Why quality language is killing quality - and how the IHI governance framework can help...QNews2 2019

WHY DOES IT MATTER?

Why does this matter?  Because the predominant focus on safety changed the way we thought about, and therefore approached, the quality of care. It put us on  - and keeps us on - a different trajectory. This narrow, albeit important, view has turned  'quality'  into a passive, defensive and reactive risk and compliance focus in many organisations.  

'Crossing the Quality Chasm'  re-asserted the importance of the dimensions of quality in 2001, describing quality care as safe, effective, patient-centred, timely, efficient and equitable.  But it seemed the horse had bolted.   Once funders, policy makers and standards-setters prioritised safety, so did provider organisations.  What we won on the swings but lost on the roundabouts.  I remember being told in no uncertain terms by a bureaucrat, circa 2008, that the dimensions of quality were 'old hat'.  This belied a breathtaking lack of knowledge in one simple sentence.  As far as I knew, what human beings wanted from a health or human service experience hadn't changed. What had changed was what the bureaucrat thought was important - and new. 

Since then, we've continued to muddle along in a haze of words,  doggedly avoiding developing a common understanding of and aspiration for what we're trying to achieve. Strategic plans and quality frameworks everywhere describe the quest for improvement as being about achieving safe care; safe, quality care; safe, effective and high-quality care; safe, high quality and person-centred care...and the list goes on.  Occasionally we throw in an 'excellent' or 'best in sector'...No wonder managers and staff turn off in disgust. We can't even describe what we're trying to do in any way that makes sense to them.  We treat these words are meaningless and inter-changeable - but they're not.  Along with this has developed the depressing propensity to call the quality manager, and any participation in monitoring and improvement, 'quality'.  For many managers and staff it's become a grab bag of the things we do to achieve compliance and the person who makes us do them.  Not very guiding - or inspiring.  Of course there are exceptions - those who do get it and strive to help others to understand through the way they describe what they're trying to achieve, but this is far from universal.  

'We don't talk about 'quality' because the staff don't like it' people say to me.   In fact, what they don't like is the way we've turned it into a compliance to-do list.  They won't like any term that's associated with that, no matter how fancy.