Empowering junior doctors: a qualitative study of a QI programme in South West England

Abstract

AimTo explore how the South-West Foundation Doctor Quality Improvement programme affected foundation year 1 (F1) doctors’ attitudes and ability to implement change in healthcare.MethodsTwenty-two qualitative interviews were carried out with two cohorts of doctors. The first F1 group before and after their participation in the QI programme; the second group comprised those who had completed the programme between 1 and 5 years earlier. Qualitative data were analysed using thematic analysis techniques.Results Prior to taking part in the QI programme, junior doctors’ attitudes towards QI were mixed. Although there was agreement on the importance of QI in terms of patient safety, not all shared enthusiasm for engaging in QI, while some were sceptical that they could bring about any change. Following participation in the programme, attitudes towards QI and the ability to effect change were significantly transformed. Whether their projects were considered a success or not, all juniors reported that they valued the skills learnt and the overall experience they gained through carrying out QI projects. Participants reported feeling more empowered in their role as junior doctors, with several describing how they felt ‘listened to’ and able to ‘have a voice’, that they were beginning to see things ‘at systems level’ and learning to ‘engage more critically’ in their working environment.Conclusions Junior doctors are ideally placed to engage in QI. Training in QI at the start of their medical careers may enable a new generation of doctors to acquire the skills necessary to improve patient safety and quality of care.

Aligning quality improvement with better child health for the 21st century

“…In the UK, junior doctors' attitudes towards QI are mixed: while there is agreement on the importance of QI in terms of patient safety, not all share enthusiasm for engaging in QI. 4 Comparable studies in the US focusing on paediatrics have revealed that although national bodies have proclaimed the importance of incorporating QI into the daily fabric of clinical care, the evidence of practicing paediatricians participating in QI activities is much thinner. 5 It seems that health professionals, including doctors, are yet to be fully convinced of the virtues and value of QI.…”

Foundation doctors and quality improvement: frustrations from the frontline

“…The idea that clinicians should strive to promote patient care by actively seeking to evaluate and improve the service provided is well accepted by the majority of Foundation Doctors in the NHS. Participation in and contribution to the design of effective QI projects can be a source of great personal satisfaction, as well as provide benefits to patients and services 6. Understanding and applying QI methodology, in itself, have also been shown to empower Foundation trainees to be an agent for change in the workplace and improves perceptions of their professional role within a team 6 7.…”

“…Participation in and contribution to the design of effective QI projects can be a source of great personal satisfaction, as well as provide benefits to patients and services 6. Understanding and applying QI methodology, in itself, have also been shown to empower Foundation trainees to be an agent for change in the workplace and improves perceptions of their professional role within a team 6 7. A growing evidence base indicates that organisations who actively engage clinicians in QI have higher assessed staff medical engagement scores.…”

“…The participation of Foundation doctors in QI is desirable from both a theoretical and practical standpoint. The question thus remains: why is it that many Foundation trainees feel disillusioned and disengaged with the QI process?6 12…”

“…Yet many doctors or medical students, when asked to define QI or how they might embark on a QI project, demonstrate a lack of understanding, conflation with audit and/or research, or even scepticism. This persists despite efforts to educate all grades as to the benefits of QI in everyday practice 6 12 13…”