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Managing quality in trusts in England: time for a Chief Quality Officer?. Nick Black Professor of Health Services Research London School of Hygiene & Tropical Medicine Chair, NHSE National Advisory Group for Clinical Audit & Enquiries International Medical Leaders Forum Brighton
Managing quality in trusts in England: time for a Chief Quality Officer? Nick Black Professor of Health Services Research London School of Hygiene & Tropical Medicine Chair, NHSE National Advisory Group for Clinical Audit & Enquiries International Medical Leaders Forum Brighton 5 June 2014
Why a new approach is necessary • Need for Trust boards to engage more effectively with quality of their services • “Building on the report of the first inquiry, the story it tells is first and foremost of appalling suffering of many patients. This was primarily caused by a serious failure on the part of a provider Trust Board.” Francis Report; Letter to SOS, February 2013
Managing quality is difficult... • Growing complexity of care • Challenge of improving productivity • Increasing demand and expectations • Lack of coordinated approach to domains of quality • Effectiveness • Safety • Experience
Quality as important as finance • Financial management needs an Executive Director on the Board • and a non-Exec Director with financial expertise • So why doesn’t quality management receive same attention? • What does this say about a Trust’s view of importance of quality?
Need a Chief Quality Officer • Quality remains ‘everybody’s business’ • Just as responsibility for good financial management is ‘everybody’s business’ despite a Director of Finance • Doesn’t absolve other Board members from sharing responsibility and CEO/Chair ultimately responsible • CQO work closely with other Board members • Particularly medical and nursing directors • Overcomes potential conflicts of interest between quality and medical/nursing priorities • Common in the USA
Scope of role • Leadership, vision, inspiration and oversight of quality • Accountable to Board for the assessment and the improvement of quality • Share corporate responsibilities • Possess expertise in quality management • Technical/scientific aspects • Behavioural/organisational aspects • National policy developments
Six main functions • Ensure activities across all three domains of quality are coordinated • Establish scientifically rigorous quality assessment throughout the Trust • Lead development and implementation of quality improvement throughout the Trust 4. Relationships with external agencies related to quality initiatives • Patients/public, Commissioners, ‘Regions’ (AHSN, LETB, QSG), Regulators, Risk management, etc
5. Ensure education and training in quality management for clinical and non-clinical staff 6. Managerial responsibilities • Director of quality ‘department’; provide leadership for: • clinical audit staff, clinical info and coding staff, infection control staff, patient surveys, Foundation Prog doctors’ audits, Consultants’ audit PAs, patients/public, (R&D staff). • Develop strategy & manage quality programmes • Involve public/patients in quality management • Measure, review and inform about Trust’s quality performance
CQO: attributes • Expertise and competency in three distinct but related components • Technical/scientific • Quantitative and qualitative assessments of quality • Quality improvement interventions • Relational/behavioural • Change management; leadership/inspiration; facilitation; team management • Knowledge/understanding national policy • Credibility with doctors, nurses, managers • Ability to operate strategically at Board level
Where do we find them? • Look internally in Trusts • Consensus builders with passion for assessment & improvement • Any professional background • clinical or non-clinical • Provide personalised experiential training • Possibly at Masters’ level (universities and management schools) • Funded by HEE
Vision • In the next three years... • Create a cadre of CQOs to lead the management of quality in Trusts • Key contributors to the re-imagining of health care that is needed to maintain the NHS as a tax-based, free at point of use, comprehensive health system • They’re out there...just need to be identified, supported and encouraged!