The 2nd Excellence in Action Conference: Leading Edge Practice

Citation

(2002), "The 2nd Excellence in Action Conference: Leading Edge Practice", International Journal of Health Care Quality Assurance, Vol. 15 No. 2. https://doi.org/10.1108/ijhcqa.2002.06215bac.002

The 2nd Excellence in Action Conference: Leading Edge Practice

The 2nd Excellence in Action Conference: Leading Edge PracticeKeywords: Developing excellence, EFQM model, Improvement, Quality in clinical practice

The 2nd annual Excellence in Action Conference, hosted by the Centre for Excellence Development, University of Salford, was held on Friday, 9 November 2001 at Manchester Airport. This cosmopolitan venue provided the setting for a stimulating event of cutting edge debate with high-profile speakers.

The aims of the Conference were to help delegates discover how other organisations have used the EFQM excellence model to improve their performance and enable Conference participants to consider their first steps towards developing excellence in their own organisation.

Sue Jackson, Head of Programmes at the Centre for Excellence Development, University of Salford, UK

The Conference began with a popular early morning optional session, aimed at novices. The overview of concepts and fundamental principles was informative but not overwhelming, which epitomises the Centre's approach to applying the EFQM excellence model. This outline laid the foundations for the rest of the day.

The presentation emphasised the importance of the non-prescriptive self-assessment and continuous self-improvement framework. Novices were guided through the fundamental principles of customer focus, results-orientation, leadership and constancy of purpose, management by processes and facts, people development and involvement, learning and continuous improvement, partnership development and public responsibility. They were then shown how these relate to the five enablers: leadership, people, policy and strategy, partnerships, and resources and processes, and the four result areas: people, customers, society, and key performance. The dynamic nature of the model was highlighted, particularly when continuous improvement was demonstrated with the use of Radar logic. Delegates were shown how clear, measurable results can be determined, and how the development and deployment of approaches can be assessed and reviewed to identify any areas for improvement.

Peter Mount, the Chair of Central Manchester and Manchester Children's University Hospitals NHS Trust

The Chair opened the Conference and introduced the morning programme. The speaker is also Chair of Greater Manchester West Education and Training Consortium, Chair of Greater Manchester Workforce Development Confederation and a member of the Court of Manchester University, UK. The delegates were treated to a fascinating history and critique of quality approaches from management by objectives through to accreditation models. The performance of prestigious companies of the past was then assessed, using the concepts and principles of the EFQM excellence model to identify whether their demise could have been predicted. For example, Rolls-Royce failed to modify their product in the face of increased competition, a changing customer base and environmental issues.

The session concluded with some pointers for excellent organisations that included a balanced approach, avoidance of single-issue measures and a consistency of implementation.

Professor John Oakland, Executive Chair of Oakland Consulting Plc and Head of its Research and Education Division

The first speaker, also affiliated to the European Centre for Business Excellence, Chair in Business Excellence at Leeds University Business School, UK, delivered an informative presentation, entitled "Total organisational excellence", and stressed the importance of organisations engaging people, customers and partners in understanding the organisation's vision, values, purpose and key result areas. How progress in these areas has been measured was also discussed.

The importance of identifying critical success factors and core end-to-end processes was emphasised. The interconnected links between internal customers in the final delivery to the external customer were demonstrated, together with the impact on the customer if any process collapsed. It was recognised that this cross-functional approach to managing core processes was not an academic exercise but integral to a successful organisation's business, and enhanced performance is achieved through the involvement of all people in the continuous improvement of their processes.

The public sector recognises that it needs to evaluate to enable it to evolve to meets its future challenges; improved communications and increased empowerment are needed to achieve flatter, project-based organisations. The session concluded with the thought-provoking statement that excellence in leadership sets the scene for continuous improvement and excellence in service delivery.

Graham Curtis, self-employed management consultant for GAC Associates

The second speaker, who is also adviser and assessor for Investors in People, Co-ordinator for Tameside CITB Partnership, and Lay Board Member for Tameside and Glossop Primary Care Group, UK, led the delegates on a comprehensive and enlightening journey of how Tameside and Glossop Primary Care Group had successfully achieved public involvement. According to the UK Government guidance, it is vital to involve service users in the development of health services, which Curtis maintained could be achieved by informing people of what is expected of them and providing them with appropriate education.

It was recognised that users come from all sectors of the community, including the statutory user representative bodies, local education authorities, social services, voluntary sector and patient participation groups, all representing a wide range of interests. The importance of involving underrepresented groups was vital.

The public participation sub-committee was established initially, but user involvement has since become an integral part of the work of the Primary Care Group. A user involvement strategy was developed, together with an annual action plan, which is reviewed monthly. The session concluded with an emphasis on the importance of commitment from the top, as well as the value of a dedicated manager and budget.

Dr Charles Shaw, Clinical Research Fellow, CASPE Research, London

The speaker is also Chair of the UK Accreditation Forum, Consultant Adviser to the European Quality Programme of WHO and Convener of a Network of National Accreditation Programmes in Europe and Asia.

The delegates were given a comprehensive and informative overview of the assessment models available in Europe, namely visitation, European Quality Awards, ISO Certification, accreditation and government inspection. It was suggested that there was potential convergence between the models, as they had common fundamental principles relating to policy and values, methods of assessment, resources and evaluation.

The function of assessment for the purpose of regulation versus organisation development was explored. Organisational development is internal and focuses on educational and professional issues and the development of optimum standards, whereas regulation is external and concerned with investigation, enforcement, protection and maintaining minimum standards. It was indicated that real change occurs when organisations self-assess, as, when organisations are externally assessed, the real change occurs in the six-month period prior to the assessment, following which the organisation relaxes again into its former ways of working.

The key factors for effective healthcare assessment were identified as: including a clear framework of values, published validated standards, focus on patients, including clinical processes and results, systematic measurement with assessment, self-assessment, emphasis on continuous improvement and the importance of training the trainers.

Dr Mike Perides, Chairman of the EFQM Health Sector Group

Dr Perides chaired the afternoon programme.

Kate Harmond, Clinical Director, NHS Modernisation Agency/National Patients' Access Team, UK

The first speaker of the afternoon provided a lively and entertaining after-lunch session entitled "Lessons in leadership", which emphasised the importance of effective leadership in getting new ideas adopted. It was clearly demonstrated that, while this can be challenging and liberating, it could also, at times, be terrifying. Particular significance was placed on being mindful of how people react when faced with change, especially identifying what motivates them, specifically change for the benefit of patients, hassle reduction, new "kit", happy staff, improved esteem and, last, but by no means least, a "thank you".

It was indicated that there are some important lessons to be learned from mental health services, for example, user focus, anti-hierarchy, challenging pre-conceptions, articulate advocates and strong team ethics. However, in keeping with the theme of earlier presenters, in the quest for continuous improvement, mental health services could benefit from implementing and learning from the lessons of others in developing clear goals, effective performance management, being open to reporting, "influencing up", working across organisations and telling good news stories.

Lorraine Avery, Consultant Diabetes Nurse from Royal West Sussex Trust, UK

The second presenter of the afternoon demonstrated how the EFQM excellence model had been implemented in the Diabetes Centre where she works. Re-emphasising the message of earlier presenters, it was clear how important initial and continued commitment from the chief executive is, but in itself it is not enough. There are resource implications for self-assessment and in the light of an ever-changing agenda staff can be sceptical of new ideas. Delegates were shown how simply changing the name of the EFQM excellence model to the "clinical outcomes model" made it more appealing to staff. Furthermore, by focusing initially on the Radar logic the complexities of the model were simplified, while the organisation still benefited from self-assessment and continuous improvement.

The presentation clearly demonstrated how the EFQM excellence model helped the team within the Diabetes Centre improve patient satisfaction, which led to improvements in clinical outcomes and new ways of working. This presentation demonstrated the necessity of a whole team approach with a clear results focus and identification of key action to attain continuous improvement.

Zolik Schperberg, Clinical Laboratory Scientist

The third speaker of the afternoon, a Consultant in Health Care Quality Management, Improvement Programme Consultant, USA and a Representative for the Austrian Foundation of Quality Management, gave a comprehensive speech on integrating quality into clinical practice from peer review through to medical audits and systematic quality assurance. The confusion was clarified between total quality management, a management philosophy, continuous quality improvement, a collection of tools and techniques applied to processes, problem solving, quality assurance and a formal set of activities to monitor and evaluate practice to improve care and meet accreditation standards.

The presentation critiqued the above, as they tend to focus on individual practitioners, ignore the operational context of processes and rarely address cross-departmental problems. In addition, a lack of strong management support can limit the implementation of the changes needed to improve quality outcomes. The speaker demonstrated how in the EFQM excellence model the individuals become the process owners and learn by doing, which serves as a quality control and results in continuous improvement.

Michael Melewicz, International Consultant for Kaiser Permanente and Internist for Permanente Medical Group, USA

This final session focused on the population-based management of chronic conditions. The management of chronic conditions focuses on keeping individuals as healthy as possible, resulting in a better quality of life. This results in better utilisation of health-care services and more efficient use of resources and improved patient satisfaction.

Melewicz stressed how important it was to integrate quality improvement into clinical operations by using evidence-based quality indicators, based on quality outcomes together with the development of a database of chronic conditions. He emphasised the importance of sharing best practice, developing and maintaining care management, including care pathways, clinical interventions and protocols. It was evident that the integration of IT functions to support the development and implementation in the care of patients with chronic conditions was critical.

Overall themes

Several themes emerged from the Conference and recurred throughout the day. It is clear that change is constant, but does not always result in improvement. However, with commitment from the top, effective leadership, the freedom to make mistakes, developing new ways of working, customer and stakeholder focus, integrating quality into clinical practice and using the EFQM excellence model to fit the context in a holistic approach, organisations can self-assess and continuously improve in their striving towards excellence. The Conference provided a fascinating and illuminating blend of the theoretical concepts relating to the EFQM excellence model together with practical examples of excellence in action. Copies of the slides using during the presentations can be obtained through the Web site: www.som.salford.ac.uk/ced

Acknowledgements

To conclude, many thanks to the organisers of the Conference: Dr Henry Stahr, Director; Sue Jackson, Head of Programmes; Morgane Héligon, Administrator; Vicky Hirst, Administrative Assistant; and Carole Chisnell, Associate of the Centre for Excellence Development, University of Salford.