Putting the Q into quality with The Health Foundation

Q initiative logo and strapline.

By Michael Spence, NIHR CLAHRC Greater Manchester Programme Manager

I’ve been working across the NHS and academia for almost 7 years now and the time seems to have flown by. I still remember my first day working for CLAHRC Greater Manchester as if it was yesterday. I walked into a 1960s developed University of Manchester building to meet my new employers at the Centre for Primary Care, which, on the face of it, shouldn’t have been difficult for a young (I’m taking writers’ liberty here), career-driven professional looking to make a good impression. However, 45 minutes later (and 20 minutes late) I finally managed to find where I was supposed to be. It turns out the lift doesn’t go any further than the 4th floor; from there you have to navigate your way round a rabbit warren of doors and corridors to find a set of stairs with more of a resemblance to a fire escape than stairs, to then go up another two flights to get to a locked door with a keypad and a telephone that was out of order! Already I found myself thinking that if I couldn’t find where I was supposed to start my new job on my first day, then I would guess that not many healthcare professionals who had busy day jobs had been to the centre for primary care.

Umbro SpecialiLooking back, and 7 years on, I hope that through initiatives like CLAHRCsAHSCs and CRNs we are moving closer towards bridging the gap between universities and the NHS, to ensure the more effective use of research in NHS practice and the more appropriate design and development of research studies. As part of our work I often hear people talk about ‘better quality’, but I often wonder if I asked people what ‘quality’ meant if they could describe it. How would you define quality and what would you describe as a quality product, service etc? Well, for me, I love watching and playing football so I would argue that Umbro Speciali football boots (one for the purists) are a ‘quality’ pair of football boots; they are comfy, lightweight but robust, they use ‘wishbone’ support and the uppers are made from ‘k’ leather.

But how easy is it to actually quantify what quality means in every situation, service and product? Perhaps the best description of quality that I’ve heard is from Philip B. Crosby, who in the 1960s was the pioneer of the Zero Defects (or ZD); Crosby described quality as being a product or service that is ‘fit for purpose’.

Q Initiative resize 100415You may be asking why this is relevant, but the NHS is facing unprecedented financial  resource pressures. We currently have a service where Roy Lilley suggests that two thirds of hospitals are in the red, and it doesn’t look like there is much light at the end of the tunnel. But the NHS provides quality, free-to-access healthcare services, and will continue to provide quality services, and we need to ensure that we are always driving to improve and advance practices in line with the latest evidence. Hence, improving quality and promoting quality improvement in the NHS is a modern day necessity and I’m grateful to be working with around 230 likeminded colleagues from the across the UK, 10 from within Greater Manchester, the Health Foundation and NHS England, to co-design the adventurous and ambitious Q initiative. The Q initiative began as an initiative to recruit ‘5,000 safety fellows’, following a recommendation of the widely respected 2013 Berwick report ‘A promise to learn – a commitment to act’.

Now, I’m writing this as I travel on the train to the final two formalised days with my peers to assist with the design of Q, so I have a little time to look back and reflect on my first day for CLAHRC Greater Manchester almost 7 years ago… and I can safely say that the directions and instructions I was given on my first day were not of sufficient ‘quality’, but through a process of continuous learning, testing and reflection (similar to the widely used plan-do-study-act (PDSA) process promoted via the Institute for Healthcare Improvement’s model for improvement) I’m confident that for any new CLAHRC Greater Manchester employees we have a ‘quality’ new starter induction process which is fit for purpose. There are a wide number of quality improvement tools and techniques that we could all use within aspects of our work, be that clinical, managerial, academic or allied support professional.

If anybody is keen to know more about The Health Foundation’s Q initiative, or would like to discuss anything related, I’m more than happy for anybody to drop me a line via michael.spence@srft.nhs.uk.