Achieving High Quality Care

Practical Experience from NICE

Achieving HighQuality CarePractical Experience fromNICE

E D I T E D B Y

Gillian Leng CBE, MBChB, MD, FFPH,FRCP, FRCPEdDeputy 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 MFPH, MSc, PGCert EdImplementation Programme Director,National Institute for Health and Care Excellence,London, UK

Sasha Abraham MRCGP, MBBS,DRCOG, DFSRHGeneral Practitioner, Tower Hamlets,London, UK

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Library of Congress Cataloging-in-Publication Data

Achieving high quality care : practical experience from NICE / edited by Gillian Leng,Val Moore, Sasha Abraham.

p. ; cm.Includes bibliographical references and index.ISBN 978-1-118-54360-3 (pbk.)I. Leng, Gillian, 1960- editor. II. Moore, Val, 1962- editor. III. Abraham, Sasha, editor.[DNLM: 1. National Institute for Health and Care Excellence (Great Britain) 2. Quality

of Health Care–standards–Great Britain. 3. Patient-Centered Care–methods–Great Britain.4. Quality Assurance, Health Care–methods–Great Britain. W 84.4 FA1]

RA395.G6362.10941 – dc23

2014014237

A catalogue record for this book is available from the British Library.

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Cover image: Courtesy of NICE

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1 2014

Contents

List of Contributors, xiForeword, xiiiPreface, xvAcknowledgements, xvii

1 Introduction, 1Gillian 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 improvepatient 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, 13Val Moore

Introduction, 13

vi | Contents

Why take a systematic approach to guidance implementationin a health care provider organisation?, 15

Legal and regulatory context, 15Cost pressures and quality improvement, 15Public and patient involvement, 16Staff training and continuing professional development, 16

What defines quality improvement for health care providers?, 16

What practical advice do health care providers require?, 18Why board support and clear leadership for achieving

high-quality care is important?, 19Who should be the day-to-day lead for quality?, 19Do you have an effective multidisciplinary forum for strategic

decision-making on the use of best practice guidance?, 20Why a lead for each new development should be nominated?, 21Why take a systematic approach to financial planning

for service change?, 22Developing an action plan, 22Evaluate uptake, provide high-level assurance and share

your success story, 23Summary, 23

Learning from practice, 24

References, 24

Further reading, 24

Example in Practice: A hospital-wide approach to reducemortality 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, 27Paul 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 bechecked?, 31

How can high-quality evidence be found?, 31

Contents | vii

What is NICE accreditation?, 32What 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 onpre-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 effectiveinterventions, 45

Elaine Whitby and Julie Royce

Introduction, 45

What are the main factors that will influence an implementationproject?, 46

What are the context and resource issues to consider?, 46What have others done?, 48Is there a recognised need for change?, 48How 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 careto improve the management of children with feverishillness, 60

Four key components not being measured, 60

viii | Contents

Provide prompts to change current practice following education, 61

Measuring improvement, 61

5 Using financial systems to support improved care, 63Jennifer Field

Introduction, 63

Why is good financial management important?, 64

Can financial systems and levers help drive improvementsin the provision of health care?, 65

How is quality incentivised in the English NHS?, 66What is the QOF?, 66What are PbR and BPT?, 66What is CQUIN?, 67

How can funding arrangements incorporate NICE and otherevidence-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 redesigndiabetesservices, 74

Remodelling services for type 2 diabetes, 74

Using savings from implementing NICE guidanceto redesign services, 75

Multidisciplinary team brought several improvements, 75

Learning from practice, 76

6 Using measurement to support change andimprovements in health care, 77

Nick Baillie

Introduction, 77

How can measurement be used to support change?, 79Developing measures and indicators: lessons from

the national experience, 79Developing measures and indicators: issues for local consideration, 81

Contents | ix

What is the best way to report and communicate data?, 82Involving the team, 82Reporting to the board, 83Engaging patients through reporting of data, 83Formats for reporting to each audience, 83

How to provide leadership for change?, 85Acknowledging the structure and context of service provision, 85Identifying 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 peripheralarterial 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, 91Danny Keenan and Sasha Abraham

Introduction, 91Why we think high-quality evidence should be sought?, 92

Review of the chapters in this book, 93What constitutes clinical quality and what is quality improvement?, 93How does guidance support evidence-based medicine?, 93What are the barriers to the use of guidance?, 95Reflections on service improvement, 96How is clinical quality defined and how is it measured?, 97Clinical audit, 99How 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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List of Contributors

Sasha AbrahamTower Hamlets, London, UK

Nick BaillieIndicators, Health and Social Care Quality Team, National Institute forHealth and Care Excellence, Manchester, UK

Paul ChrispMedicines and Prescribing Centre, National Institute for Health and CareExcellence, Manchester, UK

Jennifer FieldHealth Education England, Leeds, UK

Danny KeenanManchester Royal Infirmary, Manchester, UKUniversity of Manchester, Manchester, UKDepartment of Cardiothoracic Surgery. Manchester Heart Centre,Central Manchester University Hospitals NHS Foundation Trust,Manchester, UK

Gillian LengNational Institute for Health and Care Excellence, London, UKDivision of Health and Social Research, King’s College London,London, UK

Val MooreNational Institute for Health and Care Excellence, London, UK

Julie RoyceImplementation Support, National Institute for Health and Care Excel-lence, London, UK