PEPs - Clinical Quality and Evidence

Module 1 - Clinical Quality

Clinical quality

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On the face of it this is an easy concept and it is what clinicians should strive towards in all of their activities. Clinical Quality can be defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge ¹ . Clinical Quality may be considered as a synthesis of several dimensions ² .  For convenience I have chosen the following six dimensions although the NHS has often focused on the first three (see below).

1. Effectiveness

Healthcare that is adherent to an evidence base resulting in improved health outcomes for individuals and communities based on need - Examples include:

  • The use of policies, procedures, guidelines and protocols
  • The implementation of NICE guidance and the guidance of other professional bodies.

2. Safety – A major focus of this first module

Healthcare which minimises risk and harm to service users - Examples include:

  • Incident reporting
  • Analysis of healthcare outcomes such as infection rates, survival rates and complications
  • Implementing Systems control policies. For instance, to prevent adverse occurrences (e.g. “never events”) we will examine this further using the BMJ Learning module. Some systems controls will depend on technical and human barriers to error (eg. the many steps or ‘rules’ involved in preventing Wrong patient Transfusion.  Others will be simpler: The SBAR system could be seen as an example of the latter as it relies on each of us to understand and fulfil our own role in giving, receiving, checking and even challenging team Communication.  

3.  Patient Centeredness

Healthcare that takes into account the preferences and aspirations of our service users and the culture of their communities - Examples include:

  • Meaningful involvement of patients and the public in our business affairs (e.g. through consultation and in committees)  
  • Sampling of opinion through regular local satisfaction surveys
  • Participation in national surveys for opinion of the quality of care
  • Collection of evidence regarding the impact of our treatments on the whole patient through, for instance, the assessment of quality of life.
  • Avoidance of complaints and, when they occur, swift resolution and the use of complaint statistics for improvement.

4. Efficiency  

Healthcare that is delivered in a manner which maximises resource use and avoids waste - Examples include:

  • Ensuring our theatres and radiology facilities run optimally
  • Having bed occupancy consistent with the delivery of high quality care by appropriately trained and competent staff.

5. Accessibility

Healthcare that is timely, geographically reasonable and provided in a setting where skills and resources are appropriate to need - Examples include:

  • Avoiding inappropriately long waiting times
  • Delivery of care from GP referral to ultimate treatment within a set time
  • Is the right care being delivered by the right people in the right place and in a timely fashion (movement of services to where people are)?

6. Equity

Healthcare which does not vary in quality because of personal characteristics, such as age, gender, ethnicity, race, geographical location or socio-economical status - Examples include:

  • The analysis of the provision of care segmented by age, sex, ethnicity and checking for equity of treatment to all.

Supporting the six dimensions is the need to ensure strong leadership for Clinical Quality and system-wide change resulting in continuous improvement.

Teacher's Comment

As we have seen many factors can impede this. It is part of your role to inquire into and comment on these barriers to change.

As you consider setting your objectives for the Quality and Evidence Report OR the Lay Document, almost all these dimensions could offer you opportunities. You may need to prompt your Supervisor to make suggestions on such topics, but it is his/her role to discuss your ideas on areas to investigate.

Achieving high quality care requires three activities

There are three components to quality management:

  • defining what constitutes good quality care (usually described in guidelines, based on scientific evidence and clinical experience; or from collation of events such as safety breaches)
  • assessing the quality of care provided (clinical audit; patient experience surveys; SEA / critical incident review; qualitative methods)
  • improving the quality of care provided (education; performance review; peer review, incentives; regulation; inspection; reorganisation; legislation)
Teacher's Comment

So over the course of the year and within your two QE-PEP modules, we would like you to investigate aspects of the first two components.  If you can be involved in the third area, particularly the learning contexts shown in bold, so much the better!

  1. Institute of Medicine. Medicare: A Strategy for Quality assurance. Vol 1. Washington, DC: National Academy Press, 1990.
  2. Getting the measure of quality. The King’s Fund. 2010.