Quality - Northern Ireland
In recent years, the NHS has seen a shift in focus from increasing the quantity of care to improving the quality of care, as experienced by people who use its services.
During this period we have seen growing requirements for health professionals, including physiotherapists, to demonstrate the efficacy and quality of their service to a range of audiences.
This means that physiotherapists need to keep abreast of the health service quality agenda and understand how this translates to their daily work.
- Quality in healthcare can be defined as: 'the total package of features and characteristics in healthcare service or product and the way in which it is provided, that bear on its ability to satisfy the agreed need of the consumer and the agreed requirement of the purchaser within the constraints imposed by professional judgement at lowest cost, and whilst minimising waste and losses.' (1)
- There has been much debate about the key themes within which quality should be assessed and measured, and there is no definitive model of healthcare quality, although most versions have strong similarities. In this resource we use the model set by the Institute of Medicine in 2001(2), which argues that the key six aims for improvement should built around the core need for health care to be:
- Safe – the provision of services that do not harm the patient or expose them to any unnecessary risk
- Effective – the extent to which an intervention is appropriate and produces its intended result, drawing on a strong evidence base underpinned by rigorous research
- Patient centred – healthcare delivered in partnership with patients and their families with compassion, empathy and responsiveness to individual needs, values and preferences
- Timely – the provision of services at the time they are needed, within the appropriate setting and without excessive waiting times
- Efficient – the cost-effective resourcing of systems to enable delivery of appropriate, efficient and coordinated services
- Equitable – 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.
- Different authors and government policies identify different themes within quality, or use slightly different terminology or concepts. Each of the UK countries has agreed its own key indicators for quality improvement and clinical outcomes. These indicate what specifically needs to be measured within your services. (For more information see the individual country pages.) However, the broad principles of quality tend to be similar across countries and over time.
- Today, across the UK, there is a strong emphasis on safe systems, a strong evidence base, and a positive patient experience.
- Quality in healthcare is judged against standards in order to provide quality assurance. These specify what needs to be achieved, and to what level. They may apply to any activity of feature of health care that is important for quality. An example of a standard might be '95% of patients in an outpatient clinic are seen by a therapist within 10 minutes of their scheduled appointment time.'
- Across the UK, quality and outcome measures are routinely collected to assess quality. Meanwhile, work is being carried out across the UK to provide practitioners with appropriate tools and indicators to enable them to measure the quality of their provision across a range of dimensions. For more information about this area of work, see the separate topic measuring for quality improvement in physiotherapy.
All physiotherapists have a professional duty to maintain and develop their competence and the quality of their service provision. This means using national guidelines to support the development of physiotherapy services, including evidence-based guidelines, to define quality in terms of effectiveness.
Physiotherapists working in Northern Ireland need to be aware of the quality measurement and improvement initiatives that impact on their organisation. Where NICE guidelines and other robust evidence exist for their areas of clinical practice, physiotherapists need to identify recommendations and standards, implement them and demonstrate their impact. (For more on this process, see the measuring for quality improvement in physiotherapy topic.)
Meanwhile, all physiotherapists working in Northern Ireland should be looking to identify initiatives that can be taken up locally to drive up the quality of provision – particularly within the five quality themes. The Quality Standards for Health and Social Care and the Standards for Improving the Patient and Client Experience provide a framework for physiotherapy service providers to use when addressing the issue of quality improvement at a local level.
Physiotherapists need to be aware of the quality assurance framework defined by the Quality Standards for Health and Social Care, and should to measure the impact of their services on the identified quality themes as defined by the specific criteria: see the measuring for quality improvement in physiotherapy topic for more information.
News & Comment
There are no related news and comments for this policy.
In Northern Ireland, responsibility for health and social care sits within a single government department: the Department of Health, Social Services and Public Safety (DHSSPS). Health and social care is provided across the sector by the Health and Personal Social Services (HPSS). As a result, the quality agenda in Northern Ireland places a strong emphasis on public safety, underpinned by the broader principles of public engagement, shared ownership of decisions and consumer power, which run throughout the country's health and social care policy, along with equity, accessibility and celebrating diversity.
The main policy document focusing on quality in healthcare is Quality Standards for Health and Social Care(14), which was published in 2006 and is due for review. The standards focus on quality improvement for services and improved health and well-being for the people of Northern Ireland. The standards have five key quality themes:
- Corporate leadership and accountability of organisations
- Safe and effective care
- Accessible, flexible and responsive services
- Promoting, protecting and improving health and social well-being
- Effective communication and information.
The document identifies specific criteria for each standard. These can then be used to assess and measure services for quality assurance. The document emphasises the commitment to clinical effectiveness based on nationally agreed best practice and guidelines, including those defined by the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE). DHSSPS endorses NICE and SCIE guidelines that are considered appropriate for Northern Ireland.
These are supported by a further set of standards published in 2008, entitled Improving the Patient and Client Experience(15), which relate to respect, attitude, behaviour, communication, and privacy and dignity. The document emphasises that services must also embrace these five standards, and monitor and continually improve in these areas.
The organisation responsible for monitoring the availability and quality of health and social care provision in Northern Ireland is the Regulation and Quality Improvement Authority (RQIA), which is involved in quality assuring services against DHSSPS standards and encouraging continuous improvement through inspection and review.
- Familiarise yourself with how the quality agenda is developing within Northern Ireland the key quality themes, and the frameworks relate to your work.
- Take some time to understand the government drivers in this field and how they impact on physiotherapy in your area:
- Quality Standards for Health and Social Care (14)
- Standards for Improving the Patient and Client Experience(15)
- DHSSPS-endorsed NICE guidelines
- DHSSPS-endorsed Social Care Institute of Excellence (SCIE) guidelines
- Regulation and Quality Improvement Authority (RQIA).
- Identify what this means for your practice.
- See the measuring for quality improvement in physiotherapy topic: this explains measuring quality in more detail, and will help you think about what data you could use to demonstrate the quality of your service against the relevant frameworks.
- Use our action planning tool to help you get started on producing quality metrics for quality improvement.
- When you are in contact with commissioners, think about how you could draw on your specialist knowledge to influence the way they measure and assess quality.
- Look for local initiatives that can drive up the quality of provision, and identify the impact of these changes to demonstrate the contribution that physiotherapy can make to quality improvement within your organisation. Visit the NHS Quality and Productivity Library for examples of good practice.
- Refer to the CSP's Standards of Professional Practice to determine the quality of service you should provide.
- Refer to the CSP's Core standards of physiotherapy practice to determine the quality of service you should provide.