Measuring for quality improvement in physiotherapy

Key Points Background Implications News Resources Action Points References

Key Points

Physiotherapy clinicians and service providers need to demonstrate the quality of their service to a range of audiences and influence the development of appropriate quality measurements.

In recent years there has been a shift in the NHS from a focus on increasing the quantity of care delivered to a focus on improving the quality of that care as experienced by patients and their families
This shift has been driven by a number of challenges that are impacting across the UK, namely: rising patient expectations; the development of improved information and connectivity; advances in treatments; concerns around patient safety within the healthcare setting and the embedding of evidence-based guidelines into clinical practice
This is all taking place within a context of financial insecurity and increasing budgetary constraints resulting in a sharp need to balance quality against value for money
Quality in healthcare is not solely about the impact of a specific intervention on the health status of a patient. Increasingly, practitioners and service providers are being required to consider, and report on, the quality of all aspects of the patient experience
Work is being carried out across the UK to provide practitioners with appropriate tools and indicators to support them in measuring the quality of their provision across a range of dimensions
Physiotherapy clinicians and service providers need to be aware of these developments to ensure that they can demonstrate the quality of their service to a range of audiences and to have an impact on the development of appropriate quality measurements for physiotherapy

Resources

Publication

Calculating the economic value of a physiotherapy service

1 year ago
Publication

A survey of NHS physiotherapy waiting times and musculoskeletal workload and caseload in England 2009-10

1 year ago
Document

Care Quality Commission consultation

2 years ago

Implications

All practitioners and service providers need to be aware of how the measurement of quality – or quality metrics – agenda is developing within the country in which they work. Information specific to each of the four UK countries around the quality metrics agenda in the NHS, including the key policy documents, quality frameworks and initiatives in each country can be found on the their dedicated quality metrics pages (see links top right).

There is no doubt that physiotherapists working in the NHS in any of the UK countries will increasingly be feeling the impact of the push towards the measurement of quality and outcomes for patients. Measurement may be specifically around the physiotherapy services being offered or may be as part of a broader package of care structured around the patient journey.

In England, the added dimension offered by the market model of healthcare resulting in a move to quality-led commissioning, has the potential to significantly impact on the way in which physiotherapists measure aspects of their service. The linking of payments to providers to the quality of the care given to patients as well as the volume, as part of the Commissioning for Quality and Innovation (CQUIN) agreement, could result in data being collected against quality markers agreed with commissioners.

Moves to measure quality also represent opportunities for providers. The introduction of the Quality and Outcomes Framework (QOF) for GP services across the UK can offer physiotherapists an opportunity to provide services that attract some QOF monies that could be reinvested in the physiotherapy service.

Whichever is the case, it is essential for physiotherapy clinicians and service providers to make themselves aware of the quality frameworks operating nationally and locally as these will provide the context for any initiatives around quality measurement.

The key domains of quality in physiotherapy

Effectiveness

All physiotherapists have a professional duty to maintain and develop their competence, and through this, the quality of their service provision. Where national guidelines exist around specific clinical areas, it is essential that these are used to support the development of physiotherapy services.

All the UK countries have made a commitment to the use of evidence-based clinical guidelines, from the National Institute for Health and Clinical Excellence (NICE) or the Scottish Intergovernmental Guidelines Network (SIGN), to define quality in terms effectiveness.

Key indicators for quality improvement and clinical outcomes are being agreed in the UK countries to measure effectiveness in practice. These tools are nationally agreed for local and national implementation. All physiotherapy service providers should familiarise themselves with the relevant measures in use within their organisation and area of practice. More information on the different indicators and measures in use in the four UK countries can be found on the relevant country-specific pages in this section.

News & Comment

News item

NHS Atlas shows variations in healthcare

1 year ago
News item

Profiles help identify health needs in the population

1 year ago

Background

Key words/terms used in this section cover: clinical outcome measures; quality; commissioning for quality and Innovation (CQUIN); quality accounts; economic modelling; quality-led commissioning; indicators for quality improvement (IQI); quality measures; intelligent targets; quality metrics; patient reported outcome measures (PROM); quality standards.

Improving the quality of healthcare in the NHS is currently top of the agenda in all the four UK countries, resulting in an increasing focus on methods of measuring the quality of clinical practice and services.

In the past decade there has been a growing consensus internationally about the key dimensions of quality in healthcare and relevant measures and indicators to assess performance in these dimensions.

In 2001, a report for the Institute of Medicine, Crossing the Quality Chasm, A New Health System for the 21st Century described six core dimensions of healthcare quality.

The core dimensions of quality in healthcare

Effectiveness – the extent to which an intervention is appropriate and produces its intended result
Access and timeliness – the provision of services at the time they are needed, within the appropriate setting and without excessive waiting times
Capacity – the cost-effective resourcing of systems to enable delivery of appropriate, efficient and coordinated services
Safety – the provision of services that do not harm the patient or expose them to any unnecessary risk
Patient-centredness – healthcare delivered in partnership with patients and their families with compassion, empathy and responsiveness to individual needs, values and preferences
Equity – services provided on the basis of clinical need, regardless of personal characteristics and circumstances and in such a way as to reduce differences in health status and outcomes across various subgroups

While there may be agreement about what is meant by quality in healthcare there are many and varied approaches being taken across the UK to the measurement of quality. Although some of the differences can be attributed to the various national values and principles underlying the development of health policy, all four governments talk of measuring for quality improvement as a key driver.

Measuring quality

Quality improvement in healthcare cannot be calculated by a single performance measure or simple metric. What is measured, and how, will depend largely on the reasons why measurement is being undertaken. Across the UK quality and outcome measures are now routinely collected around GP practice through the Quality and Outcomes Framework.

Under the framework, quality is measured against national standards around clinical and organisational performance, the provision of additional services and a measure of the patient experience. Payment to GPs is directly linked to their performance against these indicators.

There are four main drivers for measuring quality in healthcare, although it is the first of these that is the primary stated driver in the NHS across the UK:

Service improvement and patient safety – improving the quality of health interventions is part of everyday work and the professional responsibility of all practitioners. It is the measurement of those quality improvements that is central to service improvement and safety for patients
Policy development and strategic decision making – through the identification of trends and an analysis of performance towards achievement of health service goals, planners, policy-makers and commissioners can work towards informed decision-making around the service needs of the population they serve
Research and development of the evidence-base – data collection around the quality of service provision can provide valuable material to support research and the development of an evidence-base to support practice
Accountability and quality-led commissioning – measuring quality enables practitioners to be held accountable for the services they provide, with the potential – in some contexts – for a direct impact on commissioning decisions

Measuring for quality improvement

The activity enshrined in measuring for quality improvement can be described using the Plan, Study, Do, Act (PDSA) model. Before making an improvement aims are set and measures to be applied are agreed. The change to be made is selected and then, using the PSDA cycle, the impact of the change is evaluated.

Applying PDSA cycle will involve the collection of data/information against the agreed measure. The CSP's Principles of recording and utilisation of patient based information provides members with a set of generic information recording and utilisation principles that should be applicable in all work settings. It is intended that the principles will support members in their day-to-day management of information and in their dialogue with information and technical specialists.

Action Points

The key message for all practitioners around the quality metrics agenda is to get started. Measuring for quality improvement is fast becoming a fact of life in the NHS economy across the UK. It is only a matter of time before all NHS services are required to provide measures of the quality of their provision and physiotherapy will be no exception.

These web pages have given members key information around the key policy documents, quality frameworks and initiatives in each of the UK countries around quality metrics, as well as guidance on the healthcare quality context and the drivers for quality measurement.

The next step is for practitioners to take this agenda forwards by engaging with quality measurement at a local level. An action planning tool has been devised to help members structure their activity and identify key resources and tools for getting started.