What does "quality" mean?
For the last three years, almost every official document on health policy has contained the word "quality". The title of Lord Darzi's review of the NHS published in 2008 is "High Quality Health for All". The word has a "feel good" factor - but what does it mean, and when it is used, does it mean the same thing to clinicians, patients, commissioners and politicians? In the context of health-care, it should have a universal meaning - doing the right thing, at the right time, for the right reasons to obtain the best achievable health outcomes. Although there is probably little disagreement with the definition, there is less agreement about how quality should be measured; in particular, the extent to which measures of cost-effectiveness or productivity should contribute to measures of quality. There are sometimes tensions between what constitutes high quality care for an individual and what represents high quality care for a population and these can be particularly acute if the intervention in question is very expensive. At times, measures of productivity can be direct conflict with standards of good clinical care. For instance, a new to follow-up ratio of less than 1:2 (a target commonly required of providers by commissioners) in a glaucoma service can only be achieved at the expense of good clinical care.
A simple and inexpensive way of measuring the quality of a clinical service is to use a self-assessment questionnaire. Self-declarations form an important part of reviews of healthcare organisations by regulatory bodies and honest self-appraisal is incentivised by the possibility that responses may be verified by external inspection.
The College's Quality Standards Group has produced a suite of simple self-assessment tools for the following clinical services: cataract, glaucoma, diabetic retinopathy (England, Wales and Northern Ireland), diabetic retinopathy (Scotland), age-related macular degeneration (AMD), vitreoretinal surgery, oculoplastics, and for paediatric services. They do not attempt to assess every aspect of the service in detail, but focus on areas where problems are likely to show where the service is under stress. Very few clinical services will achieve a perfect score, so the questionnaires can be used as quality improvement tools.
The documents will be reviewed in 2012 and the Group would be grateful for feedback on the documents to help inform the review. Specifically we would like information on how the documents are used, how the questions are interpreted and how easy it is to get the information to complete the questionnaire. To that end we have produced a short feedback form which we would as you to complete and return to Beth Barnes at the College. There is no intention to compare the results of the questionnaires or units but we wish to validate the questionnaires as a tool for improving quality of clinical care.
Please send feedback to Beth Barnes, Head of Professional Standards.
Mr Richard Smith FRCOphth
Chairman, Quality Standards Group