Improving quality not just ‘Quality Improvement’ 


The Academy Patient and Lay Committee (APLC) advises the Academy on patient and lay perspectives, as well as assisting patients and lay people involved in the medical royal colleges and faculties to maximise their effectiveness and share good practice. The APLC meets regularly and holds an annual patient seminar. A summary report from the 2019 seminar is available on this website. At the seminar participants discussed quality improvement and also shared views on improving patient engagement. Of course, these topics are inter-related, as patient engagement is essential to improve quality, however, here I will give a personal perspective about improving quality – we can return to other aspects of engagement on another occasion.

The term ‘quality improvement’ (QI) means different things to different people. Within health organisations and academia it is often an umbrella term for various systematic and measurable approaches to improving efficiency, outcomes and patient experience and reducing harm. Many QI methodologies share common features, such as a cyclical approach and the continuous application of learning into practice. Some approaches, however, are highly prescriptive, sometimes costly and their advocates may take a narrow view of what works best. While patients may benefit from a systematic approach, they also favour flexibility and the use of local knowledge and insight from patients, families and friends, as well as from the staff who care for them. In other words, as speakers at the 2019 APLC seminar recognised, patients are interested in improving quality and not just in ‘quality improvement’.

It goes without saying that patients want services to be safe and effective. But they also have views on what a successful outcome might look like. That may go far wider than saving lives and reducing the impact of disease. For some patients, a good outcome will include being able to do the garden or to get on a bus to see friends or be able to participate in after school/college activities. So listening to what matters to patients and sharing decision making is an important dimension of quality from a patient’s point of view.

So too are courtesy and respect, and these can take myriad forms. For example, it’s nice that staff don’t routinely assume that everyone wants to be called Mr, Mrs or Ms, but if you are always known as Sandy or Sue and staff insist on addressing you as Sandeep or Susan, it can be annoying. What’s the answer? Ask the patient, make a note of their preference and act on it.

Many aspects of quality seem obvious to patients but seem to be unbelievably hard to solve. Is it really beyond human endeavour to design hospital gowns that don’t gape at the back? Looking at patients in my local X-ray department who wear one gown opening at the back and another with the opening at the front to cover the gape at the back, you’d think so!

If I had 6,000 words for this blog rather than 600 , I could keep going with examples of the small but important aspects of quality. But the point is this – a scientific approach to QI has its place, but no amount of adherence to specific methodologies such as LEAN or Six Sigma can substitute for personalised care and listening to patients – and giving staff the authority and the very modest resources required to make things better.

Neither the Academy nor the APLC has the same relationship to patients as local providers do, but we are all well placed to encourage medical royal colleges and faculties to work with patients on a broad range of approaches to quality, and to ensure that this approach is reflected in all aspects of their work.


Ros Levenson
Chair of APLC