ACHIEVING IMPROVEMENT THROUGH QUALITY - AN EVALUATION OF KEY FACTORS IN THE IMPLEMENTATION PROCESS

Quality, audit and standard setting are major issues on the present da y nursing and health care agenda. Considerable time, energy and resour ces have been invested in developing and implementing a range of diffe rent quality and audit systems, yet there is limited evidence to date to suggest that they are having any significant impact in terms of cha nging practice and improving patient care. This paper will present the results of a study undertaken to evaluate the implementation of three of the most common nursing quality systems used in the United Kingdom : Monitor, Qualpacs and the dynamic standard setting system (DySSSy). In each case, the focus was on identifying key factors in the process of implementation that could predict positive programme outcomes - def ined in terms of acceptance by clinical nursing staff and perceived im pact on the quality of patient care. The study adopted a three-stage e valuation design, with three distinct levels of investigation and anal ysis, and utilized a range of descriptive and exploratory methods. In total, 14 sites implementing one of the three nursing quality systems were studied. Additional data, derived from individuals' experiences o f implementing quality in nursing, were used to enhance and validate t he findings. The results indicated a number of important system-relate d, contextual and practical issues of implementation. These were under pinned by two key factors, defined as ownership for quality and action to improve. However, most present day nursing quality programmes appe ar to be failing to embrace these two concepts simultaneously. The pap er will conclude by discussing the implications of these findings for future developments in nursing and health care quality improvement.