Applying a new approach to the governance of healthcare quality at board level

Abstract

PurposeThis paper describes a quality improvement project to improve oversight of quality at national board level using statistical process control (SPC) methods, complimented by a qualitative experience of patients and frontline staff. It demonstrates the application of the “Picture-Understanding-Action” approach and shares the lessons learnt.Design/methodology/approachUsing co-design and applying the “Picture-Understanding-Action” approach, the project team supported the directors of the Irish health system to identify and test a qualitative and quantitative picture of the quality of care across the health system. A “Quality Profile” consisting of quantitative indicators, analysed using SPC methods was used to provide an overview of the “critical few” indicators across health and social care. Patient and front-line staff experiences added depth and context to the data. These methods were tested and evolved over the course of six meetings, leading to quality of care being prioritised and interrogated at board level.FindingsThis project resulted in the integration of quality as a substantive and prioritised agenda item. Using best practice SPC methods with associated training produced better understanding of performance of the system. In addition, bringing patient and staff experiences of quality to the forefront “people-ised” the data.Originality/valueThe application of the “Picture-Understanding-Action” approach facilitated the development of a co-designed quality agenda item. This is a novel process that shifted the focus from “providing” information to co-designing fit-for-purpose information at board level.

IJHG Review 28.1

“…They argue that audit often fails to lead to intended improvements because of a lack of understanding of the audit process and why, when and how audits should be done. This recommendation for deep understanding complements the "Picture-Understanding-Actions" approach to health board management proposed by Martin et al (2023).…”

“…The authors explore some of the dilemmas and difficulties inherent in this approach but make a valid case for insider research as a legitimate methodology. Indeed, the reflexivity which this approach necessitates can be seen as a positive factor for both the individual health resilience researcher as well as a means of ensuring rigour and validity in the research.This review is based on, Martin et al (2023), applying a new approach to the governance of healthcare quality at Board level.…”

“…(5) This review is based on, Martin et al (2023), applying a new approach to the governance of healthcare quality at Board level.…”

“…However, perspectives can only be developed and thus discussed and debated if the information on which they are based is both accurate and relevant. Martin et al (2023) describe an approach developed by two of the authors to improve the ability of a health board to oversee and improve quality and safety by identifying actionable steps that can be undertaken following each board meeting. Called the Picture-Understanding-Actions approach, this aims to provide an accurate picture of the issues, topics and problems under consideration, to ensure that all board members understand these issues and the contexts within which they occur, and then to identify actions which can be implemented towards the necessary quality and safety improvements.…”

“…Martin et al . (2023) describe an approach developed by two of the authors to improve the ability of a health board to oversee and improve quality and safety by identifying actionable steps that can be undertaken following each board meeting.…”