Managing quality in healthcare seems like a rather sedate affair in the academic literature, but in my experience it's more like trying to control a herd of wild horses! Sounds a bit dramatic I know, but this is how I see it when I reflect back on my service management days. My observations suggest quality management is as unpredictable today. Probably more so.
The wild horses I'm referring to are the Six Dimensions of Quality - timely, safety, person centred, efficiency, effectiveness and equity - a framework widely used in the NHS. While the Six Dimensions framework has its origins in the USA health sector, the versatility of the framework makes it applicable to most service sectors. Personally I find the framework a useful way of making sense of quality, particularly in situations of high complexity.
In Scotland the Scottish Government sets the strategic direction for improving quality in the NHS. A few years ago the spotlight was on improving waiting times for treatment in cancer services and for surgical operations such as in hip and knee replacements (the timely and equity dimensions). Things improved and waiting times became shorter. The focus then moved to ensuring services were safe, effective, efficient and person centred.
I can understand why different dimensions are selected for closer attention at a strategic level. This prioritisation allows additional resources to be targeted at areas identified as needing improvement. However the closer you get to the people you serve, the more unpredictable the management of quality becomes. Rather than being selective, there's a need to keep a watchful eye all six dimensions simultaneously.