Evaluating mandated quality improvement: Results of a survey in the NHS in England

Introduction: There is a substantial and growing investment in quality improvement in healthcare internationally. In the UK context, this trend is evident in a succession of recent policy initiatives. The authors assess progress in quality improvement in the UK NHS after 10 years of mandated quality improvement activities and several waves of reform. The effectiveness of existing systems for quality improvement is explored in the context of the most recent round of mandated reforms. Four dimensions of effectiveness are considered: existence of direction at an organisational level, frequency of reporting arrangements to the organisation's board, extent of coverage across the organisation, and perceived effectiveness at bringing about change. Methods: A self-completion postal questionnaire was sent to all NHS trusts in the West Midlands and South West regions. Results: Notwithstanding considerable investment, existing systems for quality improvement are highly variable within and between trusts in both their coverage and perceived effectiveness. Discussion: UK NHS trusts exhibit wide variation in the robustness of their quality improvement activities, yet they share a common policy context. This suggests that direct mandating of quality improvement processes does not result in uniform development. Alternative approaches should also be considered. There is clearly a need for rigorous evaluation of the impact of quality improvement systems before their widespread dissemination.