Culture change and mandating quality improvement

Abstract

Across the domains of knowledge, attitudes and motivations, there were no significant differences between the pre-intervention group and the comparison group. Pre- and post-intervention [mean (SD) median] there was a significant increase in overall QI knowledge [2.1 (0.76) 2.0 versus 3.2 (0.62) 3.0; p = 0.000]; however, by the end the FY1s were less motivated to complete the projects [3.9 (0.54) 4.0 versus 3.4 (0.91) 4.0; p = 0.02] and were less positive about them [2.3 (0.69) 2.0 versus 3.0 (0.77) 3.0; p = 0.005]. They felt that the projects were less important for their professional development [3.89 (0.66) 4.0 versus 3.1 (0.73) 3.0; p = 0.000] and were less likely to generate positive change in the long term [2.72 (0.61) 3.0 versus 3.4 (0.92) 3.5; p = 0.007]. Doctors perceptions [of QI] were evaluated to refine a mandatory programme DISCUSSION: Despite delivering a successful theoretical and experiential QI teaching programme with more trainee involvement, the results suggest that mandatory participation for the completion of training risks losing the innovative and creative force of junior doctors and, for some, reducing it to a tick-box exercise.

Analysis of the Interprofessional Clinical Learning Environment for Quality Improvement and Patient Safety From Perspectives of Interprofessional Teams

“…Existing studies show mixed attitudes toward and mixed impact of this increased emphasis within UME and GME, with more successful efforts requiring special attention to the mode of QIPS education and the educators selected. [23][24][25][26][27] However, through carefully designed curricula that emphasize QIPS in UME and GME and value the contributions of residents in these efforts, institutional initiatives can help change the perception of QI work from being a peripheral component of medical training to a more central component.…”

A peer‐led Quality Improvement Committee for Foundation doctors

“…Most NHS trusts seek to provide QI‐related teaching sessions to their trainees. In some hospitals, QI education programmes have been trialled and delivered in order to increase general knowledge around QI and inform practice, as well as to facilitate the achievement of yearly ARCP requirements . At our trust, the East Lancashire Hospitals NHS Trust (ELHT), QI teaching was further enhanced in 2015 with the appointment of a Quality Improvement Committee (QIC).…”

Introducing quality improvement in medical school

“…W e read with interest the article by Bartlett et al, regarding the introduction of a quality improvement (QI) programme for Foundation year-1 doctors (known as FY1s, interns or PGY1s [postgraduate year-1s]). 1 As fourth-year medical students at King ' s College London, we have recently completed a compulsory QI module in which we were responsible for identifying ineffi ciencies in a patient-centred process at our teaching hospital, and implementing suitable countermeasures. 2 Therefore, we feel that we can suggest ways to mitigate some of the barriers highlighted by Bartlett et al 1 The main challenge mentioned was the 'hardening of attitudes towards QI' caused by time constraints and the pressure to deliver, which is unsurprising given the heavy workload of FY1s.…”

“…1 As fourth-year medical students at King ' s College London, we have recently completed a compulsory QI module in which we were responsible for identifying ineffi ciencies in a patient-centred process at our teaching hospital, and implementing suitable countermeasures. 2 Therefore, we feel that we can suggest ways to mitigate some of the barriers highlighted by Bartlett et al 1 The main challenge mentioned was the 'hardening of attitudes towards QI' caused by time constraints and the pressure to deliver, which is unsurprising given the heavy workload of FY1s. 1 Moreover, given the clinical responsibilities of FY1s, QI may not have been viewed as integral to their career development or patient care, which explains why it may have been viewed as a tick-box exercise.…”

“…2 Therefore, we feel that we can suggest ways to mitigate some of the barriers highlighted by Bartlett et al 1 The main challenge mentioned was the 'hardening of attitudes towards QI' caused by time constraints and the pressure to deliver, which is unsurprising given the heavy workload of FY1s. 1 Moreover, given the clinical responsibilities of FY1s, QI may not have been viewed as integral to their career development or patient care, which explains why it may have been viewed as a tick-box exercise. As medical students we dedicated 1 day per week to QI, which included comprehensive training, a privilege not extended to FY1s.…”