The RCP outlines and defines its core approach to quality.
The RCP's approach to quality takes a population, system and individual perspective. When approaching quality, we need to create, maintain and improve the best possible balance between population health and wellbeing, individual care, and sustainability.
This balance requires a system-level approach to quality involving multiple partners and other agencies. The concept of value is the best balance we can achieve between these three domains.
Best possible care
The best possible care for the individual and the population should be (after Institute of Medicine, 2001*):
- safe – minimising harm to staff and patients from the care that is intended to help them
- effective – based on scientifi c knowledge reliably delivered to all who choose to benefi t from it and refraining from actions to those not likely to benefit
- person-centred – care that is respectful of and responsive to the needs and values of the individual patient, family and carers. Care should be coordinated, and care decisions made in partnership between professionals and patients/carers
- timely – reducing waits and harmful delays for both those who receive and those who give care
- efficient – minimising waste and maximising benefi ts of resources, including skills, equipment, finance, ideas, and energy
- equitable – care that does not vary in quality of delivery or outcome because of personal characteristics, geographic location, time of the day/week and socio-economic status.
Sustainable healthcare means taking into account the financial, environmental and social impact of health services. In terms of the approach to quality, including a focus on sustainability means improving the quality of care for patients today without compromising health and care provision in the future.†
Quality is a continuum and can range from unacceptable to outstanding. Quality improvement should aim to improve all dimensions of quality. Any intervention should be evaluated to ensure that it does not improve one domain while adversely affecting another. Quality must be measured serially over time against defi ned standards, using an evidence-based approach to quality measurement and evaluation.
There are a number of areas of work that enable us to deliver this approach to quality. These include defining clinical standards, clinical guidelines, professional education for clinical and non-clinical skills, clinical audit, peer review, service accreditation, quality improvement, sharing best practice, the use of technology, and innovation and research. Connecting these areas of work, working with others and infl uencing through policy will have the biggest impact.
* Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st century. National Academies Press (US): Washington (DC), 2001.
† Royal College of Physicians. Breaking the fever: Sustainability and climate change in the NHS. RCP: London, 2017.