Achieving High Quality Care Practical Experience from NICE

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

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.