Embedding quality: Principles for a national quality management system

This briefing presents trust leaders’ perspectives on QMSs and presents a vision of what trusts perceive ‘good’ to look like. It also examines the factors that enable greater systemisation – and at times standardisation – in service pathways in the health service, along with trust perspectives on where the challenges lie.

While most patients experience good outcomes from their care, how should we address the level of avoidable harm in the health service that persists?

Making the shift from reactive quality improvement to proactive quality management could be transformational for patient care and staff experience, and may play a crucial role in preventing avoidable harm.

As a tool to enable this shift, there is increased interest in the potential of approaches such as quality management systems (QMSs), which extend beyond quality improvement to include management of other key components of quality – planning, control and assurance.

QMSs play a pivotal role in other high-risk industries such as aviation, providing a systematic approach to ensure that products and services meet stringent safety and performance standards. It's useful to examine the applicability of such safety systems in the health service.

What is a quality management system? 

QMSs are already often used in high-reliability service pathways, such as pathology and in health service laboratories. In this setting, a QMS relates to a series of processes and documents in the form of policies, standard operating procedures and records which specify ways of working, objectives and results of activities, which may need to meet relevant International Organisation for Standardisation (ISO) standards.

There's increasing national interest in expanding the QMS approach beyond specific high reliability service pathways to create whole-organisation QMSs

An NHS England (NHSE) board paper from December 2024 states that ‘a clear framework to support and drive improvement is needed, based on a balance of quality improvement, planning, control and assurance (a quality management system), implemented at every level’.

Dr Penny Dash’s recent report on the patient safety landscape recommends that ‘commissioners and providers should operate effective quality and safety management systems that cover all aspects of quality, including efficiency or use of resources and people management’. 

There is increasing national interest in expanding the QMS approach beyond specific high reliability service pathways to create whole-organisation QMSs.

Q has defined this type of whole-organisation QMS as a ‘coordinated and dynamically interconnected approach to planning, improving, controlling and assuring high-quality care. A QMS is applied across all levels of an organisation, from team to board. It's aligned to strategy, underpinned by documented processes, procedures and responsibilities, and embedded in organisational culture.

A whole-organisation QMS has the potential to provide a shared understanding of what quality means and to connect strategic goals with everyday work. NHSE has stated that the forthcoming quality strategy will likely ’develop a national framework for quality’ to this end.

Put simply, a QMS consists of:  

• Defining what high quality care looks like for the local population and setting a standard for services to meet. 
• Codifying what needs to happen and be in place for these standards to be met.
• Ensuring that standards are consistently met across all levels of the organisation. 
• Identifying what improvement action needs to be taken if standards are not being met.  

Potential benefits of a QMS

A well-designed QMS offers a coordinated and embedded approach to quality planning, control, improvement and assurance. Its key benefits include:

• Creating shared purpose and vision: a QMS can support alignment across an organisation, helping everyone understand what matters and why.
• Enabling a focus on people and outcomes: by placing the needs of the local population and patients at the centre, it can help drive better experiences and improved results.
• Bringing clarity to roles and processes: staff benefit from clearly defined responsibilities, consistent ways of working and access to the right data to sustain high-quality care.
• Fostering collaborative working: a QMS can demonstrate how clinical and operational colleagues work together to improve quality of care, potentially helping to reframe cost-saving and quality improvement as mutually reinforcing goals rather than competing priorities.