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.