Five key learning points about quality improvement

Last month a number of the ASPH team were fortunate to complete the ‘Improvement Coach Professional Development Program’ run by the Institute for Healthcare Improvement (IHI).

The course is a 12-week programme, designed to further develop improvement knowledge and skills in coaching and facilitating improvement teams.  It was a great course and the latest in a number of opportunities made available to members of team ASPH as we continue to grow the QI expertise within our organisation.

We asked one member of the ASPH team, Dr Peter Wilkinson, to share his reflections on the course as well as his top 5 learning points about QI.  We hope you find this helpful and let us know what you think in the comments section below.

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We can always deliver health care more effectively, more safely, more economically and with better quality.

If you believe that and do not think that we just need more money, staff and resources then Quality Improvement (QI) is for you; in fact it should be for everybody working in healthcare.

However many members of staff have good ideas about how to improve the delivery of care but do not know how to put them into action or try and nothing happens so they lose heart and give up.

I was fortunate to be asked to go on a short residential course run by the IHI to provide me with the skills and confidence to support and teach QI as well as completing the IHI online Open School course giving me a Basic Certificate in Quality and Safety.  The latter consisted of 13 modules each with 3 sections so now I feel that I have the tools to support the developing QI and ‘Be the Change’ programme at ASPH.

What were the main concepts that I learnt?

1 – There is a rigorously developed methodology around QI and if not followed change is unlikely to occur or be maintained. It is different from the approach taken in scientific research which relies on large study populations and a randomised design.

2 – All staff in healthcare, if asked in a genuine spirit of enquiry, will have ideas that they are keen to develop. In addition themes will be apparent in relationship to the strategic direction of the Trust which can influence the kinds of QI topics that are chosen.  However change imposed from the top for reasons that may not be apparent to those at the clinical front line are often not taken up or taken up grudgingly.

3 – These ideas may need a forum and a technique to bring them to the surface, such as brainstorming, affinity grouping and multi-voting. http://www.ihi.org/resources/Pages/Tools/BrainstormingAffinityGroupingandMultivoting.aspx

4 – This is the basic structure of the model for improvement with 3 key questions followed by a PDSA cycle.

Model for Improvement

What are we trying to accomplish is described by the ‘aim statement‘; a tightly crafted sentence which describes the aim as well as a numerical measure of improvement and a date to complete.

Measurement is key to QI as without it there will be no idea if a change has led to an improvement.  The basic way of showing this in QI is with a run chart but there are more sophisticated methods.

A run chart gives a temporal picture of changes in what is being measured and allows attempts at a change in a process have actually made an improvement.  If there is no improvement then the change should be stopped .  It is much better to admit to failure and learn from it rather than pursue an idea that just does not work.

The PDSA cycle follows with further cycles testing variations in the improvement being tested until a significant change is seen.

5 – Change occurs slowly at first testing potential improvements in small areas before spreading the change where appropriate.

Conclusion

Healthcare organisations that provide high quality and safe care are continually looking to improve the care they give.  Our talented staff have many ideas on how to make our care better and working with patients and using the methodologies that I have learnt I know we can harness their ideas.

Introducing this culture of QI takes time and effort and is not accomplished quickly but our Trust has started on this journey.”

Peter Wilkinson, Consultant Cardiologist, Ashford and St Peter’s Hospitals NHS Foundation Trust

 

 


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