Managing quality in trusts: time for a Chief Quality

Managing quality in trusts in England:
time for a Chief Quality Officer?
Nick Black
Professor of Health Services Research
London School of Hygiene & Tropical Medicine
Chair, NHSE National Advisory Group for Clinical Audit & Enquiries
International Medical Leaders Forum
5 June 2014
Why a new approach is necessary
• Need for Trust boards to engage more
effectively with quality of their services
– “Building on the report of the first inquiry, the
story it tells is first and foremost of appalling
suffering of many patients. This was primarily
caused by a serious failure on the part of a
provider Trust Board.”
Francis Report; Letter to SOS, February 2013
Managing quality is difficult...
Growing complexity of care
Challenge of improving productivity
Increasing demand and expectations
Lack of coordinated approach to domains of
– Effectiveness
– Safety
– Experience
Quality as important as finance
• Financial management needs an Executive
Director on the Board
– and a non-Exec Director with financial expertise
• So why doesn’t quality management receive
same attention?
• What does this say about a Trust’s view of
importance of quality?
Need a Chief Quality Officer
• Quality remains ‘everybody’s business’
– Just as responsibility for good financial management is
‘everybody’s business’ despite a Director of Finance
• Doesn’t absolve other Board members from
sharing responsibility and CEO/Chair ultimately
• CQO work closely with other Board members
– Particularly medical and nursing directors
• Overcomes potential conflicts of interest
between quality and medical/nursing priorities
• Common in the USA
Scope of role
• Leadership, vision, inspiration and oversight of
• Accountable to Board for the assessment and
the improvement of quality
• Share corporate responsibilities
• Possess expertise in quality management
– Technical/scientific aspects
– Behavioural/organisational aspects
– National policy developments
Six main functions
1. Ensure activities across all three domains of
quality are coordinated
2. Establish scientifically rigorous quality
assessment throughout the Trust
3. Lead development and implementation of
quality improvement throughout the Trust
4. Relationships with external agencies related to
quality initiatives
– Patients/public, Commissioners, ‘Regions’ (AHSN,
LETB, QSG), Regulators, Risk management, etc
5. Ensure education and training in quality
management for clinical and non-clinical staff
6. Managerial responsibilities
– Director of quality ‘department’; provide leadership
• clinical audit staff, clinical info and coding staff, infection
control staff, patient surveys, Foundation Prog doctors’
audits, Consultants’ audit PAs, patients/public, (R&D staff).
– Develop strategy & manage quality programmes
– Involve public/patients in quality management
– Measure, review and inform about Trust’s quality
CQO: attributes
• Expertise and competency in three distinct but
related components
– Technical/scientific
• Quantitative and qualitative assessments of quality
• Quality improvement interventions
– Relational/behavioural
• Change management; leadership/inspiration; facilitation;
team management
– Knowledge/understanding national policy
• Credibility with doctors, nurses, managers
• Ability to operate strategically at Board level
Where do we find them?
• Look internally in Trusts
– Consensus builders with passion for assessment &
• Any professional background
– clinical or non-clinical
• Provide personalised experiential training
– Possibly at Masters’ level (universities and
management schools)
– Funded by HEE
• In the next three years...
– Create a cadre of CQOs to lead the management
of quality in Trusts
– Key contributors to the re-imagining of health care
that is needed to maintain the NHS as a tax-based,
free at point of use, comprehensive health system
– They’re out there...just need to be identified,
supported and encouraged!

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