Quality Development - CLAHRC

NICE recommends to service commissioners that ‘A patient education programme for people with type 2 diabetes needs to be quality assured’ (1). The DESMOND collaborative developed a Quality Development (QD) process rather than ‘assurance’ as it recognised the need to be clearer about what could be delivered by educators and that this is an evolving process.

The need to develop the quality markers for the DESMOND programme was guided by the recognition that training health care professionals to deliver the DESMOND programme may not always result in their behaviour change to deliver a programme/intervention as it was designed to do so (2).

The Quality Development processes for the current DESMOND programme include both internal and external processes. The internal processes are focused on the educator undertaking personal and peer reflection on their practice following their initial training.


The external component starts with the initial training support and is followed by the application of external review tools (at predetermined times): The DESMOND observation sheet (DOS) is a paper-based assessment tool designed to assess the extent to which the content and process indicators of observable educator behaviours are being delivered. The DESMOND Observational Tool (DOT) is a quantative measure of who is talking at 10 second intervals and is designed to assess the interaction of the educator and the participants of the group. (3)


Collectively these tools help determine quality of the programme in an objective way.




1. NICE- Ensuring Quality Assurance
2. Pill R., Rees M.E., Stott N.C.H., Rollnick S.R. Can nurses learn to let go? Issues arising from an intervention designed to improve patients' involvement in their own care Journal of Advanced Nursing 1999 29:6; 1492 – 1499

3. Cradock S, Stribling B, Dallosso HM, et al (2010) The need for assessing reliability of quality development (QD) tools in structured self management education (SSME) programmes in diabetes. Diabetic Medicine (Awaiting paper)