‘Quality assurance and quality improvement ensure the best care for patients’ | Nursing Times

At the start of my nursing career I thought that there were only a handful of wound dressings. When I completed my aseptic technique training, I thought that one sterile kit would cover me for my entire career.

A little snip of gauze, couple of bits of packing strip, a roll of tape and a smattering of topical cream and the patient was good to go.

I soon learned that there’s an overwhelming number of options, with hundreds of hydrogels, bundles of alginates and a variety of foams. It can be similar trying to define the terms for quality.

We use the word quality everywhere in healthcare. From quality standards, quality control, quality planning, and quality management. With this endless ocean of quality terminology it is easy to feel adrift to their meanings. One of the latest debates is around the difference between quality assurance (QA) and quality improvement (QI).

QA is about being able to check that a system is running as we expect it to. It is all about doing randomised spot checks to ensure that a system or process is operating smoothly.

In the NHS, we have historically been very reliant on QA as a means of assessment. However this form of measurement cannot easily help us to improve a service.

Every hospital run hundreds of clinical audits, unfortunately the learning from these audits are often not disseminated widely across an organisation.

Clinical audit is a check that we are meeting a certain set of standards but this does not give us the ability to learn and grow systems. It is a pass or fail structure, that makes it difficult to see the larger picture and difficult to know how to change or improve.

For instance, with a QA mind-set, I could walk out of my house in August and it could be a bright sunny day. I can do the same the following month and get the same result, a gloriously sunny day.

If I was to just look at these two points in time, I could falsely assume that the weather is always sunny between August and September in the UK, however what I have failed to take into account is that the other 30 days it poured with rain! Therefore we need to look at something else…

As opposed to QA which looks at specific intervals, QI tracks progress over a short period of time. QI is all about making a series of small quick changes to see and learn from their impact.

“QI is a great way to improve services quickly and to test out and trial new ideas”

To do this, we need to know the change was an improvement through monitoring the data closely. QI does this through the use of measurement called statistical process charts (SPC) that help to tell the story over time.

QI is a great way to improve services quickly and to test out and trial new ideas. However, for QI to be effective, you need to know very clearly what you are planning to change and why. Too often we can rush into making changes to a process without understanding the impact that it might have upon our patients and colleagues.

Both QA and QI have their place and are important to ensuring the safest and best care for our patients. While QA tells us that everything is in the right place and performing as we expect, QI is for when we know that something needs to work better. Knowing which one to apply to your workplace is key.

Adam Burrell is improvement lead, Imperial College Healthcare NHS Trust