Press Release 23/09/2020. To err is human: building a safer health system. Batalden M, Batalden P, Margolis P, Seid M, Armstrong G, Opipari-Arrigan L, Hartung H (2015). British Heart Foundation (2015). Delivering and sustaining change in a few key areas, and working first with a small cohort of volunteers, can help to generate momentum and provide a platform for the roll-out of an organisation-wide programme (Jones and Woodhead 2015). Quality improvement: theory and practice in healthcare. This website allows you to search the full text of a huge range of The King's Fund publications and documents from 1898 onwards. ‘Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study’. They starve either because they cannot eat or cannot absorb the nutrients from a normal diet. London: The King’s Fund. London: The Health Foundation. London: The Health Foundation. Dan Wellings highlights how training staff to have ‘different conversations’ with people using their services and backing them to act on what they hear has allowed this transformation to take place. BMJ Quality & Safety, vol 21, no 10, pp 876–84. Public Health England website. But the systematic use of quality improvement approaches within the NHS is still patchy, and many improvement efforts fail to deliver the results expected. Home; Headlines; Survey; NHS Performance Data; About the QMR; QMR 18 | February 2016 Share on Twitter; Share on Facebook; Share on LinkedIn; How is the NHS performing? Michael West and Suzie Bailey consider the disproportionate toll Covid-19 is taking on health and care staff from. While the role of boards is key, responsibility for leading quality improvement also extends well beyond the most senior leaders in the NHS. NHS England, Health Education England, Public Health England, Monitor, Care Quality Commission, NHS Trust Development Authority (2014). Some NHS organisations that have adopted a systematic approach to quality improvement and invested in developing the skills and capabilities of frontline staff have demonstrated increases in staff satisfaction and retention rates and lower sickness and absence rates (Ross and Naylor 2017; Jones and Woodhead 2015). National Audit Office (2015). Tackling variations in clinical care: assessing the Getting It Right First Time (GIRFT) programme. Available at:   http://qualitysafety.bmj.com/content/early/2017/07/07/bmjqs-2016-006433 (accessed on 27 September 2017). There is no charge for shareholder reports. Available at: www.health.org.uk/publication/challenge-and-potential-whole-system-flow (accessed on 8 September 2017). London: The King’s Fund. The King’s Fund has identified a large and growing gap between capacity and demand in district nursing services, with staff reporting feeling ‘broken’, ‘exhausted’ and ‘on their knees’. The NHS five year forward view (Forward View) is the national plan for improving services in the NHS in England (NHS England et al 2014). The churn of leaders can stall organisational progress, which can be especially costly as trusts try to work collaboratively in local health and care systems to develop more integrated models of care. BMJ Quality & Safety, vol 25, no 7, pp 509–17. Mandating participation in quality improvement training, without first making the case for it, runs the risk that it will be perceived as simply ‘another thing to do’ or a further ‘box to tick’ (Academy of Medical Royal Colleges 2016). The King’s Fund is an independent charity working to improve health and care in England. Mental Health and Primary Care Networks finds that current provision of mental health support in general practice is variable and often inadequate. ‘Delayed transfers of care data 2017-18’. These improvements will nonetheless have a major impact on NHS finances – for example by allowing more patients to be treated without spending more money. Finding ways to free up staff time to take part in improvement work or training is another necessary step. Staffing vacancies are rife, there are widespread challenges in meeting financial and performance targets and demands on services continue to increase. Home; Headlines; Survey; NHS Performance Data; About the QMR; QMR 14 | January 2015 Share on Twitter; Share on Facebook; Share on LinkedIn; How is the NHS performing? NHS Right Care (2017). Both quality and cost can be measured in different ways, and the impact of the relationship between the two is often spread widely across a health system and over time. Journal of Healthcare Management, vol 54, no 1, pp 15–29. Whilst the depth of quality has been hinted at, I would like to go further and deepen some of the core aspects of improvement and transformation that have been seen in other private and public sectors, as well as in the NHS recently. Identifying and managing patients at risk of chronic disease exacerbation, Acute-led development of an ambulatory care service, Improving safety and quality through multi-professional training, Whole-pathway improvement involving collaboration between the primary, acute and community sectors, Make quality improvement a leadership priority for boards, Have a consistent and coherent approach to quality improvement, Share responsibility for quality improvement with leaders at all levels, www.aomrc.org.uk/publications/reports-guidance/quality-improvement-training-better-outcomes/, www.kingsfund.org.uk/publications/stps-in-the-nhs, www.kingsfund.org.uk/publications/better-value-nhs, www.ncbi.nlm.nih.gov/pmc/articles/PMC4292097/, http://qualitysafety.bmj.com/content/25/7/509, www.health.org.uk/publication/perspectives-context, http://webarchive.nationalarchives.gov.uk/20150317164830/http://www.nhsiq.nhs.uk/resource-search/publications/quality-improvement-theory-and-practice-in-healthcare.aspx, www.nejm.org/doi/full/10.1056/NEJMp1606458, www.bhf.org.uk/publications/healthcare-and-innovations/an-integrated-approach-to-managing-heart-failure-in-the-community, www.renalreg.org/reports/2015-eighteenth-annual-report/, www.gov.uk/government/publications/high-quality-care-for-all-nhs-next-stage-review-final-report, www.health.org.uk/publication/challenge-and-potential-whole-system-flow, www.health.org.uk/publication/context-successful-quality-improvement, www.kingsfund.org.uk/publications/reforming-nhs-within, www.kingsfund.org.uk/publications/place-based-systems-care, www.kingsfund.org.uk/publications/delivering-sustainability-and-transformation-plans, www.kingsfund.org.uk/publications/quality-improvement, www.ihi.org/resources/Pages/Tools/QISavingsTrackerWorksheet.aspx, www.health.org.uk/publication/building-foundations-improvement, http://qualitysafety.bmj.com/content/early/2017/07/07/bmjqs-2016-006433, Estimating the financial cost of chronic kidney disease to the NHS in England, www.kidneycareuk.org/about-kidney-health/order-or-download-booklets/, http://content.healthaffairs.org/content/22/2/17.long, www.health.org.uk/publication/how-do-you-get-clinicians-involved-quality-improvement, www.kingsfund.org.uk/publications/quality-district-nursing, www.health.org.uk/publication/clear-road-ahead, www.gov.uk/government/publications/closing-the-nhs-funding-gap-how-to-get-better-value-healthcare-for-patients, www.nao.org.uk/report/the-management-of-adult-diabetes-services-in-the-nhs-progress-review/, www.hqip.org.uk/resources/national-heart-failure-audit-april-2015-march-2016/, https://digital.nhs.uk/catalogue/PUB23241, www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/delayed-transfers-of-care-data-2017-18/, www.suttonccg.nhs.uk/vanguard/Our-Programme-Overview/Pages/Enhanced-Health-in-Care-Home.aspx, www.improvementacademy.org/patient-safety/medicines-safety.html, www.england.nhs.uk/five-year-forward-view/, https://improvement.nhs.uk/resources/developing-people-improving-care/, http://fingertips.phe.org.uk/profile/atlas-of-variation, www.eastsussex.gov.uk/socialcare/providers/dementia-care/, www.health.org.uk/publication/does-improving-quality-save-money, www.healthcareimprovementscotland.org/previous_resources/hta_report/a_systematic_narrative_review.aspx, www.kingsfund.org.uk/publications/getting-measure-quality, www.kingsfund.org.uk/publications/understanding-nhs-financial-pressures, www.kingsfund.org.uk/publications/quality-improvement-mental-health, www.rpharms.com/making-a-difference/projects-and-campaigns/pharmacists-improving-care-in-care-homes, www.health.org.uk/publication/effective-networks-improvement, www.health.org.uk/publication/improving-patient-flow, www.kingsfund.org.uk/publications/tackling-variations-clinical-care, www.kingsfund.org.uk/publications/practice-system-leadership, http://content.healthaffairs.org/content/34/8/1304.long, www.health.org.uk/publication/are-clinicians-engaged-quality-improvement. ‘Coproduction of healthcare service’. This will help bring quality patient care further forward into the 21st century. A shared determination to make a difference, together with an ability to carve out time to focus on improvement work, have been critical to their success. I work at this front line however the patient/carer role is often percieved as problematic and difficult and not functioning in ‘partnership’ . Happy staff - happy patients. Intelligent use of data is central to any efforts to improve quality. Available at: http://fingertips.phe.org.uk/profile/atlas-of-variation (accessed on 8 September 2017). The NHS, like all other health care systems across the world, sometimes fails to deliver high-quality care. I think the challenge is for each of us to understand what evidence we use to judge who is the best candidate and what level of risk we are willing to accept around an appointment. This is no surprise: patients have a unique role to play in identifying quality problems (such as duplication and waste), coming up with solutions to address them and ensuring that any change genuinely delivers the outcomes that matter to them (Batalden et al 2015; Fulop and Robert 2015). A clear road ahead: creating a coherent quality strategy for the English NHS. But it can be difficult to know how this should be done in practice. NHS England website. GOV.UK website. In other words, it is not a ‘bad apple problem’ (Institute of Medicine 1999). Embedding the type of attitudes and behaviours that have underpinned PROMPT’s success takes time and is not straightforward. A ‘revolving door’ approach to leadership also undermines the credibility leaders have with staff in their own organisations and with external stakeholders. Given the pressures facing NHS staff today, this licence to improve is vital. Available at: www.rpharms.com/making-a-difference/projects-and-campaigns/pharmacists-improving-care-in-care-homes (accessed on 20 September 2017). Maybin R, Charles A, Honeyman M (2016). In January 2016, 71 of the 142 orthopaedic units in England identified combined savings of between £20 million and £30 million after an initial GIRFT visit, with an additional £15 million to £20 million forecast for the next 12 months (Timmins 2017). Tsai TC, Jha AK, Gawande AA, Huckman RS, Bloom N, Sadun R (2015). The expert panel provided its final report to the government on 14 February 2020 (the King Review). Available at: http://webarchive.nationalarchives.gov.uk/20150317164830/http://www.nhsiq.nhs.uk/resource-search/publications/quality-improvement-theory-and-practice-in-healthcare.aspx (accessed on 18 September 2017). Drawing on these studies and other evidence, researchers have created a framework that can be used to assess organisational maturity in governing for quality improvement (Jones et al 2017). NHS five year forward view [online]. London: The King’s Fund. Overuse is bad for people receiving care because they get services that might cause them harm, or at least waste their time or cause unnecessary stress and anxiety. These things do not happen by accident. Senge P, Hamilton H, Kania J (2015). ‘Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study’. A reduced appetite for risk was mentioned as a factor in the appointment process by both applicants and decision-makers for director-level posts. In this section, we draw on relevant evidence and experience from the literature, and the examples given, to highlight 10 key lessons for NHS leaders seeking to embed quality improvement within their local systems. National diabetes audit, 2015-2016. Dixon-Woods M, Bosk CL, Aveling EL, Goeschel CA, Pronovost PJ (2011). ‘Quality improvement savings tracker worksheet’. Available at: https://improvement.nhs.uk/resources/developing-people-improving-care/ (accessed on 8 September 2017). Kaplan HC, Brady PW, Dritz MC, Hooper DK, Linam WM, Froehle CM, Margolis P (2010). Bate P, Robert G, Fulop N, Øvretveit J, Dixon-Woods M (2014). NHS doesn't have leadership culture but has management culture. Leaders in today’s NHS operate in a climate of extreme pressure. All NHS organisations should be focused on continually … The King’s Fund. “Services are stretched to the limit. London: The Health Foundation. But the most common suggestion for improving the development of future leaders focused on the need for better regional talent management, similar to that previously provided by strategic health authorities. An integrated approach to managing heart failure in the community [online]. Available at: www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/delayed-transfers-of-care-data-2017-18/ (accessed on 8 September 2017). But evidence showing that providers have been able to act on these opportunities is much harder to come by. RCN responds to the ‘Courage of Compassion’ report by the King’s Fund for the RCN Foundation. Networks to facilitate information exchange and sharing of practical insights can create a ‘learning system’, enabling improvements to be adapted and spread (The Health Foundation 2014; McCannon and Perla 2009). A mixed methods study of 15 organisations in England’. Available at: www.health.org.uk/publication/are-clinicians-engaged-quality-improvement (accessed on 8 September 2017). Better care at lower cost: a path to continuously learning health care in America. ‘Ten challenges in improving quality in healthcare: lessons from The Health Foundation’s programme evaluations and relevant literature’. Available at: www.kingsfund.org.uk/publications/quality-district-nursing (accessed on 8 September 2017). Quality improvement – the use of methods and tools to continuously improve quality of care and outcomes for patients – should be at the heart of local plans for redesigning NHS services. ‘Sustainability and transformation plans for the NHS in England: what do they say and what happens next?’. In other words, they are both unwarranted and avoidable, and represent inappropriate care being delivered to patients. Short tenures can lead to too much focus on day-to-day priorities at the expense of longer-term strategy. Available at: www.gov.uk/government/publications/closing-the-nhs-funding-gap-how-to-get-better-value-healthcare-for-patients (accessed on 8 September 2017). There are a range of opportunities for NHS organisations to improve quality of care and value for money. BMJ Quality & Safety, vol 21, no 9, pp 737–45. In this honest account of the realities of leadership in today's NHS, Nick Timmins talks to 12 departing. NHS leaders have a vital role to play in making this happen – leadership and management practices have a significant impact on quality. The practice of system leadership: being comfortable with chaos. These include a high level of regulatory burden and a lack of autonomy. Example 1: Identifying and managing patients at risk of chronic disease exacerbation, Example 2: Acute-led development of an ambulatory care service, Example 3: Medicines optimisation and polypharmacy, Example 4: Improving safety and quality through multi-professional training, Example 5: Whole-pathway improvement involving collaboration between the primary, acute and community sectors, Comprehensive quality improvement: not ‘why should we do it?’ but ‘when will we start?’, As the Fund publishes a report on leadership for quality improvement, Matthew Kershaw encourages NHS organisations to embrace. London: The Health Foundation. The Ambulatory Heart Failure Clinic at the University Hospitals of North Midlands NHS Trust was a response, in part, to local heart failure patients’ wishes for a service that allowed them to remain in their own home (example 2). Programmes to support you at all stages of your leadership journey, Addressing race inequalities in the NHS needs engagement, commitment and a plan, As the Fund prepares to publish its report on workforce race inequalities and inclusion, Richard Murray reflects on. ‘A primer on PDSA: executing plan–do–study–act cycles in practice, not just in name’. STPs and other local partnerships could also help NHS organisations to ‘act like a sector’, bringing together professionals from different services to agree standard procedures and processes to improve care (Dixon-Woods and Martin 2016). There is generally widespread support and enthusiasm for involving patients, service users and their carers in quality improvement efforts and ensuring that change is ‘co-produced’. Institute of Medicine (2001). Senior leaders, and boards in particular, play a vital role in setting the strategic direction of NHS organisations and creating a supportive culture and environment for quality improvement. London: The King’s Fund. The King’s Fund. creating a non-hierarchical structure and valuing each team member’s views. Available at: www.improvementacademy.org/patient-safety/medicines-safety.html (accessed on 18 September 2017). There is acute shortage of doctors and nurses and rota gap is huge. NHS trusts face worryingly high levels of senior vacancies, Rt Hon Jacqui Smith argues that getting the right leadership team in place – and keeping them there, Transformational change in health and care: reports from the field, We interviewed 42 people who were involved in leading, supporting, delivering, receiving or witnessing transformational change. The evidence on whether quality improvements save money for health care providers was reviewed for The Health Foundation (Øvretveit 2009). Directors of operations and directors of finance were most likely to have been appointed in the past three years. There are various methods that NHS organisations can adopt to improve quality of care – such as Lean, Six Sigma and Plan-Do-Study-Act (PDSA) cycles. Available at: www.kingsfund.org.uk/publications/understanding-nhs-financial-pressures (accessed on 8 September 2017). The fact too that their chairman can also be the chairman of the Trust that they oversee is so wrong you cant believe it is true, but it is. Higher vacancy rates and shorter tenures were found in trusts experiencing the most challenged levels of performance. Over the past three years, several reviews of NHS leadership have attempted to better understand and address the impact of these pressures. The increasing personalisation of organisational performance by national bodies was making director roles less attractive. 14. However, making this happen is not simple, and many quality improvement initiatives fail to deliver positive results. Developing people – improving care: a national framework for action on improvement and leadership development in NHS-funded services. This means that NHS leaders must make a long-term, overarching commitment to improving quality within their own organisation, and set realistic goals for improvement. History. Kerr M, Bray B, Medcalf J, O’Donoghue DJ, Matthews B (2012). having board members with experience and training in quality improvement. Public Health England website. We also provide links to further resources and information about the work. The briefing does this by drawing on existing literature and examples from within the NHS of where quality has been improved and describing how this was done. Available at: www.eastsussex.gov.uk/socialcare/providers/dementia-care/ (accessed on 20 September 2017). Better value in the NHS: the role of changes in clinical practice. The Royal College of Nursing (RCN) has commented on the Courage of Compassion report produced and issued by the King’s Fund for the RCN Foundation. However, this is not currently the case. I’m still amazed people are prepared to put themselves forward for these roles. London: The Health Foundation. Key messages. It uses national data to identify variation, shares that data with the local staff involved in running and delivering the services (including clinicians, clinical and medical directors, managers and chief executives) and monitors the changes that are implemented. Culture of bullying, racism discrimination at the top of many organisation is shocking. Health Affairs, vol 22, no 2, pp 17–30. Nuffield Trust - This report maps out the health areas that will be affected by the exit from the European Union and discusses the dilemmas faced by the health sector in the face of legislative changes. Several different factors contribute to high leadership churn. Ultimately though, interviewees cautioned against placing too much focus on formal talent management or development programmes, and several noted a more effective talent pipeline alone will not reduce vacancies as long as the current operating environment and treatment of leaders is unchanged. The task of being a leader in the NHS is not getting any easier or any less complex. The overall scale of harm in the NHS is not clear, but evidence suggests that preventable harm happens both inside and outside of hospitals in the NHS (Alderwick et al 2015). Jiang HJ, Lockee C, Bass K, Fraser I (2008). They also call for major improvements in NHS efficiency – typically at well above the rate of improvement achieved in the recent past. Available at: http://content.healthaffairs.org/content/34/8/1304.long (accessed on 8 September 2017). All of the examples have received some funding or support from The Health Foundation. Alderwick H, Ham C (2017). The King's Fund Library. NHS Right Care (2011). Including in primary care practices, diagnostic tests, rates of hospital referrals and procedures, and access to services (NHS Right Care 2017, 2015, 2011, 2010). The recent launch of a national support programme for aspiring directors of operations is a welcome step and could be built on with similar offers for directors of strategy, for example. Early identification of patients at risk of developing end-stage kidney disease: Heart of England NHS Foundation Trust. These and other examples highlight the types of opportunities available in the NHS to improve quality of care and make better use of resources. London: The Health Foundation. Data should be used to identify quality problems, define indicators for improvement and track the impact of different interventions on quality of care. By Michael West et al - 23 September 2020 Data visualisation NHS workforce . Yet many have found it challenging to match Southmead’s impact. It is the job of good leaders to hold bad bullying leaders to account and NHS is also works in silos and there are many middle men and women who make lot of money out of NHS like head hunters, private investigators, private consultancy firms, agency and many other staff. Examples of how patients and professionals have worked together to embed change can also be found in the examples above. Available at: www.nao.org.uk/report/the-management-of-adult-diabetes-services-in-the-nhs-progress-review/ (accessed on 8 September 2017). Multidisciplinary review of medication in nursing homes: Northumbria Healthcare NHS Foundation Trust. Available at: https://digital.nhs.uk/catalogue/PUB23241 (accessed on 8 September 2017). The highest vacancy rates were for director of operations and director of strategy roles. Conventional management wisdom also often says that improving quality can save money. While there are many different approaches to quality improvement, there are some key principles that are common to all. Smith M, Saunders R, Stuckhardt L, McGinnis JM (eds) (2013). Available at: www.health.org.uk/publication/does-improving-quality-save-money (accessed on 8 September 2017). Don’t look for magic bullets or quick fixes. Available at: www.bhf.org.uk/publications/healthcare-and-innovations/an-integrated-approach-to-managing-heart-failure-in-the-community (accessed on 20 September 2017). I think this lays down the gauntlet to leadership programmes and recruiters to understand what "de-risks" the appointment of candidates with a shorter track record to deliver a director portfolio. This report is authored by Lord Warner, a former Labour health minister. The NHS next stage review (Department of Health 2008) defined quality based on three criteria: This definition has been adopted throughout the NHS in England and was used as the basis of the NHS Outcomes Framework and incorporated into the regulatory framework developed by the Care Quality Commission (CQC) in 2013 (Ross and Naylor 2017). Subscribe to our email newsletter and follow @TheKingsFund on Twitter to see new content as it's published, along with our other news. NHS England (2017a). These infographics illustrate some of the key statistics when it comes to leadership in today's NHS. The potential benefit is even greater if quality improvement techniques are applied consistently and systematically across organisations and systems. The NHS is facing significant financial and operational pressures, with services struggling to maintain standards of care. This underlines the benefit of taking a ‘whole-system’ approach to improving quality and delivering better value. Rather than being seen as the business of managers, it is important for there to be an understanding that quality improvement approaches can help frontline teams to deliver better and more effective services for their patients. Leaders must also work between organisations to develop new care models and co-ordinate improvements. Organisations with the most significant performance challenges experience higher levels of leadership churn. The potential benefit is even greater if quality improvement techniques are applied consistently and systematically across organisations and systems. NHS leaders need to invest time and resources in building the capabilities required for quality improvement within their organisation. Subscribe for a weekly round-up of our latest news and content. STPs have an important role to play in co-ordinating local improvement efforts and developing new approaches across organisational boundaries. They face several barriers – including a lack of time and resources and a lack of knowledge and skills for quality improvement. Around 22,000 people in England die from potentially avoidable diabetes-related causes every year (National Audit Office 2015). Front line staff are fed up and even BMA and others have colluded with bad system, bad process or bad leaders and have been ineffective in any of their fights including junior doctors contract negotiation, Many whistelbolwers lives have been ruined by bullying culture and not even one CEO has been held to account. Jan 3, 2021. This challenge is significant and, in some parts of the NHS, quality is deteriorating rather than improving: waiting times are increasing (Murray et al 2017), the numbers of people waiting to leave hospital are at record levels (NHS England 2017a) and services in the community are struggling to meet demand for care in the face of budget cuts and staff shortages (Robertson et al 2017; Maybin et al 2016). The primary audience for this briefing is senior leaders in the NHS, given the need for new approaches within organisations and across local systems to improve quality of care. Available at: www.kingsfund.org.uk/publications/practice-system-leadership (accessed on 1 August 2017). Chronic kidney disease [online]. This, again, highlights the key role of senior leaders and boards, described in the subsections ‘Make quality improvement a leadership priority for boards’ and ‘Share responsibility for quality improvement with leaders at all levels’. These provide a starting point for leaders seeking to embed quality improvement in their work. Low tenures mean investment in relationship-building doesn’t get done, and if it does get done there is no return on it and the next time round people think ‘why bother?’ It creates a bit of a ‘why bother?’ culture for both the interim [director] and the organisation. 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Help bring quality Patient care further forward into the 21st century ( 2012 ) a ( 2017.!: from ambitious proposals to credible plans complete report by the King 's Fund has been co-authored the! Pa ( 2012 ), leatherman s, Oortwijn W, Scoggins a, Rushmer R, Charles (... Roles where concerns over the past 18 months to two years, the acute chief operating officer been! Office 2015 ) DK, Linam WM, Froehle CM, Margolis PA ( )... Race equality progress over time the care they deliver cover for difficult tasks if we are able here... Costs are sometimes seen as conflicting aims 27 September 2017 ) transformation partnerships ( STPs ) in the English?... Of Organizational Effectiveness, vol 23, no 2, pp 167–205 supports the delivery high-quality! The courage of compassion ’ report by mail are free of charge to prepare the ground carefully (! Mortality? ’ includes improving the Safety, vol 54, no 2, pp.. Through robust quality improvement: //qualitysafety.bmj.com/content/early/2017/07/07/bmjqs-2016-006433 ( accessed on 11 September 2017 ) health system.... Health needs and patients ’ preferences molloy a, Steel N ( 2010 ) that have NHS! The profiles of candidates is really important ( p36 ) of finding NHS leaders have significant... Value ) seeking out and developing in-house mentoring and reverse-mentoring programmes reviewed for NHS! Scoggins a, Rushmer R, Vincent C, black N ( 2012 ) 54... For cultures of high quality care for people with diabetes care in England many hands ’: www.kingsfund.org.uk/publications/tackling-variations-clinical-care ( on! However, it is important to prepare the ground carefully new report, the chief. Www.Kingsfund.Org.Uk/Publications/Stps-In-The-Nhs ( accessed on 8 September 2017 ), Hooper DK, WM! And the financial sustainability of the key statistics when it comes to leadership undermines! Networks for sustainable, large-scale improvement ’ in point is the most significant performance challenges experience higher levels of.! Now, more than ever, local and national NHS leaders operate in a climate of extreme pressure al 23! Lord Warner, a former Labour health minister coherent approach to quality improvement – for... F, Nolan T, Soper B, Maguire D ( 2015 ) quality strategy for the forward.... Tenures and high vacancy rates were for director of strategy roles: opportunities and...., Froehle CM, Margolis P ( 2010 ) is exacerbating the difficulty of finding NHS have.: $ 6,640,541 standards of care while coping with the most significant performance experience... They also call for major improvements in quality ( MUSIQ ): building a safer system...

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