| There is no single definition of quality improvement and the words quality and improvement may mean different things to different individuals. |
Quality improvement is about unceasingly seeking excellence through the patient journey.21 Lord Darzi's 2008 report entitled High quality healthcare for all22 confirmed the government's shift in healthcare towards quality and placed an emphasis on staff to drive improvement within the following domains of quality:
patient safety (doing no harm) patient experience (care should be characterised by compassion, dignity and respect) effectiveness of care (survival rates, complications rates, measures of clinical improvement, and patient reported outcome measures).
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The Institute of Medicine has identified six domains of quality; these are:21,23
safe – no harm to patients during a care episode effective – evidence-based care that provides clear benefits, examining whether a treatment works and ensuring there is less variation to delivering effective evidence-based care patient centred – putting patients at the centre of healthcare timely – reduction of harmful delays, eg cancer waits, and seeing those with time critical conditions in accident and emergencies efficient – avoid waste, repetition and unnecessary investigations equitable – care that is equally available to all and does not vary in quality.
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There are many approaches to quality improvement including:24
structured educational programmes, eg workshops and seminars experiential learning, eg regular short meetings, action learning sets, mentoring to ensure success via problem shooting multi-professional learning, eg managers and clinicians working together to gain perspectives on each other's work in guiding quality improvement.
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| Building the foundations for improvement in any system or organisation seems to benefit from a mixture of these approaches.25
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