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

1. Ensure activities across all three domains of quality are coordinated 2. Establish scientifically rigorous quality assessment throughout the Trust 3. 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!