Feedback sits at the heart of the system and is key to connecting across the four aspects of a Quality Management System (QMS).
Each of the quality aspects depend on, and need to be driven by, a central feedback system where learning from internal and external stakeholders supports continuous improvement.
- Quality Planning is driven by feedback and aligned to purpose. It supports leaders to distinguish between business-as-usual and strategic improvements that need to be prioritised, resourced and sponsored.
- Quality Control monitors processes and keeps them reliable on a daily basis. Staff should be empowered to adjust processes if needed.
- Quality Improvement activities require rapid cycles of feedback that assess whether change is positive and to detect unanticipated consequences.
- Quality Assurance mechanisms provide vital data on organisational performance that can help inform subsequent planning rounds.
The feedback system can include horizon scanning, insight generation, policy context, population needs and current organisational performance. The NHS Wales method for operating a QMS shows how making links and continuous feedback helps the QMS operating model to put quality at its core.
Q’s case studies with East London Foundation Trust and NHS Lanarkshire provide examples of well-established and integrated data, evidence and informatics teams that support quality activities. However, more generally, poor data threatens to stifle progress around developing and embedding a QMS.
We recommend a three-pronged approach to data challenges across the NHS:
- Commitment is required to tackle enduring technical issues with data (for example, missing data, inaccurate data, fragmentation and restrictive governance arrangements). This requires investment in data infrastructure and standardising data collection (or at least making data compatible).
- Alongside technical aspects, organisations must develop the culture and ‘human infrastructure’ to effectively use, learn from, and act on, data. This can include analytical and data visualisation skills but it is also about building networks of people and a collaborative, learning culture. Prioritise using data for learning and improvement rather than judgement or external assurance.
- Progress can and should be made regardless of how limited existing data is. This may require valuing different types of data to inform the different aspects of a QMS including qualitative data, staff and patient surveys and participative co-design at the organisational, directorate and service levels.
Supporting resources