EDITOR—As leaders in the
NHS Modernisation Agency, we were delighted to see the paper by Young et al
summarising three key approaches to improving manufacturing systems.1
Improvement programmes in the agency have been adapting these approaches
successfully to NHS healthcare systems for several years.2
We now refer to this body of knowledge as "clinical systems improvement." At
its heart is the graphical presentation of data and their analysis using
statistical process control. Key measures are monitored to see whether
changes to the system have made a notable impact and determine whether
improvement has occurred before the change is rolled out. Data are presented
in a format that is easily understood and statistically valid, which appeals
particularly to doctors.
We have had success in applying these methods to improve emergency flows,3
and reducing journey times in cancer care. Now we are learning to apply
these methods across entire organisations. For example, in Nottingham City
Trust elective admission rates have increased by 8% and cancelled admissions
for surgery have been cut in half by improving the emergency pathway and
reducing medical outliers.
The improvement partnership for hospitals is accumulating knowledge and
experience from Modernisation Agency programmes (www.modern.nhs/iph).4 We
offer an ambitious learning programme to NHS trusts, support senior
managers, and clinicians in reforming their local healthcare delivery
systems.
Publication of our methods and results in journals such as the BMJ will help
to spread awareness, encourage clinicians to be more involved in improving
their own services, and stimulate fruitful discussion. Our vision is that
staff in all healthcare organisations will have the capacity continuously to
improve their own services on the basis of the priorities of their patients
and that together we will improve the quality of healthcare in the NHS.