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All changed, but maybe not changed utterly
Article Type: Editorial From: Clinical Governance: An International Journal, Volume 15, Issue 3
This editorial is being written on election day in the UK. It seems an appropriate time to reflect upon what has changed since the last change of Government in the UK in 1997. Clinical Governance is a product of the reforms, which followed that election. For the first time, in 1997, Clinical Governance promised a comprehensive system of review and performance monitoring. Clinical Governance was then reformed itself in response to the events and subsequent inquiries in Bristol and Liverpool and, to a lesser extent, the Shipman inquiry, as acknowledged in the BMJ editorial that inspired the title of this editorial (Smith, 1998).
In these 13 years, there have been some notable successes and some disappointing failures to improve. First, the good news, access to secondary care has improved beyond all recognition, and waiting times are fraction of their former selves. This is good news and does have implications for the quality of care, especially for those conditions where a delay in treatment can seriously impede long-term outcomes as well as short-term discomfort for the patient.
However, of itself, access to care does not improve the quality of care itself. Waiting times are a convenient and obvious barometer that can be easily measured, and the impact of a target driven system is to focus effort in those areas that are driven by the targets. Many other aspects of the quality of care are not so easy to measure, and in these 13 years we have made less progress in improving the information that is needed to inform better decision making and to measure the impact of quality initiatives that are harder to measure.
Change, where it has happened (and lots has happened), has tended to be structural, with many organizational changes in both the health care provider organisations and the agencies established to monitor the quality of care. My favourite metaphor for organisational change is moving the deck chairs around on the Titanic. It’s a big job, it takes a long time but it doesn’t address the fundamental issue.
All major health care systems are facing a period of austerity where improvements in the quality of care will not be achieved by more resources because there won’t be more resources available. Therefore, we will need more radical thinking to find new ways of working, and better information to evaluate and implement these solutions. Clinical Governance research will need to evolve, too, to reflect the new reality. Key will be new methods to evaluate both problem situations and proposed solutions to address these issues. CGIJ will seek to publish articles, which capture both new quality initiatives and new evaluation and research methods to make its contribution to the field. The articles in this issue demonstrate the breadth of our field, and this can only increase in the coming years.
Alan Gillies, Nick HarropUCLAN, Preston, UK
Smith, R. (1998), “All changed, changed utterly”, BMJ, Vol. 316 No. 7149, pp. 1917–8