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News and Comment from Roy Lilley

It’s one of those days when two come along at once.

The first, an essay, in the BMJ, by Mary Dixon-Wood, a professor of healthcare improvement, who tells us, in terms; there’s not much evidence that quality improvement works.

This will come as deep-joy to all the NHS QI practitioners.

The second, from Ted Baker, head-honcho-inspection at the CQC. Speaking at the Patient Safety and Learning Conference, told the audience;

‘Little progress’ has been made in patient safety over the last 20 years… hospital managers routinely hide evidence from the CQC, because they regard the organisation as out to blame them.’

Well he’s got something right…

So, inspection doesn’t work and neither does quality improvement. Where next?

Dump the CQC, it’s obviously moribund. Quality? Dixon-Wood makes the point the techniques are often borrowed from industry and implies they may not be transferable.

OK, let’s go there.

Businesses no longer use inspection as a method of quality improvement. They are concerned with three things.

  • Why they do what they do
  • Solving a customer’s problem
  • Ensuring customers come back

In practice;

Starbucks aren’t in the business of selling coffee. Their business is a proposition; wifi, laptops, youth, mobility, meeting up and a-la-mode. A lifestyle offering for people to buy-in to.

A quality experience.

Uber Eats doesn’t deliver food, they solve problems. Finish a long day… don’t fancy cooking? Nothing in the fridge? Use the App. In 20 mins you’re on the sofa with a Ruby from your favourite Indian. Fast, no-messing.

A quality experience.

Apple’s iPhone has twice the customer loyalty as the next highest brand. Customers come back, because; plug-n-play, easy to upgrade, interoperable with their other stuff, works.

A quality experience.

How about the three questions in the context of the NHS?

Why does the NHS do the NHS…

… because it makes perfect sense to have a healthy population, able to use a system based on collective payments, syndicating risks, free at the point of use.

Moreover, it’s not just about health. If I’m sick, fall over, or fall short, the NHS will be there for me. Peace of mind.

A quality experience.

Solves a problem? Yup. Each one of the million people the NHS will come into contact with today, will have a problem.

They want to get into the service, get diagnosed, get fixed up, get out and get on with their lives. The five ‘gets’, done well.

A quality experience.

Ensuring they’ll come back? Well, not quite but there is a context for us; if they have to come back, have a repeat experience, or if their relatives, neighbours or friends have to look to us for help, they’ll do it in the knowledge that the last time they did, it was a good experience. Memorable for all the right reasons.

A quality experience.

A quality experience is what the NHS aims at and it’s not difficult. Quality gurus have a vested interest in making it complicated… it’s not.

Quality is not Rolls Royce, that’s ostentation and wealth. Don’t confuse cost with quality and a safe service may not be a quality experience.

Lesson from life; create the time and space for good people to do the right thing and they will.

Quality is simply consistency;

  • finding out what you’re doing;
  • deciding if it’s what you want;
  • putting things in place to make sure you get it, all the time, every time;
  • until you don’t want it anymore.

The ‘finding-out’… that’s where you come it.

I often ask the question; what would you change here, that would only cost petty-cash and would make a difference? I’ve never failed to get ten good ideas in a morning.

Quality comes when there is no fear of blame. Quality doesn’t have to wait for a strategy.

Quality comes when you understand you can’t change culture but you can change the working environment.

Quality comes when people open their minds to how good it could be.

Quality doesn’t need permission it needs the perspective; is what I’m doing good enough for my family. Is what I’m spending the way I’d spend my own money.

Quality is a state of mind and quality is what happens when no one is looking.

Quality is not the CQC, not corporate… it is us.

Contact Roy – please use this e-address –

Know something I don’t – email me in confidence.

Reproduced at by kind permission of Roy Lilley.