Thursday, 11 December 2008

Measuring for quality improvement

“I am called eccentric for saying this in public; that hospitals, if they wish to be sure of improvement, must find out what their results are, must analyse their results, to find out their strong and weak points, must compare their results with those of other hospitals and must care for what cases they can care for well, and avoid attempting to care for cases which they are not qualified to care for well … must welcome publicity not only for their successes, but for their errors. Such opinions will not be eccentric in a few years hence” (Codman, a surgeon from Boston, 1917).

Ninety one years later, Lord Darzi, another surgeon said “we can only be sure to improve what we can actually measure” in High Quality Care for All.

A set of clinical indicators have now been assembled from routine data that the NHS already collects (and sometimes, but rarely is used!). In kidney care we are fortunate to have “form” as Sir Bruce Keogh (Medical Director of the NHS) says – a “track record” or “previous”. That is in the form of the Renal Registry that collects key information on dialysis and transplantation.

The fact that the Renal dataset, covering the whole kidney care pathway has now been approved and mandated from May 2009 will also help with data completeness and quality.

The clinical indicators have been developed in partnership between the Department of Health and the Royal Colleges, comments are being sought by the Information Centre.

Clinical indicators are of course only part of quality. The Institute of Medicines’ influential report “Crossing the Quality Chasm” (2001) identified 6 aims for improvement, each of which could be considered aspects of quality: safety, effectiveness, patient centredness, timeliness, efficiency and equity.

Clinical indicators are the start point, patient experience, safety and patient reported outcomes must also be gathered if we are to achieve Lord Darzi’s vision of “High Quality Care for All”, and high quality care for all is the reason why 1.3 million people in the UK get up in the morning.