NHS boards have very clear roles. They must ensure governance arrangements are sound, probity and propriety are to the fore, a strategic steer is given to the executive team and staff, the executives are held to account and supported, and there are clear and effective performance management mechanisms.

As a board, we must have assurance that there are appropriate quality mechanisms in place, and that these are being pursued rigorously and effectively. It is for the executive team to deliver on the detailed operational aspects of this - but as a board, we require a method of obtaining assurance that it is being done.

Improvement and quality

My board set up an improvement and quality committee in 2005. As chair of the committee at the time, I found it difficult to get an answer to the question: "What are the various strands of quality assurance/performance management that this committee needs to have reports on, in order to be able to give to the board the assurance that they are seeking?"

Eventually, through a positive and constructive executive/non-executive discussion, we arrived at an agreed statement, which is summarised in the following diagram.

*081211/diagram/board talk

There is insufficient space for me to take each element in the diagram in turn - but let me take a few by way of example:


We have adopted - and adapted - the Citistat process developed in Baltimore, US, as a scrutiny mechanism to report on key performance measures. We have two regular Taystat meetings - the chair's scrutiny meeting and the chief executive's performance meeting.

The former uses a range of measures across all the activities of the local health system to provide a guide to the performance of the system and to highlight and address any perceived problem areas. The latter focuses on management processes and identifies problem areas for action.

Best value

In the context of the Scottish government report Better Health, Better Care - best value and continuous improvement, the board agreed that the principles of best value should be addressed through the work of all board committees.

Patient focus and public involvement

The lead for patient focus and public involvement provides an update on action plans on a quarterly basis to the improvement and quality committee.

Our patient focus and public involvement operational group is responsible for completing the performance assessment framework and the local delivery plan measures, which are monitored and reviewed externally by the Scottish Health Council.

Public partnership group members attend the improvement and quality committee and our community health partnership committees to provide a patient/public focus.

Infection control

Preventing and controlling healthcare-associated infections is a high-profile priority issue for NHS Scotland.

The infection control agenda in Tayside is driven by a healthcare-associated infections network, which is chaired by the chief executive and has members from across the delivery unit.

This committee reports into the Tayside improvement panel each quarter and to the improvement and quality committee of the NHS Tayside board every six months.

The operational performance of the delivery unit is further scrutinised at monthly performance monitoring meetings attended by senior clinical managers, including infection control staff. A balanced scorecard tool is used to highlight key areas, including hand hygiene compliance rates and surgical site infections.

In addition, the lead clinician for infection control provides updates on healthcare-associated infections to our delivery unit executive management team on a monthly basis.

As a board, it is incumbent on us to be concerned about improvement and quality. Improvement does not usually happen in blinding flashes of inspiration. Rather, it tends to happen incrementally. By implementing the above arrangements, we at NHS Tayside believe we are on the right track to benefit the public.