A framework for evaluating governmental quality initiatives: the Wimpole Street principles.

features and lessons which we should learn from each new In most countries, health care is a major political issue; its initiative but which we fail to carry forwards to the next? policy attracts or loses large numbers of votes, costs enormous A series of open discussion meetings was held at the Royal sums of money, and disposes of ministers faster than most Society of Medicine, Wimpole Street in London, on the other government offices. definition, measurement and improvement of quality in health The governmental definition of – and thus policy on – care. A small multi-disciplinary group of experienced clini‘quality’ in health care may or may not last until the next cians, politicians, patients and managers refined the conelection. The civil servants, whose task is to translate the clusions of these meetings, together with analysis of specific political priorities into practical action in the health care recent experience of policy initiatives, into a framework by system, often change faster than annual ‘yearbooks’ can which new national initiatives might be tested before or after record them. Meanwhile, academics and ‘nouvelle vague’ they are enacted. The draft framework was then tested against enthusiasts shift paradigms and invent new words to describe the green paper A First Class Service [3]. what is essentially the same process with the same aims. This framework was based upon experience in the UK It is not surprising that national, provincial and state but, with minor amendments of language, might also serve initiatives to improve quality may show little consistency over in other countries and systems. Would anyone care to try it time and frequently fail to incorporate learning from previous in their own setting, and recommend improvements to give successes and failures. Every new government wants to be the Wimpole Street Principles a more international apseen to create a new world but few countries have a robust and plication? independent mechanism to temper this process of innovation with an evidence-based and authoritative interpretation of Policy history in the field of quality in health care. In Britain, the wave began in the mid-1980s with ‘Quality Comprehensive and consistent Assurance’, encouraged by the Griffiths’ Report on man• The proposed framework embraces all elements of agement in the National Health Service [1] and notions of quality within integrated approaches at local and na‘customers’. Then there was ‘Total Quality Management’, tional level; ‘(Continuous) Quality Improvement’ and, from the World Health Organization, ‘Continuous Quality of Care De• the framework is able to provide national consistency velopment’ – each aiming to be more dynamic, comprehensive of purpose and priority in quality improvement; and generally to wash whiter. Apart from isolated initiatives within some specialities, • the framework is relevant to patients in independent, doctors in the UK were little involved until 1989 when voluntary and social care, as well as in the public Working for Patients [2] decreed that formal, systematic sector; medical audit would be introduced throughout the National • potential conflicts are addressed between differing Health Service. Although some disliked the term ‘audit’, it perceptions of quality by patients, professions and prospered and transformed into multi-disciplinary, multiorganizations; professional clinical audit. Then the magic wore thinner and we hailed a new drive • proposed new quality initiatives and mechanisms clearly for clinical effectiveness, evidence-based medicine and a host link with or explicitly replace existing priorities and of metastatic concepts and methods. Each of these has its structures; disciples, and perhaps a devoted journal, and maybe even a national centre for a while. The current model, to trump all • responsibilities and accountabilities of public, private others, is ‘clinical governance’. and professional bodies are defined (e.g. for training, monitoring); Is such plurality a ‘good thing’? Or are there common