Quality Improvement Curriculum Framework
Supporting an NHSScotland Workforce to deliver care that is:
Safe
Person-centred
Effective
Contents
1. The NHSScotland Quality Strategy
2. Quality Improvement in Healthcare
3. Introduction to the Quality Improvement Curriculum Framework
3.1 Purpose of the Framework
3.2 Key educational principles of the Framework
3.3 Uses and applications of the Framework
3.4 Learning Resources
3.5 Final Learning Outcomes
4. Quality Improvement Curriculum Framework Model
5. Final Learning Outcomes
5.1 Board Members
5.2 Foundation Level
5.3 Practitioner Level
5.4 Lead Practitioner Level
6. Stage Learning Outcomes
6.1 Stage Learning Outcome Table
7. Quality Improvement Workforce Development Model
7.1 Board Level (Executive and Non Executive)
7.2 Foundation Level
7.3 Practitioner Level
7.4 Lead Level
8. Learning Resources for Quality Improvement
9. Indicative mapping to Knowledge and Skills Framework (KSF)
10. Indicative mapping to the Scottish Credit and Qualifications (SCQF) Framework
11. Quality Improvement Glossary of Terms
11.1 Introduction
11.2 Glossary
Appendix I – Indicative Mapping to KSF
1. The NHSScotland Quality Strategy
The Quality Strategy is the NHSScotland blueprint for improving the quality of care that patients and carers receive from the NHS across Scotland. It sets out ambitions which acknowledge:
Putting people at the heart of everything the health service does;
A focus on providing the best possible care;
Recognition that real improvement in quality of care involves all staff, both clinical and non clinical, working at all levels in all roles.
In the NHSScotland Quality Strategy, the ambition for healthcare that is person-centred, safe and effective is underpinned by the need to ‘embed the mutual approach of shared rights and responsibilities into every interaction between patients, their families and those providing health services’ (pg 17, Quality Strategy). This requires a renewed focus on building capacity and capability for all staff to ensure that they have the knowledge, skills and attitudes necessary to deliver high quality services.
2. Quality Improvement in Healthcare
The definition below seeks to describe what improving health services means and the part that we all play in continually improving the care provided.
“The combined and unceasing efforts of everyone – healthcare professionals, patients and their families, researchers, payers, planners, administrators, educators – to make changes that will lead to better patient outcome, better system performance, and better professional development.”Batalden P, Davidoff F. Qual. Saf. Health Care 2007;16;2-3
To improve services effectively we need to be able to set clear aims, establish measures, test changes and implement these changes. There are many well-tested tools and techniques that support improvement in designing services that provide maximum benefit to the patient in an effective and safe way.
3. Introduction to the Quality Improvement Curriculum Framework
In the last number of years, NHS Boards have been developing expertise in applying quality improvement thinking and techniques to healthcare improvement, through both locally driven projects and through national improvement programmes, such as the 18Weeks Referral to Treatment and the Scottish Patient Safety Programme.
The Quality Improvement (QI) Curriculum Framework aims to provide ongoing support for the development of learning in quality improvement by describing the knowledge and skills needed to continuously improve services and enable the NHS workforce to access appropriate learning and development resources.
The QICurriculum Framework, Figure 1 – page 6, aims to support staff across all of NHS Scotland to access learning in quality improvement thinking and techniques. The Framework has been developed and refined with a group of quality improvement leads from health boards who have subject matter expertise along with an understanding of how the framework may support capacitybuilding in practice.
The Framework reflects the priorities of the NHSScotland Quality Strategy, and is intended to provide a scaffold for enabling structured and systematic professional and educational development in quality improvement. It is designed to support capacity building for everyone in NHSScotland in improvement of person-centred care, continuing improvement of patient safety and increase clinical effectiveness of care and treatment.
It is intended that the Framework will enable staff with different roles in the organisation to identify the gaps between their current knowledge and skills and future requirements and to support them to plan their own learning and development.
3.1 Purpose of the Framework
The Framework outlines the attributes that NHSScotland members of staff might expect to achieve as a result of undertaking learning opportunities aligned to key stages and topics. The Framework includes five developmental stages, and within each stage are a number of learning outcomes and related topics. Progression through the Framework model is illustrated left to right from Stage 1: Introduction to Quality Improvement, through to Stage 5: Sustaining Improvement.
It is intended to enable NHSScotland staff to enhance their knowledge of quality improvement and related professional and personal skills so they may effectively contribute to the continual improvement of the health service. It is intended to support the development of all staff and, for ease of reference and purposes of capacity building, incorporates four levels to support staff in delivering quality improvement: Lead Practitioners, Practitioners, Foundation and NHS Scotland Health Boards (both executive and non executive members). For the purposes of capacity building, at ‘Foundation’ level the learning resources are intended to provide baseline Continued Professional Development (CPD) in quality improvement for all staff. Those who have further quality improvement-related responsibilities will be interested in resources at Practitioner, Lead Practitioner and Board levels.
The Framework should also enable effective commissioning of quality improvement learning opportunities with providers in the further and higher education sector.
For all staff, the aim of the Framework is to:
enable individuals to reach a broader and deeper understanding of their roles in quality improvement;
enable individuals to gain a broader and deeper understanding of the knowledge, skills and behaviours expected/required by their roles in quality improvement;
facilitate individuals to identify their professional development needs to effectively carry out their quality improvement role;
provide benchmark statements against which individuals can gauge themselves.
3.2 Key educational principles of the Framework
The construction of the framework has been underpinned by these key educational principles:
respecting and building on prior knowledge and experience of each individual;
enabling staff to take control of their own development, providing opportunity for choice and selection of most suitable educational opportunities;
emphasis on relevance of learning to the context of the workplace;
valuing learning through work-based activity and collaboration with colleagues;
acknowledgement of individual potential and career development;
valuing reflective self-evaluation and self-direction;
transparency of expectations and standards of achievement for each group.
3.3 Uses and applications of the Framework
The Framework outlines the knowledge, skills and behaviours expected of staff working at different levels of the organisation and with defined roles. It describes the depth and breadth of each attribute as a measure of the standards expected of staff at each level.
It is intended that the Framework may be used in the following ways:for individuals to gauge their own strengths and development needs in order to contribute effectively to quality improvement within their roles;
to enable individuals and groups to plan and/or engage in educational development activities;
to enable managers to support their teams in profiling their quality improvement knowledge and skills and plan further development;
to assist with commissioning of educational activities and resources;
to enable individuals to plan their own continuing professional development;
to assist educational providers responsible for pre-registration training and education in articulating their provision with the framework.
3.4 Learning Resources
Each stage of the Framework will be supported by learning opportunities and resources. The Framework is designed to support all staff in planning and participating in CPD for quality improvement – and in choosing those elements most appropriate for their roles, responsibilities and prior learning and experience. It is envisioned that individuals, perhaps in discussion with their line manger, will plot their own pathway through the Framework, therefore individual learning journeys will differ. The Framework is flexible enough to allow individuals to have considerable engagement if the subject is relatively new to them, to 'dip in' for refresher study, to infill gaps in their knowledge, to accommodate a change in post or location or to provide baseline CPD for new groups of staff.
3.5 Final Learning Outcomes
The final learning outcomes indicated on the far right of the diagram are the overall outcomes expected after progression through the Framework; the final learning outcomes for each group of staff are listed in detail in section 5.
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4. Quality Improvement Curriculum Framework Model
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5. Final Learning Outcomes
5.1 Board Members
It is proposed that an NHS Board executive and non executive member responsible for quality improvement should be ableto:
align local policy and strategy for quality improvement to national priorities for improvement;
ensure a person-centred approach to the delivery of all services;
demonstrate clear understanding of the difference between managerial and governance responsibilities;
demonstrate commitment to a focus on quality across the organisation;
understand the business case for service improvement;
demonstrate knowledge of the science for improvement and its application to supporting improved quality of service;
understand the use of data and be able to interpret information to support effective scrutiny and quality assurance;
promote a critically reflective scrutiny of outcomes;
promote a culture of continuous quality improvement across the organisation.
5.2 Foundation Level
It is proposed that all staff should be able to:
discuss how quality improvement benefits patients, health care staff and the organisation as a whole;
describe their role and responsibility for improvement of services;
explain the general principles of quality improvement, the most widely used methodologies and the human dimensions of quality improvement;
identify a problem which could be improved through quality-based approaches and anticipate issues arising;
contribute, as appropriate, to quality improvement initiatives and projects within the workplace;
contribute to the knowledge of others by sharing ideas about quality.
5.3 Practitioner Level
It is proposed that the quality improvementPractitioner should be more able to:
incorporate and use knowledge of quality improvement principles and practices for improvement of day to day service delivery;
initiate, plan and manage quality improvement projects at a local level within the organisation to improve service;
apply understanding of the human dimensions of change to management of projects;
collaborate with others to apply and embed quality improvement within daily working practice;
share knowledge and experience of quality improvement with colleagues;
apply a problem-solving approach to delivering service improvements;
reflectively evaluate their role in fostering and implementing quality improvement and engage in CPD.
5.4 Lead Practitioner Level
It is proposed that the quality improvement lead practitioner should be more able to:
utilise broad and deep knowledge of quality improvement theories and methodologies to lead and support service improvement in healthcare;
apply deep understanding of relevant theories and professional practice to lead and support organisational change for the improvement of services;
advance understanding of the application of quality improvement science to improve services;
critically appraise merits and limitations of quality improvement methodologies in a healthcare context;
design, manage and facilitate quality improvement projects;
coach and mentor colleagues in quality improvement implementation;
engage with multi-disciplinary teams to deliver improvement of services;
influence strategy and policy development which champions and incorporates quality improvement;
critically reflect on own role, capabilities and development needs for leading quality improvement;
promote and demonstrate a collaborative approach to delivering quality improvement;
promote and defend the value of data collection and analysis for improving services.
6. Stage Learning Outcomes
The learning outcomes at the bottom of Table 1 pages 9- 11 are those that relate specifically to the topics included in each stage of the framework, so that individuals can check progress. These learning outcomes describe the breadth and depth of engagement with the content; therefore, individuals can be clear about what is expected of them. In Figure 2 on the right, the different levels of engagement are represented by the length of the arrow.
Note: There are no stage learning outcomes mapped to the NHS Board section at present.
Figure2
Figure 3
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6.1 Stage Learning Outcome Table
The following details the learning outcomes for each Stage for each role in quality improvement (not NHS Boards):
Table 1
Stage 1. Introduction to Quality Improvement / Stage 2. Learning more about Quality Improvement / Stage 3. Planning improvement / Stage 4. Testing and implementing improvement / Stage 5. Sustaining improvementTopics / 1.1 Understanding our purpose and our values
1.2 Definition of Quality
1.3 What is QI and what are the benefits
1.4 Person-centred Healthcare
1.5 Understanding our responsibilities for Improvement: individuals, teams, the organisation
1.6 Introduction to Healthcare systems
1.7 Introduction to the science of improvement
Model for improvement
PDSA
Process mapping
Lean in healthcare
1.8 Introduction to measuring
improvement / 2.1 The Policy Context
2.2 Key principles of QI
Healthcare systems and processes
Person-centred care
2.3 Reflecting on own role
Teamwork
Improvement in practice
2.4 Learning for QI
Connecting to resources
Mapping own journey
2.5 Measurement for improvement
Common tools and techniques / 3.1 Investigating systems and processes
Identifying improvements
Tools for planning
3.2 Organising information
3.3 Human dimensions of QI
3.4 Leadership and project management
3.5 Effective teamwork for QI
3.6 Evaluating success
3.7 Planning for sustainability
3.8 Measurement for QI
Setting baselines
Data collection
Data sampling
3.9 Innovation and Creativity / 4.1 Collaboration and networking
4.2 Effective communication
4.3 Human dimensions of QI
4.4 Leadership and project management
4.5 Effective teamwork for QI
4.6 Measurement for QI
Data analysis
Data interpretation
Data presentation / 5.1 Knowledge dissemination
5.2 Evaluation
Benefits realisation
5.3 Human dimensions of change
5.4 Leadership for QI
Embedding QI
Business case for QI
5.5 Education and mentoring
5.6 Coaching for improvement
Foundation Learning Outcomes / Discuss the values shared by staff of the organisation and relate them to own workplace values
Discuss with colleagues the meaning of quality improvement
Discuss with others the benefits of QI for patients, carers, staff and the organisation
Give reasons why a person-centred approach is important for quality care
Describe own responsibilities for improvement as an individual and as a member of a team
Talk with others about potential areas where care and/or service could be improved
Explain how we would know whether or not we have improved our services / Explain the relevance of the current policy context to Quality
Give examples of improvement policies which apply to own workplace
Discuss with others examples of a familiar Healthcare systems
Explain why it is important to collect and study data before making changes
Contribute to a team-based exercise using a PDSA approach
Contribute to a team-based process-mapping exercise
Discuss with others what can be learned from run charts and control charts
Explain own ways of helping patients and the difference it makes to them
Outline own learning journey and set goals for learning about quality / Contribute to the identification of areas needing improvement
Contribute to planning an investigation for improvement
Contribute to the collection of data, when appropriate
Reflect on own contributions to QI as a member of a team
Consider own role and responsibility in ensuring QI continues into the future / Given some sample data, explain what can be learned from it
Discuss with others the roles and responsibilities of team members in helping to ensure a successful outcome for improvement
Talk to colleagues about the results and implications of QI projects
Contribute to collaboration with other QI projects when appropriate / Talk to colleagues about the importance of continual improvement
Talk to patients and carers about their experiences of QI
Practitioner Learning Outcomes / Discuss own workplace values and relate them to those of the organisation
Discuss the meaning of QI and the benefits for patients, carers, staff and the organisation
Discuss the improvement responsibilities of self, workplace teams and the organisation
Relate person-centred Healthcare to the science of improvement
Explain how the model of improvement could apply to own service area
Explain how the PDSA approach might (or might not) be used in own workplace
Discuss how a known workplace process could be mapped
Discuss key principles of lean such as variation, waste and value / Critically discuss the relevance of QI to the NHSS Quality Strategy
Comment on the effectiveness of improvement policies which apply to own workplace
Diagram and annotate a typical system within the organisation
Discuss and critique with workplace colleagues the merits and limitations of PDSA
With team members, map, annotate and critique a typical workplace process
Reflect on own work and identify areas for improvement
Appraise own strengths and development needs relating to QI
Using the QI Framework, plan and participate in CPD / Facilitate identification of area for improvement in the workplace
With team members, diagram and annotate a plan for local pathway analysis using either process-mapping or value stream mapping
With team members, plan a local QI project, choosing the most appropriate tools for organising and collecting meaningful data
Involve patients and carers as well as staff in planning
Respond to human dimensions of project management and support effective teamwork
In consultation with colleagues, determine how project success will be evaluated
Discuss with colleagues how QI can become sustainable in the workplace
Contribute innovative and creative ideas relevant for QI
Reflect on and in practice about own contribution to improvement / For local projects manage and facilitate the implementation of data collection, analysis and critical evaluation of data/results
Allocate tasks to team members and monitor progress
Manage meetings effectively, promoting sharing of information, collaboration and cohesive teamwork
Facilitate reporting of results in a clear and meaningful manner
Communicate effectively with colleagues about improvement initiatives and local projects
Support team members to adapt to changes resulting from improvement and champion peer support
Collaborate with other projects to share and disseminate knowledge and experience of QI
Support establishment of QI networks / Adopt and promote the integration of a process perspective into daily working practice
Collaborate with others to embed QI in daily working practice
Periodically evaluate and review improvements
Collect and share case studies of QI
Seek and disseminate knowledge of good QI practice from elsewhere
Support colleagues to learn more about QI
Contribute to the planning and delivery of educational events
Mentor colleagues in the practice of QI
Lead Practitioner Learning Outcomes / Demonstrate comprehensive knowledge of the organisation, its purpose and its values
Demonstrate understanding of and commitment to QI and person-centred HC
Critically reflect on the QI responsibilities of self, workplace teams and the organisation
Explain the nature of Healthcare systems and processes, and give examples
Educate others in the features, applications and benefits of the model for improvement
Help others to understand the meaning and application of PDSA and process mapping
Help others to understand the principles of variation, waste and value / Question the status quo and/or unsubstantiated change
Contribute expertise to creation of QI related policy and strategy
Facilitate others' understanding of Healthcare systems and processes and the importance of person-centred care for QI
Promote and facilitate others to identify areas for improvements
Facilitate others' knowledge and understanding of common tools and techniques for measuring improvement
Promote the integration of QI in day-to-day work and the importance of multi-disciplinary collaboration
Promote, support and engage in CPD for quality improvement
Share knowledge and experience of quality improvement / Propose new initiatives for improvement
Advise on best methods and tools for planning QI according to context
Advise and mentor colleagues in choosing the most appropriate tools for measurement including an understanding of trends in data
Account for and respond to human factors in improvement initiatives
Lead and manage improvement projects when appropriate
Deal with challenging behaviour by influencing and supporting ‘difficult’ conversations
Promote and facilitate continual Improvement and forward planning
Promote and monitor integration of an evaluation framework into practice
Mentor and support teams to plan for sustainability
Recognise and encourage innovation and creativity in improvement initiatives / Lead process analysis appropriate to context
Advise on most appropriate tools for data collection and analysis
Manage the collection, analysis and interpretation of data
Supervise or mentor the reporting of results
Manage change resulting from improvement of services
Manage risk associated with QI processes
Initiate and support opportunities for sharing of QI knowledge and experience
Promote and engage in internal and external collaborations to extend the breadth and depth of QI experience / Champion a sustainable approach to QI
Promote integration of QI into the business of the organisation
Use knowledge to influence policy and strategy for continuing Improvement
Collect and disseminate case studies of good practice and success and support mainstreaming improvements
Share expertise across the organisation and beyond
Publish and present findings from QI initiatives within the organisation
Suggest and facilitate opportunities and resources for learning
Coach and mentor others in the application of QI
Appraise own strengths and development needs
Remain updated in knowledge of quality
Share and encourage others to share
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