Monday, 17 November 2008

Measuring quality in a challenging situation

“Quality is the organising principle of the NHS”. When I went to primary school the catechism and the times tables were still taught by rote. It wasn’t a bad way of embedding the detail in our brains but didn’t encourage a real understanding of the philosophical basis of religion or the beauty and power of mathematics. So when people challenge the above statement about quality and smile when the words co-production or subsidiarity are used in connection with healthcare I am pleased. Particularly pleased when the smile indicates a light bulb going on and is followed by demanding questions – less so when it’s a kneejerk reaction to change. So scepticism yes but cynicism no.

Well onto the subject. Two years ago I recall a conversation with Edwina Brown (Consultant Renal Physician, Hammersmith) and Jo Chambers (Palliative Care Consultant, Bristol) about quality in conservative and end of life kidney care. I said “oh well, hmm – very difficult to measure and where do you start?” Well, I got answers – there is a substantial literature on quality in conservative care – clinical indicators, patient experience metrics and patient/family related outcome measures. Since then I have learnt a lot more from people like John Ellershaw (Professor in Palliative Medicine) and Maureen Gambles (Research and Development Lead) from the Liverpool Care Pathway Team who have coordinated the “Care of the Dying Audit”.

If you are like I was 2 years ago, have a quick read of “Quality Markers for EoL Care”. If you are a member of a conservative kidney care team, download this document and get your team to review and comment.

As W Deming said “in God we trust, all others must bring data” (W Deming & K Griffin).