Board level “Picture-Understanding-Action”: a new way of looking at quality

Abstract

PurposeThe purpose of this study is to present a quality improvement approach titled “Picture-Understanding-Action” used in Ireland to enhance the role of healthcare boards in the oversight of healthcare quality and its improvement.Design/methodology/approachThe novel and practical “Picture-Understanding-Action” approach was implemented using the Model for Improvement to iteratively introduce changes across three quality improvement projects. This approach outlines the concepts and activities used at each step to support planning and implementation of processes that allow a board to effectively achieve its role in overseeing and improving quality. This approach matured over three quality improvement projects.FindingsThe “Picture” included quantitative and qualitative aspects. The quantitative “Picture” consisted of a quality dashboard/profile of board selected outcome indicators representative of the health system using statistical process control (SPC) charts to focus discussion on real signals of change. The qualitative picture was based on the experience of people who use and work in health services which “people-ised” the numbers. Probing this “Picture” with collective grounding, curiosity and expert training/facilitation developed a shared “Understanding”. This led to “Action(s)” from board members to improve the “Picture” and “Understanding” (feedback action), to ask better questions and make better decisions and recommendations to the executive (feed-forward action). The Model for Improvement, Plan-Do-Study-Act cycles and a co-design approach in design and implementation were key to success.Originality/valueTo the authors’ knowledge, this is the first time a board has undertaken a quality improvement (QI) project to enhance its own processes. It addresses a gap in research by outlining actions that boards can take to improve their oversight of quality of care.

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

“…This paper presents an application of the “Picture-Understanding-Action” quality improvement approach to implementing new processes to support board level oversight of quality and its improvement (Martin et al. , 2021).…”

“…This quality improvement project offers an addition to the literature by demonstrating an actionable approach that healthcare boards can implement to effectively govern for quality. This study implements the "Picture-Understanding-Action" approach at a health system board level (Martin et al, 2021). This approach facilitated the national HSE directorate to develop a quality agenda item which was then handed over to the newly appointed board of directors, who continue to use and evolve the approach three years later.…”

“…In 2018, the HSE directorate identified that the information they received about the quality of care was not at par with their sight of financial matters. Martin and Flynn (Martin et al, 2021) recently developed the "Picture-Understanding-Action" approach that outlined the steps which support a board to oversee and improve quality. The HSE directorate requested the national QI team support them to develop a quality agenda item for their meetings in order to design a robust process to support the incoming board in their role of overseeing quality.…”

IJHG review 27.1

“…Finally, Martin et al (2022) suggest the key to good hospital governance is through hospital board governance. The authors describe a strategy they call "Picture-Understanding-Action" to assist hospital boards in their identification and understanding of issues and the actions to deal with these.…”

“…This is congruent with findings from an earlier study in the US (Akinleye et al, 2019) that determined a clear correlation between safety and quality of hospital services and financial performance. In continuing the mini-theme of hospital quality, Martin et al (2022) report on a new approach which they call "Picture-Understanding-Action" to support hospital governing boards in the improvement of healthcare governance in Ireland. The "picture" component represents information presented to the hospital board; the interaction with the board to extract meaning from the picture is represented by "understanding"; while "action" represents both feedback action to improve the "picture" and "understanding" as well as feed forward which includes steps to be taken to carry out quality improvements.…”