In the example described, the group were able to demonstrate considerable improvements in care after the first complete cycle of evaluation, including more comprehensive and accurate nutritional risk assessment, better quality and choice of food for residents, improvements in food handling and hygiene and a reduction in disturbances during meal-times.
This approach to quality improvement was first published in 1990 in the form of a teaching package (RCN, 1990) which has been used widely across a range of clinical settings, both in the UK and overseas. The system has subsequently been updated and linked with a software programme, known as DQI Toolbox, which has been developed to accompany the criterion-based standards and audit programme.
Evaluating the impact of quality improvement
Whilst developing DySSSy as a model for practice-based quality improvement, we have also been involved in a number of research studies within the Royal College of Nursing (Kitson et al, 1994; Morrell et al, 1995; Harvey and Kitson, 1996) to evaluate whether implementing quality improvement systems such as DySSSy does actually bring about change and improvement in patient care. This a key question to ask of any quality programme since it invariably requires a considerable resource investment in terms of set-up costs and staff time, commitment and energy.
From the research completed to date, it does appear that improvement-based approaches such as DySSSy can realise benefits for clinical practice and patient care, through involving clinical staff and enabling them to implement changes in practice. However, it is also apparent that such change and improvement does not occur
