How to Start a Good Quality Improvement Project
Love them or hate them, you’re going to have to take part in and design quality improvement projects (QIP) throughout your medical career.
Rather than fumbling through a half-hearted VTE audit two weeks before your ARCP deadline, put some time and effort into planning your QIP and you can gain points for your speciality application and even get a poster presentation or publication.
Where Do I Start?
The most difficult thing for many junior doctors when doing a QIP is deciding what to do. When you’re rotating through placements every 4-6 months, it’s hard to get settled and complete an entire project before moving on, especially if multiple cycles are required.
Whether you need to complete a QIP as part of your yearly requirements, or you’re just keen to score a few more points in your speciality application, start looking for opportunities as soon as you can in your new placement. Tell your educational supervisor that you’re hoping to complete a QIP while you’re at your first placement meeting and ask if there are any projects they think would be suitable. This is not only a good way to come up with ideas, but your consultant might signpost you to registrars, nursing staff, and other consultants who regularly take part in QIP and can guide you through your project.
Depending on your yearly requirements, another option is to join someone else’s QIP or repeat a cycle of a QIP which has previously taken place. Foundation year 2 doctors need to show “significant personal contribution” to a QIP, but this doesn’t necessarily need to be something you came up with yourself. Many projects are cut short after one cycle as their creator moved to another hospital.
MedProjectHub has many project ideas and collaboration opportunities that will count toward your ARCP requirements. Your local audit/QIP department may also have a repository of abandoned QIPs from your department – look and see if there’s an idea that takes your fancy.
How Do I Come Up with an Idea for a QIP?
If you want to create a project of your own, or you need to for curriculum requirements, how do you come up with an idea?
To figure out how to start your quality improvement project, you first need to find an area of your working life that you think could be improved. There are many different outcomes you can focus on that will help with the end goal of improving patient care, including:
- Time-saving measures for colleagues and NHS staff
- Enhanced staff or patient education
- Improved patient flow
- Increased clinical guideline adherence
- New patient safety protocols
Here are a few tips on coming up with a fresh idea for a QIP:
Notice inefficiencies.
Junior doctors have a unique perspective on how the healthcare system runs. Moving from placement to placement, sometimes across the country, gives you a bird’s-eye view of how each department handles its day-to-day activities.
When you start a new placement, keep your eye out for areas in which you think your team could perform better or more efficiently.
Ask around.
Every single department has issues which nobody has taken the time to solve. With the ever-increasing strain on the NHS, department managers just don’t have enough time to dedicate to solving these problems. When you arrive at a new placement, ask the permanent members of staff – nursing staff, ward clerks, ward managers, and domiciliary services – whether there are any areas that they think could be improved on.
Use Guidelines
Whether it’s from NICE guidelines, collegiate documents, or internal trust guidance, there are endless opportunities for quality improvement by using standards that are already available. While a clinical audit only measures your department’s adherence to a clinical standard, a QIP takes this further by measuring this over time and taking action to improve standards between cycles. Check out guidelines in your speciality to see whether there are easy to measure standards for conditions which you see commonly.
How Do I Perform a Quality Improvement Project?
Finding the right idea might be half the battle, but now it’s time to implement your fantastic plan. Depending on your ACRP requirements, you might be able to join with other trainees on your ward to make life easier at this point. Here are some tips for doing your QIP:
Be S.M.A.R.T
SMART objectives might sound like manager-talk, but by making the objective of your QIP S.M.A.R.T, you can focus on exactly what you want to change and save yourself time by being more efficient.
SMART goals are:
S – Specific
M – Measurable
A – Achievable
R – Realistic
T – Time-based
By using this structure for your QIP objective, you can avoid wishy-washy aims like “To improve prescribing in the acute medical unit” and instead give a concise target such as “To increase the percentage of AMU patients who are prescribed the correct dose of IV iron replacement for anaemia to over 90% by November 2023”.
PDSA Cycles
PDSA methodology is key to performing a good quality improvement project. It might even be a requirement to get your QIP signed off for ARCP. Each PDSA cycle gives you the structure to:
Plan – Prepare your data collection methodology including sample size, timing, and whether you will collect data prospectively or retrospectively.
Do – Collect your data.
Study – Analyse your data to give you a measurement of your key outcome.
Act – Interpret this measurement and intervene to improve on this number.
Once you’ve collected baseline data, made your first intervention, and completed one further PDSA cycle, you’ve “completed” your QIP (unless you’re required to do multiple cycles).
Present Your Project
Mandatory curriculum items such as QIP are often left to gather dust after the box has been ticked, but if you’re clever about it you can gain a lot from your QIP.
Many core and higher training speciality applications ask about QIP at both the application and interview stage and will assign you points depending on how involved you were and how many cycles you completed.
It doesn’t take much to present your QIP at a local meeting and might net you some extra application points. Get your methodology and findings down onto a PowerPoint and use this as your QIP report. You can even go one step further and turn it into a poster, which you can present at national QIP conferences for extra CV points.
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