When I say… quality improvement

Cork, Nick; Rooney, Kevin; Carson‐Stevens, Andrew

doi:10.1111/medu.13244

Cited by 4 publications

(5 citation statements)

References 4 publications

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“…A total of 72 projects (72%) led to improvements in clinical care, with 14% achieving their stated aim. Adherence to methodology was high: 75% had a 'SMART (specific, measurable, achievable, realistic and timely)' aim; 96% implemented at least one plan-do-study-act (PDSA) cycle (range [1][2][3][4], and appropriate run charts for measures occurred in 80% of projects. QIPs were categorised based on their outcome: self-help and self-care, 12%; efficiency, 16%; prevention and early detection, 14%; drug safety, 11%; improvement to pathways and protocols, 44%; and improving patient experience 3%.…”

Section: Resultsmentioning

confidence: 99%

“…Quality improvement (QI) is defined as the implementation of systematic and data‐guided activities designed to bring about immediate, positive changes in the delivery of health care in particular settings . There are calls for medical schools to integrate QI into curricula, as clinicians have an increasing role as health care improvers . Medical schools have a responsibility to enable student learning to an appropriate standard using evidence‐based pedagogical approaches.…”

Section: Introductionmentioning

confidence: 99%

“…1 There are calls for medical schools to integrate QI into curricula, as clinicians have an increasing role as health care improvers. 2,3 Medical schools have a responsibility to enable student learning to an appropriate standard using evidence-based pedagogical approaches. This includes learning how to develop new systems for practice, and nurturing creativity and innovation.…”

Section: Introductionmentioning

confidence: 99%

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Implementing undergraduate quality improvement

Martin

Wylie

Dubras³

et al. 2019

The Clinical Teacher

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Summary Background All clinicians need to have knowledge and expertise to undertake quality improvement (QI). In 2016, a London medical school initiated a core QI and evidence‐based practice module for fourth‐year students. We describe the structure and content of the module and analyse QI projects (QIPs) and student feedback. Methods We collected data on QIPs, including number and location, adherence to QI methodology and level of improvement achieved. We also examined end‐of‐module feedback with free text analysis of the written comments. Results A total of 398 students completed 99 QIPs: 90% were based in secondary care and 10% were based in primary care. A total of 72 projects (72%) led to improvements in clinical care, with 14% achieving their stated aim. Adherence to methodology was high: 75% had a ‘SMART (specific, measurable, achievable, realistic and timely)’ aim; 96% implemented at least one plan–do–study–act (PDSA) cycle (range 1–4), and appropriate run charts for measures occurred in 80% of projects. QIPs were categorised based on their outcome: self‐help and self‐care, 12%; efficiency, 16%; prevention and early detection, 14%; drug safety, 11%; improvement to pathways and protocols, 44%; and improving patient experience 3%. The implementation challenges encountered were: suboptimal supervisor preparedness; student time limitations; and difficulties with the virtual learning platform. However, the experiences that QIPs offered in preparation for postgraduate training were appreciated by students. Conclusions We have demonstrated that students are able to robustly apply QI methodologies, equipping them to act as agents for change, learning as they do, and meaningfully improving QI capacity and capability in local health systems.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementing undergraduate quality improvement

Martin

Wylie

Dubras³

et al. 2019

The Clinical Teacher

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“…Quality improvement (QI) as both a philosophy and suite of methods [ 15 ] has underpinned the design of major national preventive efforts to tackle sepsis internationally [ 16 – 18 ]. Recent perspectives on QI argue that in complex healthcare systems the design of improvement interventions risks being flawed if there is limited focus beforehand to gain a deep insight into how the system under study actually functions when things go right and wrong [ 19 – 26 ].…”

Section: Introductionmentioning

confidence: 99%

Participatory design of an improvement intervention for the primary care management of possible sepsis using the Functional Resonance Analysis Method

McNab

Freestone

Black

et al. 2018

BMC Med

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BackgroundEnsuring effective identification and management of sepsis is a healthcare priority in many countries. Recommendations for sepsis management in primary care have been produced, but in complex healthcare systems, an in-depth understanding of current system interactions and functioning is often essential before improvement interventions can be successfully designed and implemented. A structured participatory design approach to model a primary care system was employed to hypothesise gaps between work as intended and work delivered to inform improvement and implementation priorities for sepsis management.MethodsIn a Scottish regional health authority, multiple stakeholders were interviewed and the records of patients admitted from primary care to hospital with possible sepsis analysed. This identified the key work functions required to manage these patients successfully, the influence of system conditions (such as resource availability) and the resulting variability of function output. This information was used to model the system using the Functional Resonance Analysis Method (FRAM). The multiple stakeholder interviews also explored perspectives on system improvement needs which were subsequently themed. The FRAM model directed an expert group to reconcile improvement suggestions with current work systems and design an intervention to improve clinical management of sepsis.ResultsFourteen key system functions were identified, and a FRAM model was created. Variability was found in the output of all functions. The overall system purpose and improvement priorities were agreed. Improvement interventions were reconciled with the FRAM model of current work to understand how best to implement change, and a multi-component improvement intervention was designed.ConclusionsTraditional improvement approaches often focus on individual performance or a specific care process, rather than seeking to understand and improve overall performance in a complex system. The construction of the FRAM model facilitated an understanding of the complexity of interactions within the current system, how system conditions influence everyday sepsis management and how proposed interventions would work within the context of the current system. This directed the design of a multi-component improvement intervention that organisations could locally adapt and implement with the aim of improving overall system functioning and performance to improve sepsis management.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1164-x) contains supplementary material, which is available to authorized users.

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“…Education programmes must actively enculture collective motivation for improving health systems, rooted in medical professionalism, to realise the benefit of embracing improvement tools . It is therefore crucial that educators understand and responsively attend to the cultures of their learning environments.…”

mentioning

confidence: 99%