Starting a Quality Improvement Project
Identifying a problem:
The easiest way to identify the problem is to think about the job that you currently do and what might make your job easier or improve care for the patients that you are seeing.
There are a multitude of projects that could be started but the project you choose will be determined by your personal interests, values and past experiences. Any project is easier to complete if you have a personal interest in its completion as your motivation will be higher.
Think about what motivates you, what your career goals are and whether a project can be tailored to this even if you aren’t working in that department or specialty.
Some ideas:
Interest in respiratory medicine - may want to improve asthma care for patients either in emergency or inpatient settings
Built relationship with a patient with sickle cell who struggled with pain management - may want to develop sickle cell pain pathway
Previous prescribing error - develop a process so the prescription is easier to complete, errors are avoided
Minor annoyances e.g. finding equipment - develop packs/grab-bags to find equipment more easily
Use national guidelines to help you identify gaps in patient care e.g. NICE CT head guidelines for trauma
Define the aim:
Think about what you are trying to achieve with your project. Be SMART!
Specific:
Consider scope of the project:
What do you really want to target? How many aspects of care are you trying to improve? This should only be 1 or 2.
Consider the scale of the project:
How many patients will be affected by your project? Does it affect just your department or is there crossover into another area?
Measurable:
Your aim must have something measurable. Try to set a goal % to improve something by rather than a vague measure but keep the % reasonable i.e. it would be unreasonable to expect a process to suddenly happen 100% of the time when it currently only happens 5% of the time.
Achievable:
Is your end outcome achievable based on your current understanding of your workplace? For example, ensuring patients have pain scores recorded every 15 mins is unlikely to be achievable unless it is limited to a particular time frame.
Realistic:
Is it realistic that the changes you envisage could be achieved? For example, whilst theoretically possible that every patient with chest pain receives a CT scan on arrival into an Emergency Department, it would be unrealistic to expect this to be achieved.
Timely:
Set a reasonable date by which you feel the changes could be made by. Remember it may take longer than you initially think to change the way in which colleagues are currently working.
Small changes are more likely to be successful initially, so even if your project involves big changes, the aim is to start small and then grow the project.
Building a team:
Whilst QI projects can be undertaken by an individual person, it is often easier to make a difference with a team-based approach. Talk to colleagues about your project idea, quite often you’ll find others who are interested in what you’re working on or trying to achieve and then bring them on board to help with the project. Involve other healthcare professionals in your department to gain multidisciplinary views and also to gain a larger set of opinions about possible strategies for improvement.
Engage stakeholders:
Think about who your key stakeholders are with the project. Some of these may be obvious: patients, doctors, nurses, allied healthcare professionals etc. However it is worth considering the wider hospital stakeholders:
Other departments/specialties
Finance
IT
Legal
Patient Advice and Liaison Services
Local Audit Departments
Gain support:
Remember with any project you will need the backing of your department before you can make any changes so liaise with your consultant to ensure that the project is viable before you start. Most hospitals will also require you to register the project with the Audit Department so that you can receive their support with your project as well.
