Quality Improvement in Healthcare – Reflections from the Authors

by Dr Maria Kordowicz and NiroshAn Siriwardena

Quality improvement (QI) has been the core of much of our work both as practitioners and researchers. We wanted to write an accessible guide for students and practitioners which would not only convey the theoretical underpinnings of QI, but also consider the applied elements of what it takes to be an ‘improver’.

Our original drive for writing the book was to bring our five decades of combined QI experience together into an accessible tome of guidance and reflections. We did not know at the time that we would write a lot of the book during the COVID-19 pandemic lockdowns. Since then, the demands facing not only the English National Health Service, but health systems across the world, have had a severe impact on staff and patients. Quality of care in a resource strained climate can significantly suffer. Our wish of upholding quality and quality improvement in the face of these pressures motivated us even more to bring the values and curiosity of the practice of quality improvement to a range of readers.

The book is written in an accessible way and in an easy-to-follow format. We segmented the book into four accessible parts which take readers through the journey of studying or working in quality improvement in healthcare. Part one is introductory. It conveys some of the basic building blocks of quality improvement, including key concepts and definitions. As well as the rationale for quality improvement, because in order to do quality improvement well, we need to understand why we do it in the first place.

The second part of the book presents the different perspectives underpinning quality improvement. This is something that we felt at times can be missing from the QI literature and guidance although quality improvement is quite a pragmatic art. This means that we rarely think about what the perspectives and theoretical underpinnings driving our work are, along with how they affect the way that we do quality improvement, as well as how likely it is to be effective or otherwise. We also explore the policy context of policy improvement in part two of the book and how that has changed over the decades since the founding of the National Health Service in England. We additionally unpick the concept and challenges of patient safety and place it firmly at the core of our quality improvement efforts.

Part three moves away from theorising into the practical and the applied. We present the toolkits used to make quality improvement happen. We take our readers through the different models and frameworks that help to uphold a certain standard for doing quality improvement. Importantly, we also write about the strengths and limitations of selected practical approaches to quality improvement. We believe that improvers need to remain open to giving and receiving balanced critique.

Finally, in part four, we reflect on the necessity of seeking to understand whether what we do in QI is working or indeed not working. We encourage the reader to connect with how to best monitor and evaluate the impact of improvement work, and not only in terms of the impact the QI is making, but also evaluating oneself and the team and the relational processes of QI as we go. Crucially, we also highlight the importance of sustainability considerations around quality improvement. Is the work that we're doing sustainable and should it even be sustained? And if so, how do we ensure that that we consider a range of different factors for sustainability, not least the environmental and community impact of the work that we are doing?

It has really been a pleasure writing this guide. We also wish to thank the publishers who were with us alongside our highly rewarding journey. We hope that the book will be of use to readers. And please do reach out and let us know what you think about it – we would not be improvers if, we too, didn’t seek to continuously improve our own work.

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Book Details
Quality Improvement in Healthcare
Maria Kordowicz, A. Niroshan Siriwardena
May 2023
IBSN (Paperback): 9781529762600
IBSN (Hardcover): 9781529762617

About the Authors

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Dr. Maria Kordowicz is a Chartered Psychologist, who has been working in the field of quality improvement for almost 20 years. She is the Director of www.respeo.com – an evaluation and facilitation organisation, based in Lincolnshire. Maria is Associate Professor in Organisational Behaviour and Director of the Centre for Interprofessional Education and Learning at the University of Nottingham. She also works at the mental health charity Don’t Lose Hope in Bourne. Read more at www.mariakordowicz.com.

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Niroshan (Niro) Siriwardena (https://staff.lincoln.ac.uk/nsiriwardena) is Professor of Primary and Prehospital Health Care at the University of Lincoln. He is director of the Community and Health Research Unit (https://www.cahru.org.uk/) at the University of Lincoln, a research centre which focusses on quality improvement and implementation research. He is also co-director of Lincoln Clinical Trials Unit and Honorary Professor at Cardiff University.