Centres for Healthcare Improvement: solution to the quality problem

Few healthcare systems are exempt from a seemingly constant cycle of reform and this is particularly apparent in the USA and England at present. In part this is driven by the need to provide more cost-effective care, and hence savings, but also by an increased awareness of variable quality of care for patients. Even so, large-scale reorganization and reform is often undertaken with little thought given to how changes will be implemented at a local level. The consequence is that often we see a ‘voltage drop’ – sometimes a significant one – between policy planners and implementation in the front line. The ‘doing’ always gets forgotten. The complexity and context-dependent nature of delivering improvement is well-recognized. Research has demonstrated that the skills and expertise needed to successfully deliver change include effective leadership, engagement of staff and stakeholders, and alignment with strategic goals. Continuing to identify the same solutions or problems in different settings can no longer be considered added value research. If we are to deliver the recent Health and Social Care Bill’s commitment to continuous improvement in healthcare we must develop local infrastructures to embed an evidence-based systematic approach to ‘doing’. Thus supporting the implementation of policy and research to improve everyday care. A potential solution is to create local Centres for Healthcare Improvement serving a defined health economy. The primary function of these Centres would be to work within the local health economy to deliver tangible and sustained improvements at the point of care. They would provide expert advice and directly support the delivery of national and local priorities through utilizing real-world research and improvement science to inform and drive ‘doing’. Aspects of this work could be undertaken as a form of internal consultancy to support more costeffective systems of care. Second, the Centres would provide an integrated network for collaboration within the local health and research community, engaging all healthcare organizations, higher education institutes, the local community and patients plus relevant industry partners within the network. Through the network partner organizations would share expertise in research, improvement science and leadership to coordinate the delivery of higher quality care. The network would thus provide a mechanism for peer-support and challenge, through shared learning, to increase effectiveness and reduce duplication. Centres would share learning with each other and provide opportunities for local, national and international networking. Third, to sustain improvements and maximize effectiveness the proposed Centres would build staff capacity and capability across the interface between the NHS and academia, recognizing that managers, clinicians and frontline staff are key actors in affecting large-scale change and implementing evidence-based medicine. The Centres would develop staff with the core knowledge and skills and create a permissive culture for experiential practice – learning through ‘doing’– combined with formal education for healthcare professionals (undergraduate, postgraduate or practice-based). To support the NHS, academic researchers require training to increase their awareness of the contextual issues and day-to-day challenges DECLARATIONS