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QUIP

eQIPPing the Proposed Service Change

QIPP stands for Quality, Innovation, Productivity and Prevention and has been designed to complement not supplement policies such as World Class Commissioning. QIPP focuses on the NHS working in different ways to ensure that the highest quality care is delivered. It encourages efficiency and focuses on a 'joined up' approach to delivering healthcare. Click here an image that highlights how the different components of QIPP intertwine together (source: NHS Institute for Innovation and Improvement).

The intra-operative test being described in this How to Why to guide is a prime example of how QIPP can be endorsed through a collaborative approach to implementation. The impact of introducing the technology will meet the QIPP agenda through a variety of avenues, as highlighted below:

No requirement for second inpatient admission.
Earlier return to normal activity for the patients.
Reduce length of time to access adjuvant therapy e.g. chemotherapy/ radiotherapy.
Eliminates risk of second anaesthetic within a short space of time and associated morbidity.
Reduction in follow-up appointments.
No wait time between biopsy result and surgery - currently approximately 2 weeks.
Supports the delivery of the cancer 31 and 62 day treatment targets.
Patients aware of the next phase of their treatment within hours of waking up post-operatively.

Quality

Implementation of the technology meets the 'Quality' aspect of QIPP as there will be a lower requirement for second inpatient admission, a reduction in length of time to access adjuvant therapy e.g. chemotherapy/ radiotherapy, there is no wait time for patients between biopsy result and potential second surgery - which is currently approximately 2 - 4 weeks and patients aware of the next phase of their treatment within hours of waking up post-operatively.

The NHS Next Stage Review: High Quality Care for All document describes quality as needing to be consistently safe, clinically effective and personal. This can be categorised into three elements:

Experience - Providing patients and carers with the best possible experience through their pathway. Patients should have access to services that are personalised and should feel that the staff who provide services care about what happens to them. Providing a quality service must induce a high degree of personalisation, compassion, dignity and respect.

Safety - Getting the basics right, first time, every time and making sure that people are not harmed as a result of what is being delivered, is an essential component to delivering high quality healthcare. This relates primarily to patients but does also apply to the staff who are delivering the care and the environment in which it is being delivered.

Effectiveness - Providing the best treatment available, ensuring that all our providers adopt NICE guidance appropriate to their services and we can see that they are providing clinically effective services because they demonstrate it through clinical audit and better outcomes.

Innovation

Implementation of the technology meets the 'Innovation' aspect of QIPP as this enables the redesign of the patient pathway and introduces a more efficient way of working leading to a higher degree of service improvement. There will be a lower requirement for second inpatient admission; it eliminates risk of second anaesthetic within a short space of time and associated morbidity.

It may be that implementation of the technology is taken forward by a local Cancer Action Team and/or Network Group across more than one hospital in a given area. A PCT may decide to take a regional approach to adoption. Innovation in this context is important - who is going to be the champion for change?

Prevention

This is a key part of the QIPP programme which recognises that if we prevent people becoming ill or getting sicker we will save lives, improve quality of life, add years to people's lives and prevent dependency on health services in the long term. Implementation of the technology not only lowers the requirement for second inpatient admission, but it also eliminates risk of second anaesthetic within a short space of time and associated morbidity.

There is also a case that supports the delivery of the cancer 31 and 62 day treatment targets. In practice this means that commissioned services must reflect the ever-growing expectations of the services being delivered from patients and their carers. Systematically involving patients will help to shape the delivery of the breast cancer service and ensure that the pathway is fully embraced. Communicating the benefits of the technology (e.g. in this context preventing further visits to hospital) to all stakeholders will be an important part in realising the benefits of implementation.

Productivity

Productivity is a measure of the output or outcome compared to the input. Quality and productivity are not mutually exclusive and through quality improvement programmes productivity usually gains. Productivity is, to some degree, the spine behind the QIPP agenda and is the strand that will highlight to Trusts if the implementation of the technology has achieved the anticipated benefits.

Essentially, the productivity strand of QIPP will mean that there will be a reduction in length of time to access adjuvant therapy, e.g. chemotherapy/ radiotherapy, the risk of a second anaesthetic within a short space of time and associated morbidity is eliminated, a reduction in follow-up appointments and an earlier return to normal activity for the patients.

Measuring the impact of the productivity strand will be an essential aspect of the implementation of this technology, and building it into the Trusts regular performance reviews will ensure that the process is governed appropriately.

Click here to be taken to the Service Requirement Document which highlights the de and re-commissioning processes that, if put in place, will be key indicators behind measuring productivity changes as a result of implementation of the technology.