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[Music] foreign welcome to my talk today quality improvement and quality assurance in healthcare and I'll be giving an overview of key terms relating to these two concepts this session is helpful for any Healthcare professional or Healthcare student do give me a thumbs up if you enjoyed this session and do check out my other free videos on my YouTube channel and I'm currently creating a playlist on quality improvement and change management that might be helpful for nurse Educators so I hope you find this session helpful so the session today aims to help any Healthcare professionals applying for jobs too there's often questions relating to these terms in interviews and on the job description so you need to have an understanding and an overview of key terms Healthcare students might be being introduced to Quality in healthcare on their degree course and they can become confused with all the business feet the leadership the management and organizational language being used and you might be a healthcare professional who wants to develop their career and you're aspiring to become involved with quality improvement in the future so hopefully you'll find this talk helpful so we've got a range of terms relating to Quality in healthcare and all these different Frameworks models tools linked to these two key umbrella Concepts quality improvement and quality assurance both quality improvement and quality insurance are interrelated they both aim to improve quality patient care quality improvement and cure quality assurance terms may be used interchangeably in healthcare and across Publications which is why it can sometimes become confusing you just need to remember that both are aiming to make it better for patients so if we're going to look at quality improvement and quality assurance you first need to think about what is quality and when we look at quality and health it's defined under three criteria by the Department of Health 2008 report and that's entitled high quality care for all the NHS next stage review and I have all the references at the final slide in this talk and these are helpful to remember safety experience of care and effectiveness of care and you can see that I've highlighted in bold the SE because when I go to interviews I often use mnemonics thinking about my preparation so I don't forget things so if we look at these three criteria safety relates to Quality Care that's safe it's about doing no harm to patients decreasing risk safeguarding experiences of care relates to providing Compassionate person-centered Care that meets the needs of patients their bio psychosocial needs so they have a positive experience Within the services that they're using and the effectiveness of care reducing waiting times delays preventing mortality avoiding waste looking at promoting positive clinical outcomes when we look at the quality improvement and quality assurance you can see that they're going to link to all three of these if you cannot have quality care if it's unsafe or if the patient has a bad experience and it's ineffective care and if you're going to assure care you're looking to assure safety you're looking to assure that the patient has a positive experience and that the care is effective so they're all all interrelated two other helpful papers by older wicker towel and Ross and Naylor I've also put in the reference list so older wickedale is making the case for quality improvement lessons of NHS boards and leaders and Ross and Naylor is quality improvement in mental health and both are published by the Kings fund there are great papers to get an overview of quality and health care so let's look at the two concepts now so firstly quality improvement there is no definitive definition it's an umbrella concept it came from manufacturing Industries quality improvement will use a systematic approach to improve patient care it'll involve methodical Frameworks models or tools that aim to improve Healthcare practice systems or processes so it could be about implementing a quality improvement project using a change management model to implement a change it could be looking at a service evaluation and gaining feedback from service users or patients and but the ultimate aim of quality improvement is to improve patient care through enhancing patient safety outcomes and experiences of care and I had a discussion with um some students and I've had them before with early career nurses who have said that quality improvement is only about linking projects to patients directly and not staff and that's in correct if you improve the quality of Staff experiences through education programs staff support a retention project or career Pathways and aiming to retain staff for example you're going to have better staff services better educated staff which will improve patient care and it links really under the second criteria of quality on the definition on the criteria that I presented previously that your experience of care as a patient is going to be better if you're going to be cared for by a nurse that feels supported or a healthcare professional that feels supported educated and able to deliver effective care so quality improvement aims to standardize prices and structures so that variations are reduced patient outcomes are improved so an example quality improvement project might aim to introduce a screening tool to improve early identification of patients with sepsis so the variations are reduced as staff are using a standardized screening tool patient outcomes will improve as patients are identified early with sepsis and you're going to have a knock-on effect of decreased mortality rates for sepsis so when we're looking at quality improvement methods it should involve Frontline teams there's a strong emphasis on code production and service user involvement when implementing and evaluating a change in practice and co-production if you're unfamiliar with the term is about individuals influencing the support and the services or it could link to a group of people getting together to influence the design and the delivery of services there's a range of quality improvement and change management models and there's no clear evidence that one model is better than another however we do know that quality improvement needs to be systematic and consistent to work and it's also cyclical so there has to be an evaluative element and it's ongoing and continuous so when we look at quality improvement and change management models and Frameworks and tools there are many they're several and there's some quite popular ones such as the plan do study act cycle that's recommended by The Institute of healthcare Improvement and the plan do study act cycle the pdsa cycle originated from deming's 1950 wheel that was originally pandu check act and it's a cyclical model based on the principles of continuous process of improvement then we've got the lean five principles again very popular um that include specifying value understanding demand flow level and pursuing Perfection the roots of lean thinking came from the Toyota Japanese company and their production system that was applied to healthcare and the focus in lean thinking is driving out waste in contrast to driving out waste this Six Sigma focuses on reducing process variation and enhancing process control the Six Sigma include Define measure analyze improve and control and then lastly we've got lewin's popular change management Model A very simple um three-part model that includes unfreezing which is determining change preparing for Change and enabling mood movement so you're looking at trying to unfreeze that status quo you make the change you take action you implement and then there's um the third stage is refreezing so you're solidifying that change and I will be doing some future videos giving some practical examples linked to um the plan do study act cycle and lewins model on a video on change management in the future so looking at the second concept now quality assurance the Assurance of quality in healthcare refers to making sure Quality Care standards are maintained and that quality Care happens clinical risks and harm to patients are reduced so to achieve that there must be ongoing monitoring of the quality of the Care against degree standards for equality to be measured and assured so quality assurance is the process for checking that quality standards have been met and they you do that through various strategies methods and tools so risk assessments Audits and service evaluations for example often interviewees are asked about clinical governance in healthcare and it links very closely to Quality Assurance governance is a system or framework for managing organizations and in healthcare clinical governance exists overarching system or framework where Healthcare organizations are accountable for sustaining and improving quality of their services and for safeguarding standards of care and Healthcare organizations must evidence that standards are met and maintained to provide quality Care we look at the term risk management this involves predicting and evaluating clinical risk and we do that through identifying strategies to avoid and minimize risk through analyzing data from Clinical incidents and complaints for example so often in interviews you're going to be asked about safeguarding standards reducing risk and some of the strategies you would use would be implementing evidence-based standards from nice guidelines that underpin our policies protocols and patient care Pathways we will conduct risk assessments and the actions and interventions following those risk assessments aim to safeguard standards and reduce risk we have instant reporting and action plans following analysis of instance we've got learning from complaints and we have National reporting and learning systems there's clear escalation Pathways to report poor care and areas of concern the Care Quality commission has National key performance indicators that measure quality and it's important if you're applying for sort of more senior role in an area to look at what are the key performance indicators within this area so if it was in surgery it might run out patients it might link to a number of outpatient appointments or a number of operations for example and then we've got clinical Audits and service evaluations so all Healthcare professionals need to know about what an audit is you may be involved asked to do one you may be asking other staff to you might be analyzing data from audits as part of your role and all it aims to measure the quality of care or a service against agreed national standards or a benchmark so we have handy hygiene audits so I'm sure most of you will know about but they're under pinned by a national protocol measuring how good healthcare workers are at cleaning their hands for each of the five moments of hand hygiene so you've got this National Standard um people usually when they're doing the audio going into areas observing they've got a tool and once it's completed they'll analyze the data and it will be expressed as a percentage of times that hands are cleaned by staff using good handy hygiene post audit managers will receive the feedback and they aim to either sustain good practice because it was a positive outcome from the audit or they learn from the data and it will inform future actions to improve the quality of hand hygiene and it might include staff education program or prompting posters by the sinks for example but audits are always psychical they're always ongoing you will go back to areas to see if a quality is improved or whether it's gone down or standards have improved and audits are used to compare the quality of um of care across Services locally and nationally does the care meet the standard required if not how can we improve and as I said we learn from Audits and we re-order and monitor Improvement and change it's similar to an audit we're looking at the standard of the service we're trying to get feedback so with an audit we've got our measured standard and we're going in and observing um say on a handy hygiene audit but with the service evaluation we're still making a judgment on how well things are working and What needs to improve but it's usually gaining feedback from service users so for example the friends and family test where patients submit Anonymous feedback on their experience of a healthcare service and the results from those service evaluations will provide feedback that informs future planning in a local service so again service evaluations should be repeated to look for changes in Improvement but essentially Audits and service evaluations are giving you data to tell you about what's happening in the service what is the standard of care and is is it needing to improve or do we need to sustain the quality of care we're currently providing so if any of you are interested in clinical governance you've got interviews or you've got an assignment coming up you might have seen the Seven Pillars of clinical governance that came from Donna bidian I've got the references in the reference list who developed the concept of these pillars in the 1980s and also Nichols ital um is a key reference so and you'll see that the Seven Pillars linked to what we've talked about previously in the slides you've got audit you've got patient and public involvement and patient and public involvement as I mentioned links to quality improvement you have co-production service user feedback service evaluations where we get feedback from patients you've got risk management Etc so you might want to have a look at some of those papers and also we have quality improvement additional resources so NHS websites are very good with quality improvement and quality assurance Frameworks models and tools we have some fantastic quality improvement hubs and local quality improvement leads and networks and the leads will have a wealth of information and are often got example quality improvement projects on their web pages we have the institute for healthcare Improvement the healthcare quality improvement partnership and they're an independent organization led by The Academy of Medical oops sorry Royal colleges and the Royal College of Nursing just make sure I get that right the health Foundation is an independent charity that offers programs and grants and has lots of educational resources to help carrying out research and policy professional bodies and National forums such as the Royal College of Nursing and the British Medical Association and the W Edwards Deming Institute website if you're interested in using a pdsa cycle if you're interested I have a video on my quality improvement and change management playlist what's the difference between research quality improvement service evaluation and audit that might be helpful for students looking deciding what sort of dissertation they want to focus on um and also some videos on different roles in research how to become a nurse researcher because quality improvement and change management projects give you an introduction and it might be you want to go on and pursue a career in research or in quality improvement I've got a video on quality improvement and service improvement projects for nurses and one on nursing dissertation if you're a student a healthcare student and um I'll also be creating and uploading a few more videos linked to this area I've got some key references here linked to my slides and also if you've got assignments linked to this area there's some good references so if you have any questions at all do put them in the YouTube comments if you prefer to DM me privately DM me on Twitter or my website and do check out my YouTube channel if you're interested in either of my books they is a link to the books in my description on YouTube as well so I hope you found the talk helpful