‘Quality improvement is everyday business and work.’ (Juran, 1951)
Quality of care in mental health services is important. Not only does it impact directly on health outcomes, safety and patient experience, but it also impacts on the cost of care and the reputation of each local organisation and the NHS as a whole.
The Oxford English Dictionary defines quality as:
‘the standard of something as measured against other things of a similar kind; the degree of excellence of something.’
Within healthcare, it has been less easy to define the concept of quality. The current definition of quality (see also Chapters 1 and 18) as applied in the NHS and enshrined in law through the Health and Social Care Act 2012 considers three dimensions:
• patient experience
• clinical effectiveness.
This definition fits with the US Institute of Medicine concept of quality which is often used in healthcare settings:
‘[quality is] the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.’ (Lohr, 1990)
The US Institute of Medicine also identified six dimensions of healthcare quality (Committee on Quality of Health Care in America & Institute of Medicine, 2001), stating that healthcare must be:
• safe – avoiding injuries to patients from the care that is intended to help them
• effective – providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse)
• patient-centred – providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions
• timely – reducing waits and sometimes harmful delays for both those who receive and those who give care
• efficient – avoiding waste, in particular waste of equipment, supplies, ideas and energy
• equitable – providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographical allocation and socioeconomic status.
History of quality initiatives in the National Health Service
Our current understanding of quality has, however, developed over many years of quality initiatives within the NHS and it is worth thinking about the development of the quality agenda over the longer term.