than for judgement or accountability
• By making the right management decisions with data
• By linking measurement and data to improvement strategies and aims

Question 3: How can Commissioners support providers in building capacity and capability for improvement?

• By helping providers utilise national measures, targets and data to focus their improvement efforts.

• By building your own knowledge and that of your fellow commissioners, with the science of improvement.

• By helping providers stay focused on the fact that QI needs to be understood by all members of the organisation and seen as their prime business strategy.

• By understanding the milestones in the journey to organisational excellence with a particular focus on improving care, improving the health of populations, and reducing costs.

• By demonstrating alignment between the organisation’s measures and their strategic aims and business strategy (i.e., quality as a business strategy).

• By establishing appropriate and realistic targets and goals for their measures.

• By reviewing management’s plans to close the gaps between the current capability of its processes and the targets and goals it aspires to achieve.

• By stressing the need to develop skills in statistical process control (SPC) methods that will enable the providers to understand the variation that is inherent in their KPIs over time; not in the aggregate.

• By encouraging senior leaders and managers to make decisions about their KPIs based on common and special causes of variation and not on rating and ranking schemas.

• By stressing to management and Board members that the organisation’s outcome measures (i.e., the ‘big dots’) will never move in the desired direction until all the process measures (i.e., the ‘smaller dots’) are aligned and highly reliable.

• By helping providers and commissioners realise that outcome measures take longer to move in the desired direction than do the process measures that drive the outcomes.

• By building a cascading systems of projects and related measures (i.e., a strategic dashboard). For example if you want to reduce violence directed at staff members or toward other patients, there needs to be causal thinking or a model (e.g., driver diagram) of all the variables that drive or cause patients to become violent.

• By determining who needs to have what level of knowledge about the science of improvement. Not everyone in the organisation needs the same “dose” of knowledge.  A strategy needs to be in place to make sure all employees as well as Board members have the appropriate level of knowledge that is aligned with their role in the quality journey.
• Commissioners can make significant impacts on improving the NHS, therefore, by supporting providers as they work to build integrated approaches to system improvement (S + P + C = O)

• By assessing the organisation’s strategy for creating structures and processes that will create capacity and capability for QI throughout the organisation.

• By making sure everyone throughout the organisation understands and applies systems thinking to daily work.By establishing a support structure with dedicated QI staff who can coach and facilitate the QI projects and teams throughout the organisation

• Finally, by realising that no outcome [O] will ever change unless providers take steps to:
  • (1) Link organisational structures [S] with
  • (2) The processes [P] they have in place and
  • (3) The culture [C] of the organisation.