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Thursday, March 19, 2020

WHY Fronts: Never mind the quality feel the width.

Never mind the quality feel the width was a typically 1960’s politically incorrect British TV sitcom about the ‘rag trade’ with two tailors, one Catholic and one Jewish. However, in popular culture the title of this sitcom has become synonymous with quantity being more important than quality.1

In my time as a senior manager within the NHS, within the relentless call of ‘do more with less’, this phrase often came to mind. If we were not careful, it was a slippery slope down to the lowest common denominator.

Change is good when done for the right reasons i.e. from an evidence base.

How many of us would still want to be working with the equipment and understanding of patient care/medicine we had in the eighties?

Change to allow better patient flows, quicker treatment paths and a shorter length of stay all benefit patients, but if these changes come at the cost of the quality of care we can offer, is it right?

QSI is all about quality and quality improvement; it allows Imaging Services to develop an evidence base for what they do, has an audit regime which meets the NHS desire to transform services and can provide performance data on an ongoing basis.

However, when as professionals we think about reject analysis and repeat examination analysis (easier said than done in the digital age for those old enough to remember film) is this audit or monitoring and what is the difference?

I found these definitions, which were simple enough for me to understand (albeit they are from the financial sector):

  1.  Audit – is a formal, systematic and disciplined approach designed to evaluate and improve the effectiveness of processes and related controls, governed by professional standards e.g. clinical audit.
  2. Monitoring – is an on‐going process to ensure processes are working as intended and can be an effective detective device within a process. It often uses audit techniques and is typically an operational activity, e.g. reject analysis.

The words which really captured my attention were ‘detective device’: This feeds my inner ‘Miss
Marple/Hercule Poirot’.

How as radiographers do we know we are safe, effective, patient centred and producing diagnostic images? In the Clinical domain of the QSI (CL2C3), evidence is required to demonstrate that as professionals you are producing diagnostic images.

In your efforts to meet performance targets, both operational (are you getting the numbers through)
and financial (efficient working practice), are you trapped in a ‘never mind the quality feel the width’
mentality, is quantity outweighing quality? Are you monitoring your quality and your patient dose? How
about your feedback loop? Who tells you when the images are not good enough, who decides the images are not good enough, who tells you there are too many repeats, who advises you how quality can be improved, who tells you if the patient dose is safe? Then in turn who is monitoring your feedback loop?

You can’t change or improve if you don’t know change or improvement is necessary. Why not start with an audit to find your baseline? You might be surprised by the results.

Once you have a baseline, perhaps decide quality measures you want to put in place, then you can monitor against these at regular intervals. You might want to tweak them depending on the results of the monitoring process. Then complete another formal audit and compare/contrast the results with your original audit.

Feedback is key to all of these processes:

  • Does everyone know/understand what you are trying to achieve and take ownership?
  • Is everyone following your quality measures/standards?
  • Do you get feedback from those who report your images?
  • Are there regular updates on monitoring results?
  • Is training offered to meet the quality expectations?

I am sure you could add to this list and demonstrate how feedback has changed the way quality is monitored in your service.

Why not investigate this further? Perhaps it is time for you to be able to garner the evidence to say ‘never mind the width feel the quality’

1 Editorial Australian Journal of Forensic Sciences 2015. Vol 47, No. 1, 1‐2, Taylor & Francis Group.

Christine Woodgate, MSc, PgD, PgC, DCR(R)
QI Partner RCR/SCoR

Chris Woodgate has worked within the NHS since 1980 as Radiographer, Advanced Practitioner, Radiology Manager and a Divisional Director, taking early retirement in 2016 to work part‐time for the colleges. 

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