Skip to main content

Research and Projects

PenCHORD - Quality impact in healthcare system change

Who is involved?

Theme: PenCHORD
Status: Complete


Quality Impact Assessment (QIA) was instigated by the National Quality Board in 2010 as a way of ensuring high patient care standards during the large-scale NHS restructuring process and the accompanying cost reduction required by national Government. QIA is used as part of the decision making process for cost improvement programmes (CIP’s) in addition to the standard business case presented with proposed CIP’s.

A tool to facilitate the QIA process was designed by Simon Polak, Head of Nursing and Quality at Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG). The Quality Equality Impact Assessment (QEIA) tool uses subjective evidence informed scoring of a CIP’s impact on patient safety, treatment quality and patient experience to produce an overall score of a CIP’s potential impact on the quality of care.

PenCHORD was approached to produce a report assessing the QEIA tool in terms of validity, usefulness and appropriateness. The initial QEIA tool appraisal project formed the basis for this second project that sought to understand quality in relation to the QEIA process. This included defining quality, measuring quality and modelling subjective judgements of quality.

Aims and objectives

Stage One – QEIA tool validation and improvement project

Research aim:

To review the QEIA tool and suggest changes to improve the validity, appropriateness of measurement, usability of the tool and develop future directions for research and use of the QEIA tool.

Research objectives:

  1. Independent assessment of the measurement mechanism employed by the QEIA checking for validity, consistency and appropriateness.
  2. Assessment of the QEIA tool in relation to survey/assessment tool construction best practice.
  3. Suggestion of immediate changes that can be made to improve the tool and the development of a short to long term research plan for future research.

Stage Two – Scoping project for research into quality impact assessment and further development of the QEIA tool

Building on the changes to the QEIA tool and the further research ideas proposed in the stage one project report, the objectives of stage two were:

  1. To conduct a scoping literature review of quality definition and measurement
  2. To develop a method to model subjective judgements of quality as used in the NEW Devon CCG QEIA tool.


Stage one of this project reviewed the QEIA tool and suggested changes to improve the validity, appropriateness of measurement and usability of the tool. Stage two focused on a scoping literature review of quality definitions applicable to commissioning, measurement mechanisms for quality and the modelling of subjective judgements of quality.

Quality of care has become an increasingly important issue for the NHS. Quality impact assessment is a process by which changes to service provision are assessed in terms of their impact on quality of care. However, the definition and measurement of quality is problematic and a topic of debate. The report begins with a discussion about definitions of quality of care and how quality is measured. Finally, an approach is outlined for modelling and evaluating subjective assessments of expected impact of health service change on quality of care.

The multidimensional nature of quality makes it difficult to define in a general and useful way. Some definitions are too specific and some too general. Finding a definition that balances specificity and generalisability has proven difficult. The definition and set of dimensions from Heenan et al. (2010) stood out due to it being designed for use at the board room/commissioning level, this is discussed further in relation to defining quality of care.

Determining which measurement approach to use to measure quality in the context of quality impact assessment is relatively straight forward compared to defining quality. An objective measurement approach requires extensive data collection and highly specific dimensions with measurable aspects. This would be impractical in relation to prospective quality impact assessment. In this context, the use of a subjective measurement approach is more practical.

Substantiating and evaluating subjective measurement mechanisms is not a quick and easy process. The SERVQUAL approach is used to measure service quality using self-report. This approach treats quality as a solely subjective concept making it more amenable to use with quality impact assessment. An abstract model is presented in the report, outlining how the SERVQUAL approach can be changed to describe user satisfaction agreement with expected impact on quality of care assessments.

View more PenCHORD projects


Simon Polak, Head of Nursing and Quality, NEW Devon CCG


  • Stage Two Report - PDF
  • Extended Executive Summary - PDF
  • Stage One Report - PDF