Drawing on the experience of the National Institute for Health and Care Excellence (NICE), Achieving High Quality Care is a practical guide on how to recognise and implement high quality evidence and guidance. This new title provides an overview of the evidence behind successful initiatives designed to change practice and improve the quality of health care. It provides an overall picture of change management, from understanding the barriers to change to how these barriers can best be overcome. It presents a concise summary of the evidence for change, plus examples of specific initiatives drawn from experience of putting NICE guidance into practice. The book includes a wide range of examples of positive change - plus key practical points highlighted throughout the text - to help readers achieve improvements in patient care. Finally, it shows how to measure change, assess improvement to agreed standards and to manage the ongoing process of change towards improving health care. Achieving High Quality Care is a helpful guide for busy health care professionals wanting to improve services and patient care.
It is relevant to everyone involved in the organisation and provision of quality health care, including clinicians and health care managers, who are trying to lead change and improve care through implementing evidence-based guidance.
Gillian Leng, Deputy Chief Executive, National Institute for Health and Care Excellence, London, UK; Visiting Professor, King s College London, Division of Health and Social Research, London, UK Val Moore, Implementation Programme Director, National Institute for Health and Care Excellence, London, UK Sasha Abraham, General Practitioner, Tower Hamlets, London, UK
List of Contributors xi Foreword xiii Preface xv Acknowledgements xvii 1 Introduction 1 Gillian Leng Introduction 1 What is the role of evidence? 2 How can guidance be used to track improvement? 4 What are the challenges to achieving quality improvement? 5 How does NICE support implementation? 6 Raising awareness 7 Motivating change 7 Practical support 8 Monitoring impact 8 Summary overview 8 Learning from practice 8 References 9 Further reading 9 Example in Practice: Using clinical leaders to improve patient care 10 NICE guidance highlights room for improvement 10 Audit reveals areas where care can be improved 11 Increased compliance with NICE guidance 11 Learning from practice 12 2 Practical actions for health care providers 13 Val Moore Introduction 13 Why take a systematic approach to guidance implementation in a health care provider organisation? 15 Legal and regulatory context 15 Cost pressures and quality improvement 15 Public and patient involvement 16 Staff training and continuing professional development 16 What defines quality improvement for health care providers? 16 What practical advice do health care providers require? 18 Why board support and clear leadership for achieving high-quality care is important? 19 Who should be the day-to-day lead for quality? 19 Do you have an effective multidisciplinary forum for strategic decision-making on the use of best practice guidance? 20 Why a lead for each new development should be nominated? 21 Why take a systematic approach to financial planning for service change? 22 Developing an action plan 22 Evaluate uptake, provide high-level assurance and share your success story 23 Summary 23 Learning from practice 24 References 24 Further reading 24 Example in Practice: A hospital-wide approach to reduce mortality among acutely ill patients 25 Promptly escalating care for deteriorating patients 25 How did the hospital carry out the project? 26 Improving rates for mortality and cardiac arrest 26 Learning from practice 26 3 Identifying a high-quality evidence base 27 Paul Chrisp and Sara Twaddle Introduction 27 Why it is important to seek high-quality evidence 27 How does guidance support evidence-based medicine? 28 How can the standard of guidance development be checked? 28 How does guidance perform against these standards? 29 Can the ability of guidance to improve patient outcomes be checked? 31 How can high-quality evidence be found? 31 What is NICE accreditation? 32 What does NICE accreditation say about guidance quality? 35 What if there is no relevant high-quality guidance? 36 How to get high-quality evidence into practice? 36 Learning from practice 36 References 40 Further reading 40 Example in Practice: Finding a way through guidance on pre-hospital care across South West England 41 Finding a way through guidance 41 Smart access on the move 42 Monitoring improvement in outcomes 42 Learning from practice 43 4 Key challenges to implementation and effective interventions 45 Elaine Whitby and Julie Royce Introduction 45 What are the main factors that will influence an implementation project? 46 What are the context and resource issues to consider? 46 What have others done? 48 Is there a recognised need for change? 48 How to engage and influence? 49 How to move forward? 50 How to assess current barriers and facilitators? 51 How to find out more about behaviours and barriers? 51 How to prioritise action? 52 What interventions should be used in the implementation plan? 53 How to design the implementation project and evaluation? 57 Summary overview 58 Learning from practice 58 References 58 Further reading 59 Example in Practice: Changing behaviour in primary care to improve the management of children with feverish illness 60 Four key components not being measured 60 Provide prompts to change current practice following education 61 Measuring improvement 61 5 Using financial systems to support improved care 63 Jennifer Field Introduction 63 Why is good financial management important? 64 Can financial systems and levers help drive improvements in the provision of health care? 65 How is quality incentivised in the English NHS? 66 What is the QOF? 66 What are PbR and BPT? 66 What is CQUIN? 67 How can funding arrangements incorporate NICE and other evidence-based guidance? 68 What are the components of a good business case? 69 Why should finance be considered across a health economy? 70 Summary 71 Learning from practice 72 References 72 Further reading 73 Example in Practice: Building a business case: to redesign diabetes services 74 Remodelling services for type 2 diabetes 74 Using savings from implementing NICE guidance to redesign services 75 Multidisciplinary team brought several improvements 75 Learning from practice 76 6 Using measurement to support change and improvements in health care 77 Nick Baillie Introduction 77 How can measurement be used to support change? 79 Developing measures and indicators: lessons from the national experience 79 Developing measures and indicators: issues for local consideration 81 What is the best way to report and communicate data? 82 Involving the team 82 Reporting to the board 83 Engaging patients through reporting of data 83 Formats for reporting to each audience 83 How to provide leadership for change? 85 Acknowledging the structure and context of service provision 85 Identifying the individual or groups to provide feedback 86 Summary overview 87 Learning from practice 87 References 88 Further reading 88 Example in Practice: Setting up a service for peripheral arterial disease in the North West of England 89 Using NICE guidance to redesign services 89 Benefits of managing PAD in the community 90 Learning from practice 90 7 Conclusion and reflections 91 Danny Keenan and Sasha Abraham Introduction 91 Why we think high-quality evidence should be sought? 92 Review of the chapters in this book 93 What constitutes clinical quality and what is quality improvement? 93 How does guidance support evidence-based medicine? 93 What are the barriers to the use of guidance? 95 Reflections on service improvement 96 How is clinical quality defined and how is it measured? 97 Clinical audit 99 How is a clinical audit performed? 99 Whose responsibility is the achievement of high-quality care? 100 Summary overview 100 Learning from practice 100 References 101 Further reading 101 Index 103
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