Dedicated programmes leading to a master's degree or diploma in quality assurance have been around for about 10 years. Often regarded as rather unsexy, they are becoming more important in the light of the government's clinical governance agenda.
Dorothy Whittington, professor of health psychology at Ulster University, and coauthor with Professor Roger Ellis of Quality Assurance in Healthcare: a handbook, 1 says: 'Clinical governance is now the legal responsibility of chief executives. Up until now you would have been hard put to know whose responsibility quality really was.'
Professor Whittington sees it as the umbrella under which all quality assurance initiatives can now flourish, a view echoed by colleagues in Birmingham and Leeds - centres of the country's leading postgraduate quality assurance programmes.
Shirley McIver, senior fellow at the health services management centre at Birmingham University, says that clinical governance is less about new activities but rather more about the co-ordination of existing ones such as clinical audit, staff development or management of quality.
'Clinical governance is about drawing those things together so that the quality circle is closed.' She says: 'The usual people have been managers with responsibility for quality. Then when clinical audit became the area of development, we got many more clinical audit facilitators. Now that clinical governance has come in, there is a much broader spread of people interested.'
At HSMC, the course is an MSc/diploma in managing quality in healthcare. It can be taken full-time over a year or part-time over two, and comprises six week-long modules.
There are three core modules: health service management, introduction to healthcare quality and quality measurement and monitoring. Students then choose three options from 18, including research design and analytical methods, or introduction to health economics.
They are assessed by a 6,000-word essay on each module and a final 10,000-word dissertation, usually based on a small, workconnected, research project. Diploma students complete a 7,000-word report.
Most of the 12-20 students who enrol each year are aiming for an MSc.
At the Nuffield Institute for Health in Leeds, students can gain an MA or diploma in quality assurance in health and social care. Diploma students complete four three-day study modules, two compulsory and two optional, and an 8,000word dissertation based on a work-related project. Typical modules include: managing and evaluating organisational change, and ethical issues in health and social care.
Master's students complete six three-day modules, two compulsory and four optional, and write a 12,000-word dissertation on a workrelated project.
Keith Hurst, senior lecturer at the Nuffield Institute, says there has been no problem in moulding quality assurance to the clinical governance agenda. The principles of quality assurance remain the same and can be applied in almost any setting:
health, education or commercial. He stresses the importance of connecting work and the course.
In Chester the workplace emphasis has gone a step further, albeit not as part of a master's qualification. A practice development centre has been set up as a joint venture between Chester College of Higher Education and South Cheshire trust.
'The two work in partnership in the workplace to build quality assurance into the staff development programme, ' says senior visiting research professor, Roger Ellis.
He is heading a project on three surgical wards at Macclesfield District General Hospital, involving quality assurance, human resources and clinical staff. He says: 'It's much better if they learn about quality assurance and applying quality assurance techniques where they are working, so the thing makes sense to them, and that in turn links to staff development.'
The importance of quality assurance and its application mean that its principles are taught on most health-related master's degree courses.
Many institutions run short courses or one day events.
The Institute of Healthcare Management is running one-day courses looking at clinical governance in specific clinical areas.
2 IHM chief executive Stuart Marples says: 'The modernising agenda for the NHS is throwing up many challenges for managers and quality/clinical governance is clearly one of those challenges.Some of what managers need to know is simply factual. . . but some will require new knowledge, new skills.'
REFERENCES
1 Ellis R, Whittington D.Quality Assurance in Healthcare: a handbook. Edward Arnold, 1993.
2 IHM Toolkit for Managers on Clinical Governance . 1999.
www.ihm.org.uk.
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