Editorial

Citation

Gourlay, R. (2002), "Editorial", International Journal of Health Care Quality Assurance, Vol. 15 No. 7. https://doi.org/10.1108/ijhcqa.2002.06215gaa.001

Editorial

It is very unusual for an Editor to decide to publish two articles from the same author in one issue. Rachel Fleishman has appeared in the journal before and has indeed been a recipient of an Award for Excellence given by this journal. Her two articles describe her RAF method (regulation, assessment, follow up) in conceptual terms as well as in its implementation. The reason for publishing the two articles is in their obvious linking, but perhaps more importantly, the fact that they offer an organisational intervention that combines quality assurance, change management and what she refers to as the "tracer" approach, which others may define as the use of indicators. In line with the management of change approach, the RAF method is tailored to the institution/organisation being reviewed. The implication of the overall strategy is to gain acceptance and commitment through involvement of all "actors" so that positive change emerges. Fleishman is describing a "learning organisation approach" where the culture is supportive of continuous quality improvement.

In the UK the context for such a strategy has been driven by the politicians and the media resulting in a strong emphasis on inspection, league tables and star ratings. These have been supplemented by the creation of new institutions such as :

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  The Commission of Health Improvement (shortly to become the Commission for Audit and Inspection.

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  The National Institute for Excellence.

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  The Modernisation Agency.

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  National Clinical Assessment Authority.

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  National Patient Safety Agency.

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  NHS Litigation Authority.

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  Clinical Negligence Scheme for Trusts.

Many of these agencies are welcome players onto the health scene focusing as they do on many aspects of patient care. However, although the emphasis being placed on improving quality is couched in the language of a no blame culture, one suspects that this is not how it is experienced by managers who comment/complain on the volume of standards, targets, goals that are generated centrally. Failure to achieve specified outcomes can result in public chastisement with the possibility of employment termination.

Such an ambience undoubtedly creates stress and tension with managers and others working long hours to avoid becoming a "No Star" Hospital Trust.

It is because Fleishman's model does offer a different approach that it has been published in full. Critics may say that it is only appropriate for small scale interventions; or that it takes in too much resource and time. Such comments, however, demonstrate the "quality quick fix mentality" which in McGregors' classification one would refer to as Theory X – treating organisations and their staff as rather complicated machines where a well placed spanner can turn the right nut.

For politicians who are really only interested in short term results that are co-terminous with their next election hurdle, this approach appears rational, logical and above all fast. But the lack of ongoing commitment and the disarray caused means that there is no integration of quality into the organisations blood stream.

Fleishman's approach will take time and skilled facilitation rather than crude imposition but its results will be enduring – real change that lasts will occur. She demonstrates a conceptual model and its practical implementation which could be a model for others to emulate. There is little doubt that despite all the recent work and efforts of organisational development gurus there is still a dearth of good examples of organisation wide system and cultural change interventions. What is needed is an integration of management discipline such as quality assurance, behavioural sciences, project management etc. which can lay down precepts by which organisational intervention should and could be managed.

Fleishman has illuminated a pathway with her approach. As Editors we would be interested in receiving a critique of what Fleishman has done, and perhaps also receiving alternative strategies that have resulted in continuous quality improvement.

Robin Gourlay