Measurement lies at the heart o f the improvement process and is, therefore, fundamental to any quality improvement process. The results revealed, however, that only 50.8% o f DHAs were measuring and monitoring the quality o f their own activities.
CHART 9.1 DOES THE DHA MEASURE AND M ONITOR THE QUALITY OF
ITS OWN ACTIVITIES?
Only South Thames, North Thames and South and West Regions had more than 60% o f DH As measuring and monitoring the quality o f its own activities. In the North W est Region only 36.4% o f DHA s were doing so. Yet the figures reveal that 81.8% o f the DH As in the North W est Region had determined how to manage the quality o f their own activities. Indeed, the results from both the North Thames and South Thames Regions also showed that 80% and 87.5% o f DHAs respectively had determined how to manage the quality o f their own activities. Thus, figures o f 60% and 62.5% for these two Regions would also indicate that som e D H A s had taken only the most basic o f steps to implement a quality management system .
Chapter Nine Analysis o f Research Data: Measurement EL (93) 116 “Achieving Organisation Wide Approach to Quality”, recommended that Purchasers and Providers should work in partnership to ensure that standards are set by negotiation with managers, clinicians and other health care professions and, furthermore, that these standards be dynamic, measurable, revisable and incorporate audit and research results with system s developed to ensure effective monitoring o f key performance indicators. The realisation that measuring and monitoring quality improvements should form an integral part o f a quality improvement process does not appear to have been adopted by a significant number o f DHAs. There are several reasons what this might have been the case. Firstly, DHAs might have interpreted the EL in such a way that action on their part should be focused on ensuring that Providers have such system s in place. Reading through the Quality Strategies o f many DHAs adds further weight to this argument with most DHAs seeing them selves as a policing
agent. Secondly, DHAs might have considered that the implementation o f the above
recommendations was a low priority, after all, there was no evidence that the N H S Executive were taking much o f a lead in terms o f implementing their own recommendations.
Four out o f the five RHAs which responded to the questionnaire stated that they were measuring and monitoring the quality o f their own activities through:
• Quarterly conferences looking at the quality o f RHA performance management, internal review meetings and feedback sessions, external “lessons learned” conferences with Purchasers and Providers.
• Own performance management arrangements with the executive and on sp ecific events and initiatives by “customer feedback” e.g. seminar evaluation forms.
• Corporate management performance programme and contract, covers all activities.
In discussing the measurement o f management effectiveness, Drummond (1993)- argued that in order to identify whether words and action match, the most pertinent question to ask is “What has been done?” with the implication being that a lack o f detail corresponds to a lack o f action. The impression from the above findings is one o f a lack o f rigorous, system atic processes.
One RHA provided a copy o f its Regional Strategic Framework which listed the R egion ’s strategic intent and priorities for the year 1994/95, whilst undoubtedly forming an integral part o f the R egion’s priorities and action plan, there was only one reference to a monitoring mechanism and that existed in the acute care sector.
Chapter Nine Analysis o f Research Data: Measurement
T A B L E 9 . 1
West Midlands______________________________________________
• BS 5750 standards, Internal quality circle, Lead officer identifies compliance to BS 5750
and lead TQM development
• Programme begun Summer 1994, initial development of quality in relation to -
Management commissioning, contract monitoring, purchaser staff training.
• Audit, Departmental standards
• Internal audit - telephonist and administrative support
• Peer review - Kings fund - all areas of commissioning
• BS 5750 accreditation and audit
• Regular individual performance reviews, Kings Fund Organisational audit will be
implemented covering all activities.__________________________________________
TABLE 9.2
Northern and Yorkshire____________________________________________________ • Partly through quality systems approach i.e. documentation, Through protocols and
through performance management of the DHA/FHSA business plan.
• By the development of a Commission’s Charter which will explain explicit standards against which continuous quality improvement can be measured, although the charter is only at the developmental stages at present.
• Communication groups, organisational slice groups, responses to complaints - times - outcomes
TABLE 9.3
South Thames___________________________________________________________ • Participation in formal peer review process at Kings Fund
• Yes, but against Regional criteria as part of performance management
• Performance review against objectives Departmental Audit (finance, data, etc.), corporate contract and annual evaluation. No formal accreditation system used.
• The Health Authority has an internal organisational quality strategy which addresses our
philosophy, valuing our staff and organisation wide standards. Standards include
responses to letters and phone calls, confidentiality, training, name badges, attendance at team briefings, following corporate image guidelines and presentations.
• All aspects of corporate business through review of organisations and individual objectives (which are linked), monitoring of specific standards ( handling of ECRs, complaints etc.) use of noon-executive groups (e.g. audit)________________________
TABLE 9.4
Trent__________________________________________________________________ • TQM, IPR, Investors in People
• Complaints handling, Quality co-ordination group established, communication group established, Assess against Health Improvement Priorities, Public Health annual report and strategy plans.
• Organisational development structures, performance management reviews, Individual performance review.___________________________________________________ _
TABLE 9.5
Anglia and Oxford___________________________ No measures taken by any of the DHAs in this Region
T A B L E 9 . 6
Chapter Nine Analysis o f Research Data: Measurement
North Thames__________________________________________
• We monitor our achievements to the production of quality review visits. We have conducted internal reviews of communication etc.
• We monitor how we handle complaints
• We have been subject to peer review by all Purchasers • Complaints monitoring and 6 monthly audits
• Performance management being developed as a regular reporting tool to DHA________
TABLE 9.7
North West__________________________________________________ • Performance management, monitoring objectives, organisational audit • Early stage yet - looking at TQM approach using the “Lakeview” approach • Audit using Deardon Management Framework, Investors in People • Corporate contract, purchaser plan, performance management initiatives