National Quality Policy & Strategy – Eight Elements
The eight essential elements outlined serve as the foundation for developing a national quality policy or strategy. They represent the common elements considered by countries as they set national direction on quality and were selected based on co-development with countries and global quality experts. The elements are not presented as a linear process and are intimately related; in practice some elements may be addressed simultaneously as the policies and strategies are developed and implemented, but each element merits specific consideration.
National health priorities
Policy and strategy should be aligned with existing national health priorities and the broader national health planning process. Alignment helps ensure an integrated approach that addresses quality through a focus on the important issues facing the health system and builds on the foundations already set. Alignment may also help secure political buy-in and financial resources. The strategy should outline national goals and priorities for quality of care.
Local definition of quality
A local definition of quality, developed by national authorities in close consultation with providers and users of care, establishes a shared understanding to underpin the quality policy and strategy. Policy and strategy must be grounded in local understanding of quality, to ensure implementation and evaluation appropriate to local needs and priorities.
Stakeholder mapping and engagement
Stakeholder engagement is required through design, implementation, and evaluation, to build shared understanding, mutual ambition, and commitment. Careful stakeholder mapping can ensure the right people and organizations are contributing, and account for the impact of stakeholder power and relationships. Implementation-informed policy and strategy requires connecting with those providing care. Meaningful engagement of communities & service users is critical throughout the NQPS process.
Situational analysis
A comprehensive situational analysis for the NQPS process provides a solid foundation on which to build policy and strategy that respond to local need. A well-done situational analysis builds understanding of the state of quality, identifies strengths of the health care system to leverage for improvement, and finds challenges, priorities, contextual factors, barriers and facilitators for the policy and strategy development process.
Governance and organizational structure
Success at improving quality relies on strong structures and systems for governance and accountability. NQPS development and implementation requires clear organizational structures for quality across the health system. The work on national directions on quality needs to be explicit about accountability at every level of government and health systems delivery, from national through to community levels.
Improvement methods and interventions
Interventions form the substance of the strategy, articulating what and how quality will be improvement. The interventions are change-oriented actions and can be considered in four broad areas: 1) system environment 2) reducing harm 3) improving clinical care 4) engaging and empowering patients, families and communities. The prioritized interventions should make up a coherent framework and cover all levels of health system, engage all key actors and address all domains of quality.
Health management information systems and data systems
Data, backed by adequate information management systems, is essential both in planning the policy and strategy and in implementing improvement across the system. Quality strategies can help address deficiencies in health information systems and promote the pragmatic use of data to improve quality at the point of care.
Quality indicators and core measures
Without measurement, it is impossible to know whether activities lead to improvement. A coherent quality indicator framework, adapted to local context, allows health care providers and policy-makers to assess progress across all levels of health care and allows data to drive policy, decision-making and improvement.