Quality standards help you improve the quality of care you provide or commission.
Use them to:
How other organisations use quality standards
Assess your service against quality standards
This template will help you:
- assess current practice
- develop an action plan
- monitor quality improvement.
Identify gaps and areas for improvement
Compare the care you provide or commission against quality standards to help you:
- understand the priority areas to focus on for quality improvement
- identify and prioritise improvement priorities for the coming year or business cycle
- identify potential areas for local audit
- inform local joint strategic needs assessments (JSNAs).
- identify decommissioning options by highlighting potential for cost saving or identifying services that are of poor quality.
Conduct an initial assessment
An initial assessment of services against a quality standard will help you plan quality improvement projects.
Each standard contains statements that describe priority areas for improvement. Assess each statement to understand:
- whether the statement is relevant to your service
- how current services compare with the statement
- the source of the evidence to support this
- what actions or resources would be needed in order to improve the service so that it meets the statement
- an initial high-level assessment of risk associated with not making these improvements.
This assessment can support discussions between commissioners and providers about local quality improvement incentive schemes (including the local commissioning for quality and innovation [CQUIN] scheme in the NHS).
Use our quality standards service improvement tool (Excel) to help you carry out an initial assessment.
Examples in practice
See how other organisations have used quality standards for quality improvement planning.
Measure the quality of care
Quality standards contain associated quality measures to help you:
- measure levels of care
- develop tools and metrics
- measure quality improvement after implementing changes.
Measurement is essential to show that changes to care or services have resulted in an improvement. It's a key part of the Plan-Do-Study-Act (PDSA) improvement cycle. If measurement shows there has been no improvement, you need to adapt the change - or try something different.
Using quality measures
Quality measures help you calculate how well your service aligns with a quality statement. They highlight changes to your service that you could make. There are 3 types of measure:
- structure - the environment or setting
- process - the activity carried out
- outcome - the end result or impact.
Process quality measures are generally split into two parts:
- denominator - the target population covered by the statement
- numerator - the number of the denominator who receive the care described in the statement
The figures for both define the proportion (proportion = numerator/denominator). If the numerator is 3 and the denominator is 10 the proportion would be 3/10.
For example, in NICE quality standard 48 for depression in children and young people:
‘The proportion is the number of children and young people receiving treatment for depression who have their health outcomes recorded at the beginning and end of each step in treatment.’
This is calculated with the following:
- Numerator – the number of people in the denominator who have their health outcomes recorded at the beginning and end of each step in treatment.
- Denominator – the number of children and young people receiving treatment for depression.
If 50 children have received treatment (denominator) and 25 of those had their health outcomes recorded at the beginning and end of each step in treatment (numerator), the proportion would be 25/50.
By monitoring the proportion, you can measure the impact of improvement work. This lets you make sure changes are resulting in improvements to care.
Within each quality standard we indicate where national quality assured indicators currently exist that measure the quality statement.
National indicators include those developed by NHS Digital through their Indicators for Quality Improvement Programme.
Where national quality indicators do not exist, the quality measures should form the basis for local audit and service review. Audit standards or levels of expected achievement should be decided locally, unless otherwise stated.
Examples in practice
See how other organisations have used quality standards to measure quality.
Understand how to improve care
Once you have identified areas for improvement, use standards as the basis for your work.
Develop an action or commissioning plan
An action plan details the steps needed to improve services so they align with the quality standard.
The plan should contain a list of actions that show how you will improve the service in-line with a quality statement. Record against each action:
- a person responsible
- a deadline
- a way to measure progress.
Our service improvement template (Excel) will help you create an action plan.
Examples in practice
See how organisations have used quality standards as the basis for improvement work.
Demonstrate you provide quality care
By demonstrating that you deliver the levels of care set out in a quality standard, you can provide assurance to your board, commissioners, regulators and patients.
An initial assessment of services against a quality standard can highlight areas where you are providing quality care and identify areas for improvement.
Using quality standards as part of an assurance process (that meets the needs of your board and commissioners), saves duplicated effort and avoids ad-hoc requests for data.
Producing an annual report is a way to demonstrate how you use evidence-based guidance such as quality standards and NICE guidance. You can show:
- how your service meets the levels of care set out in quality standards, informed by readily available evidence
- progress with quality improvement projects aligned to quality standards.
A positive assessment can be included in a trust’s quality account.
The CQC use NICE guidelines and quality standards as evidence for inspections. CQC inspectors look for evidence of how providers are using quality standards to improve the care they offer. This is used to inform the award of good and outstanding ratings.
Commission high-quality services
For an evidence-based assessment of the quality of services, you need to understand how services compare with quality standards. For example, compare commissioned services with standards to highlight service gaps and inform local joint strategic needs assessments (JSNAs).
Standards can also be used:
- to contribute to the improvements outlined in local health and wellbeing strategies and national outcomes frameworks.
- as a source of evidence-based quality indicators for local quality improvement incentive schemes (for example, in health this could be the local CQUIN).
- in contracts to set levels of quality care
- to develop key performance indicators to measure the performance of services
- to meet statutory requirements in terms of commissioning services (The Health and Social Care Act 2012 states that the Secretary of State and NHS England must have regard to the quality standards prepared by NICE when exercising their functions).
Examples in practice
See how other organisations have used quality standards to commission quality services: