A7. Health and Social Service Quality

This page looks at quality, with a particular focus on quality improvement. It is based on tweets summarised in the first #ScotPublicHealth Storify.

Make sure you also check out the page on quality improvement using Emojis (with GIF animation).

The discourse around “quality” has changed over recent years. The Healthcare Quality Strategy for Scotland (2010) detailed 6 dimensions of quality, from an earlier Institute of Medicine report, but spent less time explaining how to improve quality of care and services. The expectation by governments around the world at that time was that high quality services would be assured by targets and inspection. This approach has not had the desired impact.

6 dimensions of quality from Institute of Medicine

  • Person-centred
  • Safe
  • Effective
  • Efficient
  • Equitable
  • Timely

More recently, however, the focus in Scotland has shifted to quality improvement, with collaboratives in healthcare (eg health acquired infection, patient safety, maternal and neonatal care) and communities and education (eg Early Years Collaborative):

  • working to shared aims (rather than targets)
  • using the Model for Improvement to test ideas developed and refined by front line staff
  • and using a set of tools and approaches detailed on the NHS Scotland QI Hub website.

The work of these collaboratives addresses the 6 dimensions of quality listed above, but with specific actions, developed through testing, to bring about tangible improvement.

Model for Improvement (Associates for Process Improvement, from Institute for Healthcare Improvement site)

Embedded image permalink

I have summarised three events and some personal reflections that are relevant to quality improvement on my Storify page:

i. Lessons in Healthcare Improvement by Brent James of Intermountain

brent james

Picture taken by Scott Purdie

ii. Scottish School for Health and Care Radicals by Helen Bevan


Image from Helen Bevan presentation

iii. Reflections on film: Andrew Foster (Chief Exec, Wigan Hospitals) and Dr Umesh Prabhu (Medical Director, Wigan Hospitals) meet Care Quality Commission

andrew foster

Image: CQC film referenced in Storify

iv. Personal reflections on Quality Improvement


These resources, and in particular the QI Hub website, provide a detailed overview of quality improvement.

Rather than repeat the information I have simply posted a summary of the Early Years Collaborative Healthy Start work in Leith. This has been submitted for peer review. Check the original tweet for full credits. Thanks to all involved. I have prepared a 2 minute #videoposter about this work for #Quality2016 in Gothenburg, April 13-15. Healthy Start film for #Quality2016 Gothenburg. Watch an earlier film of this work on our #HealthImprovement page.





See leadership page on this site for more on the IHI 5 high impact leadership behaviours.

During 2015 the Health Foundation and Public Health England established the Q Initiative, recruiting 231 founding members to 3 coproduction events. Read Storify summaries of event 1 in Birmingham, event 2 in Glasgow and event 3 in London. Keep an eye on the Q Initiative website for more developments during 2016.

Health and Social Service Quality is one the Faculty of Public Health’s 9 areas of Public Health

Graham Mackenzie 3.1.16 Cynergy_Graham MacKenzie_509 (1)

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