Achieving high-quality care: a view from NICE

Abstract

The National Institute for Health and Care Excellence (NICE) was established in 1999 to provide evidence-based guidance. The task of producing guidance by reviewing primary research data and using an advisory committee to develop evidence-based recommendations, is not straightforward. Guidance production is, however, less challenging than the task of putting evidence-based recommendations into practice.NICE is very sensitive to this challenge as, since 1999, over 1500 pieces of NICE guidance have been published. A number of pieces of guidance relate to heart disease, including pharmaceutical agents, new medical technologies and clinical guidelines. Examples include guidelines on acute heart failure and atrial fibrillation, and advice on technologies including edoxaban and implantable cardioverter defibrillators.The research evidence is clear that a change in practice rarely comes about as a result of simply disseminating guidance on best practice. Simple dissemination is particularly ineffective if the guidance has not been produced by a well-respected, credible organisation. It is also clear from the literature that implementation is more successful when more than one approach is taken, and when there is alignment between efforts at organisational, local and national levels.At an organisational level, there should be support from the Board for quality improvement, with ongoing measurement of progress. Resources should be provided for targeted change programmes, particularly where new guidance suggests improvements are required. A systematic process for putting change in place should include identifying barriers to change, agreeing interventions to overcome the barriers and drive forward improvement and planning for implementation and evaluation.

Do perceived working conditions and patient safety culture correlate with objective workload and patient outcomes: A cross-sectional explorative study from a German university hospital

“…In our results, better teamwork correlated significantly with increased quality with both quality of care measures (fewer readmissions and shorter lengths of stay) and for both professional groups. Thus, as has been shown in other studies [63, 86, 87] our findings support the notion that good teamwork and communication can contribute to better outcomes. The converse is also true; difficulties in communication and teamwork can lead to more complications.…”

An intervention model with self‐assessment and subsequent multi‐professional review might be effective and feasible to improve drug safety in primary healthcare. A survey‐based evaluation of SÄKLÄK2

“…The multi‐professional approach was highlighted as being successful when it comes to implementation of new guidelines, improvement in work, and gains in patient safety, which is well in line with SÄKLÄK2. Since this intervention model is considered effective to improve drug safety among elderly patients and furthermore considered to be feasible to implement on a broad front, the idea is now to implement this intervention model at regional level.…”

“…A good method, after all, needs to be implemented to have an effect. A range of conditions has been shown to result in change of practice, such as financial incentive systems and organizational support . SÄKLÄK2 provides feedback from colleagues, both verbal and written and, furthermore, an action plan; something that in conjunction with clinical audits has been shown to be effective when studying the implementation of interventions …”

“…This would likely lead to improved drug safety since committed participants have been shown to enhance improvement work . It was further emphasized that the reviewers should be clinically active and familiar with the conditions in primary healthcare, which would likely lead to both highly relevant action agreements and enhanced opportunities for implementation . Furthermore, the multi‐professional approach was stated as highly important to create relevant action agreements, which has previously been shown to improve drug safety …”

Quality Improvement Support Agencies as a systemic quality strategy: France and Québec

“…If all efforts in a health and social service system are aligned toward the same objectives in a coordinated and coherent way, improvement in quality becomes more likely. In contrast, if the approaches remain less aligned and not supportive of the system, it becomes much more difficult (Leng & Partridge, 2018). Thus, to develop a high-quality, sustainable health and social services system, decision-makers must not only encourage action at all levels of change, but also ensure the coherence of all quality strategies at the systemic level, in which the other three levels of change are nested.…”