Harnessing the power of the front-line clinician
Back in 1999, Lord Ara Darzi ditched his surgical scrubs to don a hospital porter's uniform for the day. Fed up of waiting for patients to arrive in theatre, he moved patients around St Mary's Hospital to find out where the bottlenecks were and fix them.
This changed Darzi's attitude and that of his surgical team - they became focused on understanding the problems and finding appropriate solutions. He said: “We changed to a type of mindset that's constantly challenging, constantly developing.”
Speaking at the 9th LSE Health and Social Care Annual Lecture earlier this year Darzi said he wants the 800,000 clinicians in the NHS to change their mindset in a similar way, leading to changes in practice and better quality care. Front-line clinicians have the knowledge and power to identify where “better customer service” is needed and how to improve patient care.
Darzi involved more than 2000 clinicians in his next stage review. Working for the first time with management and policy-makers, these clinicians discussed ways of improving healthcare and providing a better quality service for patients. They focused on three important elements of quality - clinical effectiveness, safety and patient experience. Across 10 regions, these clinicians discussed eight care pathways from newborn and maternity care to end-of-life care. Proactive assessment of these eight pathways together with local decision-making based on the best available evidence will help achieve Darzi's goal of ‘high quality care for all'.
Even small changes in practice can have a big impact on quality of care, said Darzi. He and his team at St Mary's recently trialled the WHO's surgical safety checklist as part of the ‘safe surgery saves lives' campaign. The 19-point checklist was designed to improve communication among clinical staff and promote best surgical practice. Across the eight study sites (which included hospitals in India, the Philippines and Tanzania) the checklist cut death rates by half and reduced complication rates by a third. One hospital saw an 82% reduction in its surgical site infection rates. Darzi explained how introducing a simple checklist, based on best practice and the best available evidence, had had a “tremendous impact on improving patient safety”.
Setting targets will continue to play a role in improving patient care, but Darzi believes clinicians will strive to achieve beyond them. “A target is only a target when trying to achieve it,” said Darzi - quoting Roger Bannister, the athlete and neurologist. “When you hit a target it becomes standard.” Darzi said that pride in delivering high quality care will be a powerful incentive for clinicians to produce better and better results.
But Darzi recognises that the vision of high quality care for all will take time to achieve, and that it requires engaged clinicians and strong clinical leadership. He closed by quoting John Ruskin: “Quality is never an accident. It is always the result of intelligent effort.”
NICE has been placed firmly at the forefront of that “intelligent effort”. Darzi's next stage review envisaged a key role for NICE in delivering high quality care, recommending, among other things, that patients are guaranteed access to NICE-approved drugs and treatments as part of the new NHS Constitution. The report also asked NICE to set up and manage a new NHS Evidence service to enable NHS staff to access clinical and non-clinical evidence and best practice - this service was launched by Lord Darzi in April this year.
NICE was asked to work with the Department of Health and professional and patient groups to create an independent, transparent process for developing and reviewing the indicators in the Quality and Outcomes Framework for GP practices. This work is well underway, with the first meeting of a new, independent Primary Care Quality and Outcomes Framework Indicator Advisory Committee being held on 8 June. A guide setting out the interim process for developing QOF indicators is also available on the NICE website.
Finally, the next stage review outlined a new remit for NICE in determining how quality should be defined and assessed, emphasising the need for the setting of “independent quality standards” and the publication of ‘Quality Accounts' based on systematically developed measures. NICE is currently working with its partners across health and social care to achieve that vision.
12 June 2009
This page was last updated: 18 January 2010