professions, particularly in relation to communication. Consequently, there is an increasing focus on applying quality assessment methods that are underpinned by a more improvement-based philosophy. To demonstrate a practical example of using an improvement-based approach to quality assessment, I will describe the system we are working with in the Royal College of Nursing.
The RCN Dynamic Standard Setting System
The Dynamic Standard Setting System (or DySSSy, as it is known) is one example of a practitioner-based approach to quality improvement. It has evolved out of the work of the Royal College of Nursing's quality improvement programme, which was first set up in 1985, with the initial remit of developing a framework and a methodology which practising nurses could use to define and evaluate their own standards of patient care.
The philosophy adopted in developing this approach reflects a model of achieving quality through involvement and collaboration. This philosophy was first made explicit in a publication titled 'A Framework for Quality' in 1989 (Kitson, 1989). It is from this starting point of a basic philosophy and framework that DySSSy has developed as a system for quality improvement which practitioners can use to translate quality into their own clinical practice. It is an example of a criterion-based standards and audit system and it provides practitioners with a template which they can use to apply the quality improvement cycle of defining, implementing and auditing standards and introducing appropriate corrective action.
