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The purpose of this paper is to review the implementation of seven components of quality systems (QSs) linked with quality improvement in a sample of Australian hospitals.

The authors completed a systematic review to identify QS components associated with measureable quality improvement. Using mixed methods, the authors then reviewed the current state of these QS components in a sample of eight Australian hospitals.

The literature review identified seven essential QS components. Both the self-evaluation and focus group data suggested that none of the hospitals had all of these seven components in place, and that there were some implementation issues with those components that were in use. Although board and senior executives could point to a large number of quality and safety documents that they felt were supporting a vision and framework for safe, high-quality care, middle managers and clinical staff described the QSs as compliance driven and largely irrelevant to their daily pursuit of safe, high-quality care. The authors also found little specific training in quality improvement for staff, lack of useful data for clinicians on the quality of care they provide and confusion about how organisational QSs work.

This study provides a clearer picture of why QSs are not yet achieving the results that boards and executives want to achieve, and that patients require.

This is the first study to explore the implementation of QSs in hospitals in-depth from the perspective of hospital staff, linking the findings to the implementation of QS component identified in the literature.

Clinical governance was introduced in 1997 as a comprehensive framework to improve the healthcare quality in the National Health Service. Since then, the proliferation of various definitions and models of clinical governance illustrates that different perceptions are emerging on clinical governance. However, none of these definitions captures the essence of clinical governance in terms of its organisation‐wide implications for continuous quality improvement. Although there is discrete mention of structure, process and outcomes in the literature on clinical governance, it is hard to find any clear explanation on how clinical governance influences organisational elements. This paper therefore analyses clinical governance in terms of the inputs, processes, structure and the outcomes of healthcare organisations. The fact that the introduction of any new governance framework will have much wider implications for the management of healthcare organisations is illustrated through a refined definition of clinical governance presented in this paper.

This article aims to review the available literature on how clinicians meet the daily challenge of translating medical information into clinical EBM. It also seeks to describe the procedures involved in a local initiative in the UK to develop software applications for implementation of national clinical guidelines to enhance EBM in routine clinical practice.

It was hypothesised that improved access to these guidelines in routine clinical practice could be achieved through integrated local procedures, thereby enhancing the quality of care provided to children and adolescents with asthma or UTI. A literature search was performed using databases. To explore the preferences of the doctors and other healthcare professionals on how they accessed clinical guidelines, feedback was obtained. Stepwise implementation of the clinical guidelines was instituted over a period of three years in different primary care and hospital settings.

The professionals actively engaged with all the different stages in the implementation of the clinical guidelines. The majority preferred the interactive computerized system based on its ease of use, better aesthetic features, familiarity with the software and limited dependence on the technical skills of the users.

The limitations of this study include lack of systematic data to assess the clinical effectiveness of the guidelines' implementation. Another apparent limitation of the study is the small size of participants within the paediatric unit of each organisation where the study was conducted.

There is a need for further comparative studies between the local intervention strategies described in this study and other implementation strategies, to identify the most effective implementation methods for electronic guideline‐based systems.

Reliable high quality guidelines from reputable professional bodies could be successfully implemented at the primary or hospital‐based levels through a series of coordinated multidisciplinary interactive processes. This study has positive implications for improving the quality of care provided to children and adolescents, enhancing the role of clinical governance, provision of useful information to patients/carers and other healthcare providers.

This study highlights a potentially effective way of implementing and integrating an electronic guideline‐based computer system into local practice.

The purpose of this paper is to examine the suitability of current care pathway modelling techniques for supporting business improvement and the development of information systems. This is in the light of current UK government policies advocating the use of care pathways as part of the £12.4 billion programme for Information Technology and as a key strategy to reducing waiting times.

A qualitative analysis of the variety in purpose, syntax and semantics in a selection of existing care pathways is conducted.

Care pathways are typically modelled in an ad hoc manner with little reference to formal syntax or semantics.

The research reviews a small selection of existing pathways. The feature set used for evaluation could be further refined. Future research should examine the suitability of applying existing process modelling techniques to care pathways and explore the motivations for modelling care pathways in an ad hoc manner.

The development of care pathways can aid process improvement and the integration of information systems. However, while syntax and semantics are not standardised the impact of care pathways in the work of Department of Health agencies, in particular Connecting for Health, is likely to be limited.

The results provide insight into the limitations of the state of the art in care pathway models. This highlights a significant omission in the Department of Health's approach and identifies an important direction for further development that will aid Connecting for Health, healthcare organisations and healthcare professionals to deliver more effective services.

Ward rounds in hospitals are crucial for decision-making in the context of patient treatment processes. However, these tasks are not systematically managed and are often extended due to missing information or equipment or staff unavailability. This research aims to assess whether ward rounds can be structured more efficiently and effectively from the perspective of patients and staff.

This mixed-method approach examines the ward rounds conducted in three units within a haematology department of a major Danish hospital. Baseline measures were collected to capture the value of the ward round described by patients and staff. The information on patient and equipment flows associated with a typical ward round was mapped with recommendations for improvement.

Staff aspired to deliver a good-quality ward round, but what this meant was never articulated and there were no established standards. The duration of the ward round was unpredictable and could take 6 hours to complete. Improvements identified by the team allow the ward rounds to be completed by mid-day with much more certainty.

This research provides an insight as to how ward rounds are conducted within a Danish haematology department.

The research has implications for those involved in ward rounds to reduce the time taken whilst maintaining quality and safety of patient care.

This research has implications for patients and their families who wish to spend time with consultants.

Previous research has focused on the interactions between doctors and nurses. This research focuses on the operational process of the ward round and presents a structured approach to support multi-disciplinary teams with a focus on value from the patient’s perspective.

Data have a critical role in supporting service improvement and this is particularly the case for service improvement to reduce waiting times. The purpose of this paper is to identify some of the barriers managers face in accessing and using data effectively for 18 weeks and then describes how a service improvement tool developed by the NHS Institute can help to overcome these.

A review of the core function of data to support service improvement processes and the development of a national tool to support the transformation of access with the National Health Service in England.

The review of the core function of data identified a range of barriers: access to data for service improvement; the appropriate use of data to analyse the dynamics of variation and therefore for decision making; and the capacity and capability to use data. The size and immediacy of the 18‐week challenge means that a national solution needs to focus on being practical and overcoming some of these barriers.

A perspective of the reality of using data for service improvement and using it to transform access to health services.

The purpose of this paper is to explore some of the key factors that trigger and drive improvement in the NHS and in health care more widely, and to suggest what practical steps can be taken to speed it up.

The paper outlines the varied improvement drivers that impact on health care organisations today – establishing a basic understanding of the different motivating factors behind each. Building on this, the paper explores the shared attributes of successful health care improvement practice and highlights the processes and tools that are helping many frontline NHS organisations achieve faster and better improvement locally.

There are many reasons that trigger improvement efforts in the health service and most have a valid role to play. But underpinning them all are four fundamental skill and knowledge sets: leadership; performance and metrics; the right tools and processes; and relationships. One important way to unlock the potential for faster improvement in patient care is for organisations and individuals to understand the profound relevance of these four areas to their own improvement work, and to know about the tools and techniques that are proven to help.

This paper helps address the broad and recognised need across the NHS and wider health service to build service improvement capacity, capability and will. It clarifies the priority areas where organisations, clinicians, health care professionals and improvers at all levels need to develop, and it offers practical steps to help ensure this happens.

This article aims to explore quality improvement (QI) at individual, group and organisational level. It also aims to identify restraining forces using formative evaluation and discuss implications for current UK policy, particularly quality, innovation, productivity and prevention.

Learning events combined with work‐based projects, focusing on individual and group responses are evaluated. A total of 11 multi‐disciplinary groups drawn from NHS England healthcare Trusts (self‐governing operational groups) were sampled. These Trusts have different geographic locations and participants were drawn from primary, secondary and commissioning arms. Mixed methods: questionnaires, observations and reflective accounts were used.

The paper finds that solution versus problem identification causes confusion and influences success. Time for problem solving to achieve QI was absent. Feedback and learning structures are often not in place or inflexible. Limited focus on patient‐centred services may be related to past assumptions regarding organisational design, hence assumptions and models need to be understood and challenged.

The authors revise the Plan, Do, Study, Act (PDSA) model by adding an explicit problem identification step and hence avoiding solution‐focused habits; demonstrating the need for more formative evaluations to inform managers and policy makers about healthcare QI processes.

Although UK‐centric, the quality agenda is a USA and European theme, findings may help those embarking on this journey or those struggling with QI.

The purpose of this paper is to discuss the perspective debates upon the real-time challenges for a three-staged Performance Improvement Continuing Medical Education (PI-CME) model, an innovative and potential approach for future CME, to inform providers to think, prepare and to act proactively.

In this discussion, the challenges associated for adopting the American Medical Association’s three-staged PI-CME model are reported.

Not many institutions in USA are using a three-staged performance improvement model and then customizing it to their own healthcare context for the specific targeted audience. They integrate traditional CME methods with performance and quality initiatives, and linking with CME credits.

Overall the US health system is interested in a structured PI-CME model with the potential to improve physicians practicing behaviors.

Knowing the dearth of evidence for applying this structured performance improvement methodology into the design of CME activities, and the lack of clarity on challenges inherent to the process that learners and providers encounter. This paper establishes all-important first step to render the set of challenges for a three-staged PI-CME model.

The purpose of this paper is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement.

A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case.

The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information.

The small number of cases limits the generalisability of the findings at this time.

Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems.

Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high-leverage solutions, supports the transfer of appropriate best practices even between organisations in dissimilar business and economic settings.