Quality Matters

15 April 2013

Dr Gill Turner is the recently appointed BGS Vice President for Clinical Quality and is a clinical consultant at  University Hospital Southampton

The BGS exists to promote quality health care for frail older people. So, why do we need a Vice President for Clinical Quality in the BGS?

I asked this very question when I applied for the post last summer – and although not yet fully answered, I now believe I understand some of what might be needed of this leadership role. I have spent the 4 months since my appointment considering how we need to develop our ‘quality’ agenda. This has, so far, involved much thought, hours of reading and many visits and conversations with experts from throughout the UK.

My intention is to produce, by the end of April, a Quality Strategy which acts as a framework to describe the quality agenda for the next 2 – 3 years.  Much of the outstanding work which has been produced by the BGS over the last 20 years has happened because of the enthusiasm and dedication of individuals who worked hard in moving forward issues in which they believed passionately. This has resulted in some high profile results such as the work around the medical care of older people in Care Homes, Quest for Quality and Failing the Frail, and the Falls and Bone Health guidelines produced in collaboration with the American Geriatrics Society which were adopted by NICE as standards of care. There has also been produced, a wealth of information in the form of good practice and consensus guidance on the BGS website -  a source of considerable expertise for the many hundreds of site visitors weekly.

However, there is a risk that we reduce our impact by this slightly unfocussed approach – it is hard to  provide all the support that is needed for each individual project from the, admittedly excellent, staff at Marjory Warren House.  We might consider that if we define our agenda for the next 2 – 3 years, we could plan a programme which ensures we deliver a smaller but high impact series of  quality ‘products’  which take account of our priorities and the predicted priorities of our stakeholders. This might mean we produce less paper ourselves – but  plan to have greater impact on working alongside others (such as HealthCare Improvement Scotland, NICE, Age UK, RCN and the Colleges) to deliver results which are part of our agenda.

The quality strategy will therefore need to define our priorities and the method by which we will achieve the results we want. We will need to appoint a Quality Steering Group comprising a number of sources of expertise from the membership. For example, we need to include members who are familiar with the National Audit programme (largely delivered through the RCP London) and the NICE agenda, who will promote our interests therein.  I am also keen to improve the quality and  expand  the  value of  the Clinical Effectiveness section of the posters and presentations at the scientific meetings. This means that we need to promote the quality improvement that comes with peer review – and I believe that the expertise within the Trainees group needs to be part of the Quality Steering group to do just that.

So what about the content of the agenda for the BGS? I feel we need to document and promote quality tools along the whole spectrum or pathway of healthcare travelled by older people in Britain. This means both within hospitals of all types and outside – in people’s own homes, care homes and hospices. The quality tools will need to look at all the domains of quality including clinical effectiveness, value for money, patient safety and perhaps, most importantly, the preservation of dignity.

On discussion with many people about our priorities in the immediate future, there is plainly a need to specify standards of care for frail older people in their own homes. Many  have also suggested we need to help departments of Geriatric Medicine establish how well they do their job by developing easy to use performance measurements which will complement others being produced nationally, for example, the DoH (England) outcomes frameworks.

Whatever the content of the agenda (and this will ultimately be determined by the quality steering group and endorsed by the trustees), it will only exist to produce tools which help promote quality. The main job is the actual delivery of quality health care. This will, of course, remain the quest of all BGS members whose task in this respect will become more difficult but ever more important in these politically charged and financially challenged times.  Members will read others’ accounts of the Francis report in the BGS newsletter including David Oliver’s quoting of the role of geriatricians to promote multiprofessional health care for frail older people.

Whilst of course this is music to our ears and what we have been saying for some time, we must not forget the other much more difficult obligation.  We must advocate for our patients and demonstrate leadership in all aspects of day to day care by our own behaviour and by challenging bad practice.  If we all do this for every patient encounter, every ward round, every domiciliary visit, every clinic appointment (even for the patient who is late through no fault of their own), day in and day out, then things will have to change and the  sad story of the isolated whistleblower becomes history. Geriatricians know what good health care for frail older people is – our job is to make sure that others do too.

“If not you, then who? If not now, then when?“

(after Hillel, 1st Century Scholar)

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