Quality Improvement (QI)
What is it?
In the NHS we deliver healthcare to patients, however our system is not perfect. There are always improvements that can be made to the way in which we work which will benefit patients and staff. As clinicians we want to be able to deliver the best care we can to our patients however this is not always easy and is particularly challenging in the complex nature of the NHS
Quality is a degree of excellence in healthcare which encompasses healthcare being safe, effective, patient-centered, timely, efficient and equitable.
Quality improvement is a process which aims to make a difference to patients by improving safety, effectiveness and experience of care by using the understanding of our complex healthcare environment and applying a systematic approach. It requires designing, testing and implementing changes using real time measurement for improvement.
All doctors need to be able to demonstrate a commitment to improving the quality of care we provide in the NHS. Quality improvement is a core component of the CREST form and all postgraduate training curriculums.
Expectations:
At a junior level e.g. SHO you are not expected to lead a project but to learn methodology and start to develop a curiosity in improvement capabilities within the NHS.
Once you become a registrar you are expected to take on a bigger role and potentially start to lead projects within your department.
As a consultant you are expected to be leading projects and supervising junior colleagues with their projects
What skills do you need?
Enthusiasm
Optimism
Curiosity
Perseverance
Interpersonal skills
Teamwork
Time management skills
The Difference between Audit, Quality Improvement and Research
Most doctors have been involved in audit, quality improvement or research at some point in their careers although the terms can often be confused and used incorrectly.
Audit: How are we currently performing?
Audit, in simple terms, compares the current practices in the department to an agreed standard of care which is often set out in local, national or international guidelines.
Quality Improvement: How do we improve our performance?
Quality improvement does not require a set standard, however describes the process of change when trying to improve patient care. It identifies a problem (which may have been identified during an audit) and works on processes within the department to improve patient care. Some quality improvement projects directly impact patient care by improving patient care e.g. falls prevention strategies, however others indirectly improve patient care by improving the systems that we work with. Quality improvement can involve a breadth of topics from preventing adverse events, reducing human factors, sustainability, education, wellbeing and more.
Research: What new knowledge can we discover?
Research seeks to find an answer about the best options to improve health and care for all of us. It starts with a hypothesis about which the answer is unknown or not fully understood and then utilises a process to try to answer this question. It can be quantitative or qualitative. It also often involves an ethics process for participants.
Origins of QI
Modern QI methods come from the work of Mr W. Edwards Deming, He was an engineer and statistician who after World War II championed the work of an earlier statistician, Walter Shewhart. This work focused on industrial quality control, and the use of the ‘Shewhart Cycle’ to maximize learning from changes to processes. Shewhart Cycles became PDSA (Plan, Do, Study, Act) cycles.
A group of individuals who had studied under Deming formed Associates for Process Improvement (API) and worked with other organisations to improve their processes. API built upon these by developing the Model for Improvement (MFI), a simple yet effective tool to bring about positive change.
Although the original methods were designed for industry, they can in theory be used to successfully improve any area. They are particularly useful in complex systems such as healthcare where the way to improve isn’t always obvious and there may be multiple influencing factors.
Don Berwick was the first person to establish the use of Deming’s methods in healthcare. He was a paediatrician who in 1991 founded the Institute for Healthcare Improvement (IHI) in Boston, USA.
Quality Improvement Processes and Tools
Most QI projects require the use of methodology to show the process that you have completed. This also helps you to understand the system in which you work more and where its flaws are. Not all tools are needed for every project but you might find some of these helpful.
8 Stage Change Model - The Steps of QI
Driver Diagrams
Force Field Analysis
Step Back Process
Model for Improvement and PDSA cycles
Run Charts and Data Collection
Completion of your Quality Improvement Project
Following completion of your Quality Improvement Project you may wish to present your project at a conference. This can be useful to gain points for applications and adds another skill into your repertoire. You will need to write up your project including the tools that have been used to demonstrate the project aims, drivers, and measures. Most conferences will ask you to submit an abstract of your project to them for evaluation. If successful you may be asked to provide a poster or oral presentation of your project. It is useful to discuss this with your supervisor prior to presenting as they can check your poster/presentation and provide feedback that may be useful.
