Practical value in the NHS

The King’s Fund has previously highlighted the fact that addressing waste and variability in clinical work can create better value in the NHS. But what does value mean to people working in the NHS – and how it is being applied in practice? | The King’s Fund Blog

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‘Value’ sounds like a familiar concept but it can mean different things to different people. One definition of value in the health and care sector is ‘health outcomes per dollar spent’, so attempts to increase value can look at either improving quality or reducing cost.

In early July we held a roundtable discussion with health service providers to better understand their approach to value improvement – initial research for a new project intended to understand the practical barriers and challenges that frontline clinical, operational and managerial leaders have encountered in pursuing better value health care. Experts who attended – including a chairman, chief executive, chief nurse, deputy chief operating officer, change leader, and representatives of national bodies – agreed that the emphasis should be on patient care. Clinicians are more likely to engage in a programme that revolves around the quality of services, and better care is typically less wasteful, so as one participant put it, ‘if you focus on quality, money will fall out’ [spending will reduce]. Consultants will often drive through successful programmes with change management teams, but we also discussed the role of junior doctors, nurses and therapists, who frequently witness low-value care and understand how to fix it. We know that substantial changes in practice can be delivered as we have seen, for example, in generic prescribing, reduced length of stay and the move towards day case surgery.

Read the full blog post here

Involving staff with quality improvement initiatives

NHS Employers has published Staff involvement, quality improvement and staff engagement:  the missing links.

This briefing aims to help managers and leaders understand more about how involving staff with quality improvement initiatives can have a significant impact on staff engagement levels.

Involving staff in quality improvement decision-making, planning and delivery has always been a good idea. However, at a time of unprecedented pressures and financial challenges it is an issue of the highest importance.

This new briefing explores the benefits, approaches and working examples of how organisations are involving staff with their quality improvement activities.

Read more about staff engagement initiatives across the NHS here.

Competition policy in five European countries

This working paper explores how policies affecting competition have been implemented and promoted in health systems in five countries: France, Germany, the Netherlands, Norway and Portugal | Health Foundation

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  • In conventional markets, customers are attracted to particular suppliers by a more appealing combination of price and quality. But in health care, patients are usually insulated from costs and may find it difficult to judge quality due to information asymmetries and their infrequent use of services.
  • This means that the question – what do we expect or want of competition? – is not so easily answered in health care settings, and lessons from other sectors might not apply.

Key points:

  • Proximity to the health care provider, rather than quality, remains the key driver of patient choice.
  • There is potential tension between stimulating quality competition and controlling expenditure because restrictions on hospital treatments imply that money does not follow the patient, and hospitals may react by making access more difficult or letting their waiting times increase.
  • Information for assessing proposed hospital mergers requires improvement, particularly information on quality.
  • There is limited scope for further expansion in the use of private providers to treat NHS patients given the current focus on controlling expenditure.
  • The economic rationale for controlling entry of providers into general practice is unclear.
  • Selective contracting for patients with chronic and multiple conditions to reduce fragmentation of care raises concerns for competition and regulation. This is because of the long-term nature of the implied contracts and the restricted pool of potential providers willing to bid for these contracts.

Read the working paper here

Improving the management of digital government

Improving the management of digital government argues that the digitisation of public services in the UK is happening too slowly | Institute for Government

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It says that appointing a minister responsible for digital government would help drive change and advance standards. Digital improvements would make government cheaper, more effective and more secure. The report points to the recent NHS cyberattack as an example of the fragility in some systems being used in the public sector.

The report warns that the Government Digital Service (GDS), the Cabinet Office unit responsible for leading digital transformation of government, faces resistance from many corners of Whitehall. Without a strong minister in charge, GDS is not able to drive digital improvements in a way that meets citizens’ expectations. It sets standards for digital government, but these need to be improved and extended throughout the civil service, and with IT contractors.

The report also makes several recommendations for both GDS and Whitehall departments on how they can work better together. The Government needs to organise services around people’s needs and to urgently clarify which system citizens should use to securely identify themselves online.

 

Information Governance in local quality improvement

This guide describes how Information Governance laws and principles apply to the use of personal data in local or regional multi-agency healthcare quality improvement studies such as clinical audit, productivity reviews, intervention testing, and service evaluation.

It is designed to assist clinicians, Quality Improvement specialists, support staff and service users who lead, take part in, or review, local and regional quality improvement studies such as clinical audits, with the application of IG law to their work.

Information governance in local quality improvement is available to download here

Promoting Evidence-Based Practice at a Primary Stroke Center

Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking | Dimensions of Critical Care Nursing

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Objectives: The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility.

Discussion: This nurse education strategy increased RNs’ confidence in ability to explain the path from evidence to bedside nursing care by demonstrating how evidence-based clinical practice guidelines provide current evidence used to create standardized order sets. Although further evaluation of the intervention’s effectiveness is needed, this educational intervention has the potential for generalization to different types of standardized order sets to increase nurse confidence in utilization of evidence-based practice.

Full reference: Case, C.A. (2017) Promoting Evidence-Based Practice at a Primary Stroke Center: A Nurse Education Strategy. Dimensions of Critical Care Nursing. 36(4) pp. 244–252

Effective events for local quality improvement following national clinical audit

This guide aims to contain everything needed to plan, organise and deliver effective quality improvement workshops – and how to follow up and maintain momentum | HQIP

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Image source: HQIP

Event planning should be straight forward and rewarding, but at times can also be time consuming and complex. You’ll find helpful ideas, checklists, useful website links, templates and case studies.

This guide is produced by the Inflammatory Bowel Disease (IBD) National Clinical Audit (NCA) team and HQIP and based around learnings from a series of local events held by the IBD team to drive quality improvement following national audit.

Download the full guide here