Quality improvement and measurement: what non-executive directors need to know

The Role of Non-Executive Directors

What is the Role of Non-Executive Directors in Quality Improvement?

'Non-Executive Directors need to understand that quality improvement is a marathon, rather than a sprint. The work will take time, resources and skills, and will generally involve shifting the culture within the organisation.'

Professor Jason Leitch

A focus on quality and improvement of the services delivered is at the heart of the role of NHS Boards. Non-Executive Directors have a major role to play in ensuring that the organisation prioritises and focuses on QI approaches, applies them, and achieves the necessary outcomes.

To succeed, all QI requires an infrastructure. This encompasses the sustained focus and time, strong leadership, intent for QI, planning so that experts and practitioners are trained in QI, and engagement and learning at all levels that are required to ensure QI becomes 'the way we do things'. Leaders need to actively demonstrate the will to make change happen, have the ambition to set high-level goals, and have an unerring focus on implementation.

QI usually starts as a 'thing' – an activity or project. Credibility has to be established and demonstrating success in a project is a straightforward way of doing this. As projects and activities continue and expand then QI will become 'the way we do things round here' – the culture. We all need to move towards a culture where it is accepted that everyone has two jobs; the job to which one is appointed, and improving that job. Non-Executive Directors can lead by example by identifying areas where their own activity could be improved – and taking steps to improve it.

Without sound leadership from the Board, QI programmes are unlikely to bring about long-term change. It is vital that QI initiatives are integrated into the overall work of the NHS Board and its governance arrangements. Non-Executive Directors are also key in providing the overview of different activities that take place in an NHS Board and ensuring they are integrated and held together by an infrastructure for QI.

If Scotland is to develop a culture of continuous QI, then it requires to be led to do so. Non-Executive Directors therefore have a responsibility to ensure that their NHS Board is led 'on the QI route' from QI as activity to QI as culture. In addition the Board needs to be aware that other, wider changes may be necessary. Legislation, the influence of how new entrants to the care system, such as doctors, nurses and social workers, are trained, and policy shifts, for example, all have an impact and a Non-Executive Director will need to be attuned to this wider context of change.

As an NHS Non-Executive Director, it is important to:

• Lead by example;
• Be aware that QI is everyone's business and cannot be a top down directive; indeed it works best when initiated by those who do the work and supported by a strategic intent for QI;
• Be aware that data is used differently for improvement and for the management of performance and be clear on what type of problem the data presented to the Board addresses;
• Ask the right questions to ensure you support and provide oversight of quality improvement in your Board and understand the answers to these questions;
• Make the connections at strategic level that ensure QI activity is held together by an infrastructure and intent for QI across the Board area; and
• Be aware of the place other processes of change have in making improvements and consider the potential to contribute to these wider changes.