An auspicious and sad occasion

Citation

Hurst, K. (2007), "An auspicious and sad occasion", International Journal of Health Care Quality Assurance, Vol. 20 No. 1. https://doi.org/10.1108/ijhcqa.2007.06220aaa.001

An auspicious and sad occasion

To mark two sentinel events – publication of Volume 20 Number 1, and Robin Gourlay’s retirement (founding editor in 1988 and later Editor in Chief), we review and republish some of the articles in Volume 1.1 and match them to manuscripts on similar topics 20 years later. We also asked one of Robin’s close friends, Professor Roger Dyson, to write a testimonial, which he did with his usual eloquence and humour. It is with great sadness, however, that we report Roger’s unexpected and untimely death only a few weeks after Roger completed the commission. Readers, I am sure, would have joined us when we sent our condolences to Roger’s family through Robin and Janet.

Hannu Vuori’s article in Volume 1 Number 1, as readers will see from its republication in Volume 20 Number 1, firmly grasped the QA implementation nettle. In a slightly offbeat piece, the author, a WHO R&D stalwart, underlined most issues facing QA managers, practitioners and academics – challenges that he felt were likely to invoke a gamut of responses, ranging from employee hostility to the QA manager’s pleasure of knowingly making a difference to healthcare services. The article turned out to be prophetic – the importance that commissioners would eventually attach to quality assured health and social care services; and the statutory clinical governance arrangements implemented in the UK following serious breaches of patient-practitioner trust such as the murders committed by Harold Shipman and Beverly Allet. Hannu also bemoaned the thin data sets necessary for supporting QA workers before going on to recommend some approaches. Twenty years later, we publish Elizabeth Murray’s and Rodney McAdam’s exploration of pharmaceutical QA theory and practice, and one that clearly shows how much road has been travelled in 20 years. They examine pharmacy industry quality management systems (QMS) and underline patient safety versus profit motive, hence the industry’s careful regulatory systems. Clearly, there is an overlap and repetition between in-house, mandatory and rigorous pharma QMSs and voluntarily adoption of a standardised, international QMS such as ISO 900:2000. Nevertheless, two important sidelines emerge from their article – the educational value of comparing QMSs; and how one accreditation system can learn from the other.

Jim Dummer’s article on health service performance and productivity never left managers’ agenda during the 20 years since publication. Indeed, productivity has experienced a resurgence in 2006 with the launch of several productive time initiatives (doing more with same resources) in the UK. Clearly, Jim’s article isn’t out-of-place in issue 20.1 even though the language has changed slightly. For example, he underlines the association between cost savings and QA – a stitch-in-time – saves-nine managerial approach. Jim also explored the shift from outputs to outcomes; once again, a hot topic in the twenty-first century NHS, although output is now called a target-driven culture. We parallel Jim’s article with Jaakko Kujala and his Finish colleagues’ report. Kujala et al.’s project is elegant. They take a fairly simple notion – improving operating theatre throughput. Simplicity, however, is counterbalanced with the number of confounding variables needing (but not easily) control (led), such as the patient’s readiness for surgery at short notice. Consequently, they develop and test a sophisticated simulation model that incorporates empirically determined operating theatre data. Using what-if scenarios, they are able to highlight the factors that explain variation in open-heart surgery throughput and suggest ways of improving operating theatre efficiency and effectiveness. Equally elegant are their recommendations – although some would say it is blindingly obvious, but it is always good to see recommendations underpinned by strong data and robust inferential statistics. For example, simply extending the theatre day’s length, while shortening the working week from five to four days is good way of reducing “down time”.

Steve Wright’s article in Volume 1 Number 1 described a relatively new nursing practice concept in the 1980s – nursing development units (NDUs). These units had several purposes, not least: increasing nursing autonomy, flattening the professions’ hierarchy and introducing primary nursing, where individual patients were cared for by a small nursing team. These were radical departures from traditional nursing that preceded NDUs, epitomised by task centredness (one nurse completes the same job for all patients – a production line in short). Nursing development units aimed to improve job satisfaction, nursing recruitment and retention, and most of all the quality of nursing in the so-called Cinderella services such as care of the elderly. Over the ensuing 20 years, many NDUs were established, accredited and monitored, and the NDU network is strong. The NDUs’ radical approach spawned other, autonomous nursing projects. Most expand and extend nursing roles. Consequently, it’s a great pleasure to pair Steve’s article from 20 years past with a recent one from a former IJHCQA editor, Sue Jackson and her colleague Gillian Morgan. Sue, as readers may recall, has a special interest and expertise in EFQM – knowledge that she and Gillian use effectively. Their case study – minimising the impact of coronary heart disease (CHD) on a particularly prone and vulnerable population using a nurse-led team, is well crafted. A bonus is the way the authors apply EFQM, notably RADAR, to increase the project’s success. So, not only can readers learn about the CHD project’s journey but also understand more about EFQM. Also, the case study is a lesson in mutual trust, collaboration and the alternating light and heavy hand-on-the-tiller approach required by senior managers and leaders. The importance of generating baseline data and realistic, short and long-term output and outcome targets is double-underlined. Reporting is honest – their warts-and-all description pulls no punches. Nevertheless, the article bristles with sound theoretical and practical guidance.

Finally, we turn to another article showing considerable foresight. The report by van Everdingen and colleagues has all the hallmarks of modern evidence-based care protocols. Their evaluation of blood transfusion policy guidelines was based on a systematic review of the literature and Delphi technique for added credibility. Twenty years on, Laurence Leigh and his colleagues take one step back from transfusion policy and describe good practice for attracting and retaining donors. The authors suggest their publication is unique. If not, then at least it is an intriguing insight into blood donor perceptions, donor care and recipient safety. This article also includes sound and practical advice. The authors focus on universities as a good place to attract donors and run blood drives. They apply marketing theory to explain behaviours, perceptions and recommend best practice. Readers also are given an intriguing account into some bizarre perceptions held by donors and non-donors, and also ethical issues surrounding donation. These matters are handled sensitively by the researchers and authors.

Twenty years on, 133 issues, approximately 665 articles and 3.4 million words later, typified by the high-quality and fascinating material published and re-published in Volume 20 Number 1, represents a marvellous testimonial to Robin Gourlay’s vision and hard work.

Well done Robin! All the IJHCQA staff wish you a long, happy and well-deserved retirement. Here’s to the next 20 years!

Keith Hurst

To echo Keith’s words above, I would like to congratulate Robin on a successful 20 years with IJHCQA, and a well-deserved retirement! Robin’s vision for the journal has helped to steer it to the place it now occupies – a leading peer-reviewed journal in the healthcare field. Robin has been ably assisted throughout his tenure as Editor by a number of co-editors; most recently, Keith Hurst. Keith has now taken over as Editor-in-Chief, with Kay Downey Ennis as Co-Editor – an excellent team who will, I am sure, drive the journal forwards over the coming years.

We would love to receive feedback on this commemorative issue, so please feel free to get in touch with Keith, Kay or myself at any time.

Vicky WilliamsPublisher