Intended for healthcare professionals

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Analysis Quality Improvement

How organisations contribute to improving the quality of healthcare

BMJ 2019; 365 doi: (Published 02 May 2019) Cite this as: BMJ 2019;365:l1773

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  1. Naomi J Fulop, professor of healthcare organisation and management,
  2. Angus I G Ramsay, NIHR knowledge mobilisation research fellow
  1. UCL Department of Applied Health Research, London, UK
  2. Correspondence to: N J Fulop

Naomi Fulop and Angus Ramsay argue that we should focus more on how organisations and organisational leaders can contribute to improving the quality of healthcare

Key messages

  • The contribution of healthcare organisations to improving quality is not fully understood or considered sufficiently

  • Organisations can facilitate improvement by developing and implementing an organisation-wide strategy for improving quality

  • Organisational leaders need to support system-wide staff engagement in improvement activity and, where necessary, challenge professional interests and resistance

  • Leaders need to be outward facing, to learn from others, and to manage external influences. Strong clinical representation and challenge from independent voices are key components of effective leadership for improving quality

  • Regulators can facilitate healthcare organisations’ contribution by minimising regulatory overload and contradictory demands

Improving the quality of healthcare is complex.12 Frontline staff are often seen as the key to improving quality—for instance, by identifying where it can be improved and developing creative solutions.34 However, research and reviews of major healthcare scandals acknowledge the contributions of other stakeholders in improving quality, including regulators, policy makers, service users, and organisations providing healthcare.56

Policies on the role of organisations in improving quality have tended to focus on how they might be better structured or regulated. However, greater consideration is required of how organisations and their leaders can contribute to improving quality: organisations vary in both how they act to support improvement78 and the degree to which they provide high quality healthcare.9

Some earlier studies suggest that high performing organisations share several features reflecting organisational commitment to improving quality. These include creating a supportive culture, building an appropriate infrastructure, and embedding systems for education and training.1011 Subsequent reviews of quality inspections12 and reviews of evidence on factors influencing quality improvement,9 and board contributions13 indicate that …

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