Background to quality in UK healthcare

“Safety, effectiveness, patient centeredness, timeliness, efficiency & equity”1 are words which combine to form a comprehensive definition of quality in healthcare. It is only in recent years that there has been a concerted push towards truly improving quality in the National Health Service (NHS). A drive towards quality improvement (QI) is usually driven by an industry ‘wake up call’. In the NHS, this call came from the exposure of significant failings in patient care in certain trusts and departments across the UK.2–4 Since then, there has been huge progress in improving the care for our patients, with greater clinical governance and standards,5 ,6 regulation7 and focus on safety.8–10 However, we are yet to become a healthcare system which truly learns from its mistakes, shares its learning and is dedicated to continual improvement.11 ,12

Audit alone cannot bring about continual improvement. True QI methodology is poorly understood and poorly used. In this article, we discuss how to undertake QI and suggest how it might be integrated into GUM and HIV services.

Understanding the quality of care we provide is the lever to delivering improvement work in our services. Four deceptively simple questions, which encompass audit and QI, can be used to comprehensively assess care delivered. These questions will be further explored throughout the article:13

• Do you know how good you are?

• Do you know how good you are relative to the best?

• Do you understand your variation?

• Can you demonstrate your rate of improvement over time?

Audit as branch of QI

Since 1989, when systematic use of clinical audit was strongly supported by the White Paper ‘Working for Patients’,14 audit has been applied as a methodology to improve healthcare service. At national and local levels, audit has raised both excellence and discrepancies in care in sexual …