Quality improvement

In the health arena, the term ‘quality improvement’ applies to any effort to improve care experiences and outcomes where there is explicit, context-specific consideration of what constitutes high quality care and where progress is monitored by benchmarking longitudinal performance using metrics that capture one or more dimensions of the context-specific definition of quality. There is now a sizeable body of work about how to implement quality improvement initiatives. Although different models exist, key features are:

• The importance of considering both systems and human factors when trying to make a change that aims to improve quality. For example, there may be good theoretical reasons why a process change will improve a particular quality metric, but this improvement will not be realised unless it is acceptable to patients and staff such that they actually implement the change.
  
• The ability to respond and refine efforts on the basis of ongoing evaluation and reflection of progress.

This may be discretised, as in the Plan Do Study Act cycle.
A key focus in the UK, identified by the NHS Next Stage Review, is the need to tackle health inequalities. A health inequality exists whenever the experience of a patient, or group of patients, differs on the basis of some socio-economic or demographic determinant (for example, ethnicity).

The eHealth unit provided design, technical and analytical support to QOF Plus, a multimillion pound quality improvement scheme run by NHS Hammersmith and Fulham which extended the pay-for-performance model used in general practice with new, evidence-based targets that focussed on specific, local health needs with the goal of reducing inequalities for its patients.

Quality improvement efforts also focus on issues of patient empowerment. The patients-as-consumers model identifies improved access to care, increased and informed choice, innovative ways of eliciting health needs, increased health-literacy and self-efficacy – as critical for improving healthcare. Information communication technology lies at the heart of strategies that aim to deliver this vision under the umbrella term ‘consumer health informatics’ (CHI).

The new opportunities for engagement and interaction between patients and clinicians that CHI creates are tempered by new challenges – for example in ensuring that other dimensions of care are not compromised and that access is equitable. Our work focuses on: 

• Evaluating implementation issues in the context of email consultation
• Scoping the role of the internet and eLearning resources for both clinicians and patients