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Narrative review
Quality planning for impactful improvement: a mixed methods review
  1. Victoria Ruth Tallentire1,2,
  2. Catherine Anne Harley1,
  3. Simon Watson1
  1. 1Quality Directorate, NHS Lothian, Edinburgh, UK
  2. 2Medical Education Department, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Victoria Ruth Tallentire; Vicky.Tallentire{at}ed.ac.uk

https://doi.org/10.1136/bmjoq-2019-000724

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    Introduction

    Improving quality is about making health and social care safe, effective, person-centred, timely, efficient and equitable.1 Quality management is a key component of any high performing healthcare system.2 A well-known and popular quality management model is the Juran Trilogy: quality planning; quality control; quality improvement (QI).3 A recent 90-day process by Healthcare Improvement Scotland (HIS) on Quality Management Systems concluded that the current approach to quality management in Scotland is ‘out of balance’, with a ‘lack of effective quality planning’.4 This review aims to help both management and improvement teams to understand the specific components of quality planning, identified through improvement work in a Scottish context and supported by an appraisal of current literature.

    Defining quality planning

    Joseph Juran famously described quality planning within manufacturing as “a systematic process for developing services and processes that ensure customer needs are met”.5 He described a six-step process that has been adapted within healthcare over the last 30 years, leading to improved patient experience through a better understanding of the unmet needs of service-users.5 In addition to refinement of current processes to reduce duplication or waste, this concept has been expanded to include the development of novel services and delivery models.6 Quality planning can and does occur at a variety of levels within a healthcare system: macro or organisational level planning at senior management level; meso or group/service level planning for locality based improvement plans; and micro or clinical team level targeting specific services or patient groups.

    Identifying key components

    In order to identify the key components of successful quality planning, a structured, mixed methods process was undertaken. First, a series of interviews and focus groups were undertaken with individuals involved in successful local QI projects. In total, 16 people participated in eight interviews and one focus …

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