This page provides guidance, resources and hints & tips to those supervising Quality Improvement activity of QIPs
Getting started: QI Expertise is not important
If you have little to no knowledge about QI, ask yourself the following questions:
- How important is the topic?
- How much do we know already?
- Who do we need to involve?
These will assist you in overseeing a trainee.
Focus on what matters - keep to a clear time scale - don’t make it overly complicated
As a supervisor, you are the clinical content expert; what is best practice and why?
You know the people who can best support / join / unlock barriers; use this ability to assist your trainee.
Developing a department plan is a great way of assessing what we would like to fix. Understanding how this plan might breakdown into steps over time is a valuable consultant conversation to have.
Using QI methodology is a discipline that is needed in complex systems if change is to be safe and effective
As a supervisor, you need to know who in the Trust can support QI methods.
You should also know the basics - current situation review, the need to really understand what happens now (process map, walk through, analysis of what goes well and what doesn't, workarounds).
You should understand time ordered measurement principles (BP Chart analogy).
Whole teams build a better project and deliver improvement faster and in a way most likely to be sustained over time
What can my department do to embed QI in the day job?
CREATE QI CHAMPIONS
- Use national audits or other quality reviews to target key areas
- Have a department plan
- Work to ensure the new trainee can take over from the current one
- Support and champion sharing at local/ regional meetings
- Join a collaborative if there is one
- Keep your consultant colleagues on board
- Promote QI in all appraisals
- Take anything less than optimal outcomes/ audit/ other review seriously even if you don’t know how to fix it or have tried before
- Remain neutral on ideas but think of how you all might know they actually are an improvement and share this
- Read about Appreciative Enquiry and how it should be used to build a better team and reduce group think errors
- Be a champion for the patient- ask them what is not working and feed this back
The most important concept to grasp is that Plan, Do, Study Act is a sequence of small steps- it is fundamental to all QI methods
Adding a QI method into the current audit loop accelerates change and measures sustained progress - but it includes far more than just an action plan!
Devising an exercise in understand complexity
Ask your colleagues for ideas on the following:
92 year old was discharged home from ward following 4 day admission for pneumonia - what could possibly go wrong?
The answer is from experience (recent or past) that there are a lot of things that might not go according to plan; be overlooked, be forgotten in the rush to manage the practicalities of discharge, be lost in the hospital notes or the process of having investigations and getting results back. The list can be organized in several ways but a good way is to group the reasons in a way that makes sense to everyone- here a group of hospital doctors and nurses organize according to these three groupings – hospital, with patient and home/community.
We all know that any one of these problems can lead to an unsafe outcome and often one thing going wrong leads to another and another. Complex system are by definition joined in many variable ways with knock on consequences that may vary from patient to patient. A complex system is the hardest to understand and to improve.
What could you do to facilitate QI following an audit?
- Shorten the audit period (25).
- Train the audit team in QI (as additional support).
- Make sure the form clearly states QI, not just audit.
- Set a time to meet and review audit.
- Use presentation at M&M to crowd-develop the driver diagram.
- Support and enable an MDT to form around the project.
- Keep it simple / keep it focused.
- Work on part of the complexity to start with.
- Have (brief) weekly meetings - coffee, biscuits, encouragement.
- Agree actions - who, what, when, plan, do and test swiftly.
- Collect and display data.
- Find new ways to promote, recognise and encourage trainees.
What can be changed that will support people to join the improvement journey?
- How you come together.
- The approach to the dialogue.
- The data you have and how it is displayed, and the types of conversations are had around it.
- The size of the steps you take to build confidence when the risk is small.
- Recalling the journey so far to show that the effort is sustainable.
- Hearing the heartfelt pride in improving from patients & staff.
Sharing and Publishing –start with the end in mind
Support tips:
Within this PDF are some helpful hints and tips on supporting and promoting quality improvement as part of everyone's job every day. There is also a huge list of additional links and resources for you to explore.
Resources:
- Royal College of Physicians has been providing guidance for ten years or more as part of the Learning to Make a Difference programme, their guide is can be found here.
- This is a very useful guidebook; one for you and one for your trainee.
- This link takes you to a set of tools, guides, shadowing frameworks and examples.
- The Royal College of Emergency Medicine also offers a good guide, building on their early experience of requiring a QI project in their final years of training.
- The Royal College of Anaesthetists guide on what makes a good QI project is universally valuable.
- HQUIP is requiring audits to show improvement plans and results; this guide on engaging and involving juniors in this critical next step from an audit is useful.
There is also a wealth of resources available through the PDF file linked above.