Table 2

A measure of organisational maturity in relation to governing for QI (QI maturity)

Dimension	Rating
1. QI as a board priority
Where does QI come in the agenda of board discussions?	High: Top of the agenda, for example, first item/included throughout/a specific standing item led by an executive director. Medium: In the middle of the meeting. Low: At the end of the meeting.
How much time is spent talking about QI?	High: Majority of board meeting related to QI. Medium: Some time given to QI. Low: Limited time at the board meeting related to QI.
Is time spent on QI elsewhere other than at the board meeting (eg, subcommittees)?	High: QI is dealt with predominantly at the subcommittee level with only points of escalation brought to the board meeting. Medium: QI is dealt with to some extent at the subcommittee level, for example, the subcommittee discussion appears to be fully reported to the board level. Low: QI is dealt with extensively at the board level, for example, discussion of all aspects of the subcommittee discussions.
Do board members undergo any formal QI training?	High: Formal training systematically undertaken. Medium: Training available and awareness of training but not necessarily taken up. Low: Limited or no QI training.
How much time is spent on QI relative to QA*?	High: Balance between QI and QA. QA monitored and when necessary actions taken that feed into QI. QI alongside QA, as an ongoing strand of discussions and focus. Medium: QA monitored and QI discussed but the balance is more towards assurance and there is not necessarily a well-managed link from QA to QI. Low: Predominantly QA.
2. Using data for improvement
Does the Trust use QI-specific data?	High: QI data available and presented to board members. Medium: Some QI data available and/or some QI discussion relating to the quality data that is presented. Low: No QI data presented and no QI discussion relating to the quality data.
To what extent is the use of data proactive rather than reactive?	High: Regular and consistent use of data. Medium: Some evidence of using data and/or some awareness of the need to move to a more proactive approach. Low: Searching for data only when there is a perceived need.
Are data presented in a meaningful format?	High: Data are used, interpreted and discussed. Format is readable. Medium: Data in a useable format but minimal interpretation. Low: A lot of data presented but unreadable and limited interpretation or discussion.
Are data used to inform actions?	High: There are clear actions derived from data. Medium: Some evidence of actions being informed by data. Low: Limited evidence of actions being informed by data.
Are QI data linked to other data (eg, staffing levels, sickness absence, throughput)?	High: Data are clearly linked and discussions about QI take into account all the data available. Medium: Data are linked to some extent. Low: Each source of data considered in isolation.
Does the board consider a broad range of data (eg, quantitative alongside qualitative)?	High: Broad range of data considered, that is, both quantitative and qualitative data. Medium: Predominantly focused on quantitative data (or one type of data) but aware and/or working towards a broader use of data. Low: Focused solely or predominantly on quantitative data and no awareness of the need or usefulness of a broader range of data.
3. Familiarity with current performance
Are the board looking at current performance frequently?	High: Monthly review of data, awareness and understanding of the data, for example, questions about the data are knowledgeable. Medium: Data reviewed less than once a month, lower awareness and understanding. Low: Data reviewed less often or not available. Limited understanding and awareness.
Does the board benchmark and compare with other organisations?	High: Comparative assessment with other organisations discussed frequently. Medium: Comparative assessments done but not frequent. Low: Limited comparative assessment with other organisations.
Is there an awareness of the data available and where data needed to be improved?	High: Highly aware of the data relating to overall quality of services and an understanding of what development is needed. Medium: Aware to less extent. Low: Aware to some extent.
4. Degree of staff involvement
To what extent are staff involved and prioritised in the production of QI?	High: Staff are fully involved, priorities identified and discussed with staff. Medium: Lower levels of staff involvement, some discussion takes place. Low: Limited involvement.
To what extent are staff involved directly or focused on by the board (eg, in board meeting discussions, agendas)?	High: Staff are involved in, or are the focus of, board discussion and agenda items. Actions and strategies are linked to staff, for example, considering the impact or highlighting the need to canvas opinion. Medium: To some extent. Low: Limited.
5. Degree of public/patient involvement
To what extent are patients and the public involved and prioritised in QA and QI?	High: Fully involved, priorities identified and discussed with patients/public. Medium: Less involved. Low: Limited involvement.
To what extent are patients involved directly or focused on by the board (eg, in board meeting discussions, agendas)?	High: Patients/public involved in, or are the focus of, board discussions and agenda items. There are actions and strategies in response to the concerns and experiences of patients/public. Medium: To some extent. Low: Limited.
6. Clear, systematic approach
Are there a manageable number of priorities that are clear and well specified?	High: Small number of priorities, readily apparent, clearly linked to actions. Medium: A larger number of priorities, less clearly articulated in terms of what they are and what the actions are. Low: A large volume of priorities, unclear descriptions and actions.
Are priorities predominantly driven externally?	High: Addressing external requirements while clearly prioritising internally led priorities. Medium: Addressing both external requirements and some internally led priorities. Low: Predominantly driven by external requirements.
7. Balance between clinical effectiveness, patient experience and safety	High: Attending to each aspect equally. Medium: Attending to each aspect but some are more prominent than others. Low: Not all aspects are being dealt with and they are very unbalanced.
8. Dynamics
How do board members challenge and ask questions of each other?	High: Probing questions alongside supportive comments and advice where relevant. Medium: To a lesser extent. Low: Repetitive questioning and discussion without timely resolution.

QA, quality assurance; QI, quality improvement.
*The aim of quality assurance (QA) is to ensure that minimum standards are being met and to deal with poor performance. It includes mechanisms such as quality monitoring and reporting, national standards, guidelines and targets.