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# 3 How do I determine improvement and identify progress?

Having explored the notion of ‘service’, you are ready to reflect on the terms improvement and progress. The two terms are not quite the same thing. Improvement implies a direction, working towards stated aims, and a new state of affairs. Progress is more about the monitoring of events, experiences, behaviour or outcomes to gauge whether a service is going in the right direction.

It is notable that key aspects of healthcare quality and quality improvement do not include cost (The Health Foundation, 2013). In other words, we should work towards an ideal. However, quality is a slippery concept and relates to that which is valued in any given context. In medicine, this focuses upon the best possible health outcome in the light of current medical knowledge. You are left to debate what constitutes an outcome. Quality improvement may focus on some or all of the following:

- patient experience
- effectiveness of the intervention
- efficiency
- timeliness
- safety
- equity.

It can be valuable to first clarify your own understanding of improvement associated with the service with which you are most familiar.

## Activity 3

Consider the different ways in which improvement might be conceived using the examples in the list below:

- working faster enabling more clients to benefit from the service
- working in a more coordinated way with others
- working more sensitively with others
- negotiating the plan of action-enabling client choice
- demonstrating that the service is based upon robust evidence
- using your skills to strategic purpose and better effect
- managing financial resources to better effect
- using technology to better effect
- making the service transaction more transparent
- keeping better records
- working demonstrably with standards, protocols or policies
- feeling professionally fulfilled in the work delivered.

Is one or more of these important for notions of improvement in your healthcare setting? Make a note on why one or more of these might apply to your service improvement and then add any relevant improvement criteria that have not been suggested here.

Then share your thoughts with someone else who knows your healthcare setting, perhaps a colleague or a fellow patient or service user.

Improvement criteria that I accept and why

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Other improvement criteria that I have identified

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### Discussion

Inviting other people to look at your chosen criteria for improvement requires a little trust, even if you are careful about who you share your notes with. However, to support the Socratic principles that were outlined earlier, this is necessary in order to learn through discourse or discussion. Simply completing your reflections will not necessarily lead to new insights. You need to gather in and respect different perspectives.

◄Contents►Next: 3.1 Indicators of improvement

OpenLearn - Understanding service improvement in healthcare
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