Becoming a Reflective Practitioner, 6th Edition

CHAPTER 21A System to Enable Practitioners to Live and Ensure Quality

Christopher Johns

Quality of care is the bottom line for all health service organisations under the rubric of Clinical governance, defined as:

A framework through which Health Service organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence will flourish. (DHSS 1988)

Organisational accountability is enforced through the Care Quality Commission (CQC), with the power to access organisations and judge the quality of care against specific criteria armed with corrective powers for failing organisations. It is a powerful stick to ensure organizations take quality seriously. The CQC bases its criteria around the patient’s experience, patient safety, and clinical effectiveness. The CQC emerged on the back of the Department of Health report chaired by Lord Darzi (2008) that sets out a vision of the National Health Service to give patients and the public more information and choices, works in partnership and has quality of care at its heart, quality defined as ‘clinically effective, personal and safe’ (p. 8). The CQC evokes a climate of fear. Most NHS Trusts are paranoid about negative CQC ratings. They jump to the CQC tune rather than take a proactive approach in the first place.

The National Centre for Clinical Excellence (NICE) also indicates and dictates the quality agenda. NICE has been ...