Maintaining high standards of quality patient care are the foundations of any healthcare provider. We previously discussed the importance of quality improvement in healthcare but which systems can be used to manage quality?
From hospitals to clinics, providers are under increasing pressure to deliver quality care under strict regulations. A robust quality management system (QMS) is needed to ensure patient safety while complying with those regulations.
Whether you need to assess or improve an existing system, or need help developing one, it’s essential to have a clear understanding of the component parts, roles and responsibilities and best practices of a QMS. This article aims to provide the information you need to assess your current QMS, identify areas for improvement and implement and maintain a system that drives continuous quality improvement.
What is a QMS in healthcare?
Healthcare organisations can employ a range of methods to measure quality, such as analysing administrative data or medical records, clinical observations, interviews with patients and staff and CQC inspections.
A dedicated quality management system helps to develop a framework of policies, procedures and processes that healthcare providers can use to plan and deliver high-quality patient care. The purpose of a QMS in healthcare is to ensure that the same information, methods, skills and controls are consistently used to improve patient safety, enhance patient satisfaction and meet regulatory requirements.
A successful QMS in healthcare involves several key elements: quality improvement, safety management and risk management.
Quality improvements via continuous monitoring and data analysis allows strategies to be implemented that enhance the quality of patient care. By completing and acting upon risk assessment and incident reports, safety management tools can be designed and implemented that address hazards and risks to patient’s safety.
Risk management involves the identification and mitigation of risks to the organisation including operational, financial or reputational that can impact the quality of care that patients receive.
A healthcare organisation might implement a QMS that aligns with industry standards, such as ISO 9001:2015 which is the international standard for quality management systems. For a healthcare organisation that includes the following aspects to improve the quality of patient care:
- A Quality Policy that outlines the healthcare providers commitments to providing high-quality care along with a set of specific objectives, for example, reducing hospital acquired infections, that will allow them to meet those commitments.
- A set of Standard Operating Procedures (SOPs) that provide step-by-step instructions to be followed at each key process including patient admission, discharge and medical administration.
- A robust risk management process to undertake regular risk assessments to identify and mitigate potential risks, such as medication errors, falls or infections.
- Establish Key Performance Indicators (KPIs) to track performance in areas like patient satisfaction, through data analysis to identify trends and to implement quality improvement initiatives.
- Undertaking regular internal audits to assess compliance with policies and procedures to highlight any gaps in knowledge and to rectify it
Participation in external audits allows the healthcare provider to benchmark performance outcomes against industry best practice to promote and improve higher quality care.
How is quality measured in the NHS?
To create conditions for continuous improvement and high performance in the NHS, NHS IMPACT was developed which includes the following guidelines to establish and sustain an effective management system:
- Develop an explicit management system that aligns with the strategy, vision and purpose of the organisation at board level and throughout all workforce structures and functions.
- Put systems in place to identify and monitor early warning signs and quality risks with clear processes of how to respond to these.
- Set up the management system as a way of operating that enables ongoing continuous improvement of access, quality, experience, and outcomes.
- Building a management system which allowed the organisation to respond to system and national priorities more easily as the organisation has a consistent and coherent management system which is used to organise all work.
- A committed board own and use this approach to manage the everyday running of their organisation.
- Evidence of how things are performing is visual and clear with progress easily trackable.
Healthcare systems like NHS IMPACT encourages organisations and their systems to learn from one another with a view to managing clinical, operational and financial challenges.
NHS Quality Management
The NHS QMS emphasises a continuous cycle of improvement focused on ensuring patient safety and delivering high quality care. The key features of the NHS QMS include leadership commitment, patient focus and evidence-based care where decisions are based on research as well as evidence to ensure safety in managing patients.
Their QMS is set out under a four pillar model; quality planning, quality control, quality assurance and quality improvement. Each pillar feeds into the next to create the continuous cycle of improvement. This ensures the QMS within the NHS remains effective as the healthcare needs of the population change.
What are the 7 essential components of a healthcare quality management system?
To foster a culture of quality, safety and continuous improvement a healthcare QMS focuses on seven key components:
- Leadership commitment
- Patient focus
- People engagement
- Process approach
- Continuous improvement
- Evidence based decision making
- Relationship management
Leadership commitment
Management plays a vital role within the QMS by setting the quality objectives and strategic direction. By communicating these strategies, championing initiatives, creating a culture of continuous improvement and regularly evaluating the set objectives, leaders can ensure that the organisation’s vision and policies are achieved.
Patient focus
The NHS QMS states “everyone in the team, including patients, should play an active part in a robust quality management system.” As the patient is at the centre of all healthcare decisions it is only right that they are involved. Taking time to understand their needs and their expectations to tailor a quality solution that meets their individual requirements which then can be fed back into the QMS is fundamental to its success.
People engagement
By involving and engaging all employees in the quality improvement process from staff training, empowering staff to speak up and to recognising and rewarding their effort adds value to the QMS.
Process approach
Quality management systems consist of several different processes working together to improve efficiency, reduce errors and enhance patient outcomes. Processes need to be consistent with everyone working towards the same goal at the same time. This consistency in approach enhances patient confidence in your ability to deliver quality healthcare.
Continuous improvement
Creating a culture of continuous improvement is essential for maintaining high standards of care. This involves monitoring performance data, identifying areas for improvement and implementing corrective actions.
Evidence-based decision making
Having access to up-to-date reliable data allows for improved decision making. Data analysis can help spot trends and has the capability to measure past decisions or opinions which in turn can affect future decisions around quality initiatives.
Relationship management
ISO 9001:2015 statement states, “competent, empowered, and engaged people at all levels throughout the organisation are essential to enhance its capability to create and deliver value.” All staff members play a role in the success of the QMS.
Different team members can offer a diverse perspective, they can take ownership for maintaining and investing into the QMS, frontline staff are often the first to detect potential problems and can feed them back into the QMS and they can drive a culture of continued learning and development to ensure the QMS is fit for purpose.
Challenges for healthcare providers when creating quality management system
Creating a QMS within healthcare can be a complex task as without the buy in from all staff members it is likely to fail. This resistance to change can come from healthcare professionals thinking that it will disrupt their established routines or that it might require additional workload. The structure of healthcare organisations themselves can be a challenge that needs to be addressed. Multiple stakeholders with different needs and drivers spread across multiple levels of expertise can make it a challenge to sustain a QMS.
Resource constraints can be a challenge that needs to be addressed when creating a QMS. Limited budget and staffing might hinder the implementation and maintenance of a successful QMS. While time constraints on staff to collect and analyse data to inform decision making processes that in turn inform quality initiatives can hinder the ongoing cycle of improvement of the QMS.
To address these challenges and implement an effective QMS in healthcare will require staff engagement.
As mentioned above, relationship management is key to the successful implementation of a QMS. Involving all staff at all levels in the development and implementation of the QMS increases ownership and buy-in. Open and honest communication and two-way feedback leads to a culture change within the organisation to successfully adopt a QMS.
Embracing a cycle of continuous improvement and regular reviews of the QMS will help free up resources. At first focusing on high-impact areas for quality improvement and prioritising those initiatives staff can see the immediate impact it has on the quality of patient care. Using technology to streamline processes and data collection can also free up resources allowing more time for staff to implement the QMS.
Healthcare quality management system examples
Healthcare quality control plays a role by managing and preventing a range of risks to ensure consistent high-quality care and improving patient safety. Below is an example of how a quality management system can manage and prevent hospital acquired infections:
Policy and Procedures
Clear policies and procedures for correct hand hygiene, sterilising technique, cleaning and disinfection protocols and proper use of personal protective equipment (PPE) are set and communicated to all staff.
Monitoring and Data Collection
The QMS tracks infection rates through regular audits to identify trends and high-risk areas.
Analysis and Improvement
Root cause analysis can be undertaken by the QMS team to discover if the policies and procedures are consistently used through reviewing patient data and interviewing staff to understand the data collected.
Action and Implementation
Based on the analysis above the QMS team develop corrective and preventive action plans. This could involve:
- Mandatory retraining on disinfection protocols
- Educational campaigns on how to wear correct PPE
- Implementation of new technology, for example, hand sanitiser dispensers at key locations
- Strengthening of protocols for equipment sterilisation
- Audits to monitor compliance with the revised protocols
Evaluation and Feedback
The QMS team tracks infection rates after implementing the above plan. If rates decline, the changes are considered successful. If not, the team re-evaluates and implements further improvements.
In summary
A quality management system in healthcare provides a structured framework for identifying and mitigating risks, improving processes and systems, and ensuring compliance with regulatory standards. By prioritising quality of care and patient safety and fostering a culture of continuous improvement, a well-implemented QMS can benefit any healthcare provider.
Verita, with its extensive experience in healthcare quality improvement, can help your organisation to create and implement a comprehensive QMS, tailored to your needs and regulatory requirements. By partnering with Verita, we can work alongside your staff to provide guidance on a range of quality management topics including risk management, performance improvement and regulatory compliance.
If you’d like to find out more about how we support organisations to improve their quality management systems, please book a free consultation or contact Ed Marsden on 020 7494 5670 or [email protected].
