Quality
What are our overall aims by 2028?
To have a single vision for quality, based on the need to provide high-quality, evidence based and personalised care for all.
There will be agreed system methodologies in place for the collection of quality intelligence for prevention, detection, and mitigation of harms.
We will work systemically, and with agility, to respond to any issues themes or trends, working with an ethos of continuous improvement and using research-based improvement methodologies.
Our overarching aim will be to reduce unwarranted variation in clinical outcomes to reduce health inequalities across our population.
What’s our starting point?
Duty to Improve Quality
As an ICB we are committed to continuously improving the quality of services provided to our population. The ICB is ambitious about achieving the highest standards of person-centred care, that is safe, timely, effective, efficient and equitable. Embedding a culture of continuous learning and improvement across our system will provide the foundations for the delivery of our ambitions.
The Coventry and Warwickshire System Quality Group (SQG) was established in 2022, based on National Quality Board guidance relating to the establishment of such groups. The SQG is chaired by the ICB Chief Nurse and brings together system partners, to focus on three key areas of quality; quality surveillance, quality improvement and quality assurance. Initial focus areas for the SQG were the establishment of system quality surveillance mechanisms and the development of a System Quality Strategy.
System Quality Group
SQG works across the system to bring together focused improvement themes and trends for system working. SQG has established a number of sub-groups which focus on key areas to inform on the quality improvement agenda:
- Quality Strategy Delivery Group;
- Safeguarding Group;
- Infection Prevention Control Group (including System Strategy and learning from incidents, events and deaths, including mortality);
- Patient Safety Strategy Group;
- Quality Surveillance Group.
System Quality Strategy
The System Quality Strategy describes a shared vision of care that is high-quality, personalised and equitable for all, now and into the future. This vision will be achieved through a focus on five key objectives:
Objective 1: We will create a culture of continuous quality improvement, where safeguarding and improving care is everyone’s responsibility.
Objective 2: We will develop a plan with all system partners to ensure that there are established mechanisms to listen to, involve and work with the population of Coventry and Warwickshire in our plans for quality improvement.
Objective 3: We will work to develop a single view of quality across health and care and develop measures so that we understand the impact of our quality improvements on our population.
Objective 4: We will develop and implement quality governance and assurance mechanisms across our system with clear decision making, reduced duplication and a focus on improvement and sustainability. We will ensure that there is effective and appropriate balance of quality control, planning, improvement, and assurance at each level of the system
Objective 5: Our focus will be on improving population health across pathways/settings with particular emphasis on reducing inequities in access, experience and improving outcomes for our population.
A detailed Delivery Plan has been developed to drive delivery of the Strategy – this includes a focus on three key components: what delivery looks like from a service user’s perspective, what it looks like from a carer’s perspective and what it looks like from the perspective of our health and care workforce.
System Excellence Framework
Coventry and Warwickshire as a system has a strong focus on care excellence, with University Hospitals Coventry and Warwickshire NHS Trust establishing one of the first centres for care excellence in the country, in collaboration with Coventry University. From these strong foundations, our system has an ambition to develop a system approach for care excellence, which will link to the wider Nursing and Midwifery Excellence Regional Network approach. The regional Network is due to launch at the end of March 2023, with Coventry and Warwickshire participating as a network partner.
Quality Assurance Framework
The system Quality Assurance Framework (QAF) builds on and reflects National Quality Board guidance on quality, risk response and escalation in Integrated Care Systems and is used collaboratively across our system. The QAF sets out our approach to managing and monitoring quality concerns and risks at a routine, enhanced or intensive level at system level. The purpose of the QAF is to ensure the delivery of care, treatment and services that avoid causing harm (safe), deliver what they are meant to (effective) and take into account the needs and feelings of our population (experience). It sets out a common language and approach to address poor quality and drive continuous quality improvement in a positive way for our population.
Patient Safety Strategy
We will seek to give our health and care leaders the right information about the quality and safety of health and care services. Through our system Patient Safety Strategy our overall aim is to drive learning from patient safety incidents and inform quality improvement through the delivery of the key National Patient Safety Strategy. The system will work to maintain compliance with the Serious Incident Framework and enact a smooth transition from the National Patient Safety Framework to the Patient Safety Incident Response Framework.
Listening to Patients
From the outset we wanted to ensure that the Coventry and Warwickshire Integrated Care Strategy was informed by the people it speaks for – local people and their communities, as well as our health and care workforce. To develop the priorities in the Strategy, we listened and spoke to nearly a thousand local people from a wide range of communities about what they thought was most important in health and care. As we deliver this plan, we will ensure that we continue to engage and seek feedback and input in an aligned and connected way (see Engaging and Involving People section).
Integrated Approach to Quality, Patient Safety and Health Inequalities
It is well recognised that patient safety incidents are experienced unequally, and consequently work has commenced across Coventry and Warwickshire to take account of this inequity. The approach that we are taking aims to align safety, quality and health inequalities. This will be through the embedding of tools within programmes of work, but also by ensuring effective data, evidence and reporting to demonstrate impact at different levels across the system.
What are some of the key links to other parts of the plan?
Quality links to all other parts of this plan. The plan is underpinned by the shared vision of care that is high-quality, personalised and equitable for all, now and into the future, set out in our System Quality Strategy.
What will we be focusing on in the next 2 years?
Collaboratively delivering the outcomes set out in our System Quality Strategy.
Ensuring that clinical quality and leadership supports system redesign and is an integral part of system transformation projects and programmes.
Delivering an effective system transition from the Serious Incident Framework to the Patient Safety Incident Response Framework.
Developing and implementing robust mechanisms to involve and listen to our population to enable us to gather and analyse quantitative and qualitative experience across pathways to identify where inequalities exist and here experience of the heath and care services delivered in our system can be improved.
Developing a system Quality Data Warehouse which is agile and responsive to inform implementation of quality governance and assurance mechanisms.
Supporting the establishment of a Freedom To Speak Up Network across our system to foster a positive ‘speak up culture’ across the system.
Developing a system level Integrated Quality Intelligence Dashboard that enables agile responsiveness to incidents and events and provides a robust baseline to inform targeted improvement.
Implementing a clinically based Prioritisation Tool. Q1 24/25
Launching the Quality Self-assessment Toolkit Q4 23/24
Implementing a system wide Equality Quality Impact Assessment approach across our systemto to promote equality in access to high quality services that meet the needs of our diverse population.
Being able to measure the impact of improving health outcomes in reducing the gap in life expectancy between people living in our most deprived communities compared with the least deprived.
Key Metrics and Deliverables
Quality Data Warehouse – delivery timeline interdependent with roadmap for the development of the geographic Care Collaboratives (see Collaboratives section).
Freedom To Speak Up Network established by quarter 4 2023/24.
Integrated Quality Intelligence Dashboard implemented by quarter 4 2023/24.
Prioritisation Tool implemented by quarter 1 2024/25.
Quality Self-assessment Toolkit implemented by quarter 3 2023/24.
Equality Quality Impact Assessment approach implemented by quarter 3 2023/24.
Reduce the gap in life expectancy between people living in our most deprived communities compared with the least deprived.
Increase healthy life expectancy for everyone living in Coventry and Warwickshire.
Reduce the under 75 mortality rate from cardiovascular diseases.
Reduce the overall smoking prevalence in adults.
Increase the percentage of cancers diagnosed at stages 1 and 2.