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What is Quality Improvement?
Quality improvement (QI) is about improving patient (and population) outcomes, system performance and professional development.
The Institute for Healthcare Improvement have adopted the Model for Improvement (MFI), which is the QI methodology we use here at NGH. The MFI is being successfully adopted in many healthcare settings to improve patient care.
More than the methodology, QI is about a change in behaviours, working together, change coming from the bottom up, creative thinking, and fundamentally, using measurement to guide improvement.
QI is distinctly different to audit and has been shown to bring about more sustained improvement.
Why should I care about QI? Is it relevant to me?
Yes! QI is relevant to everyone in the NHS (and beyond). We need to work together as individuals, teams, wards and as an organisation to effect positive change in the NHS. The buck doesn't stop with staff - QI is also for patients and visitors to the Trust as well.
If there is a process that you think could/should be improved in order to improve efficiency or reduce risk or harm, then get in touch! Our team works with staff across all divisions to support individuals on their QI projects.
How long will it take to complete a QI project? Will I have time to do it?
You will always have time for QI. How long it takes depends entirely on the project at hand. Some projects might be a simple 'quick fix', and we would support you in terms of ensuring you correctly measure the baseline and post-intervention effects, in order to make sure that the change made has had a positive impact. We will want to follow up with you on this in the future to make sure the change you made continues to have a positive impact down the line.
Some projects may be much more involved and could take months to implement and take forward. These bigger projects would have more support from the QI team in terms of project management as well as data analysis. You will always have time for QI.
We have plenty of resources to help you along the way, right from the start to the end. We can also help you publish your project, create posters and submit them to conferences.
Is QI not the same as IQET (improving quality and efficiency team) and Changing Care @ NGH?
In a nutshell no, the QI team encompasses IQET which focuses on service improvement and is part of the HR directorate. The Changing Care Programme Team was set the challenge to achieve a target of saving £12.125m through 5 work streams and reports to the Finance director.
The QI team's overarching aim is to reduce avoidable harm by 50% as well as delivering harm free cost efficient and effective care and report to the Medical Director and Director of Nursing as the guardians for Quality.
The QI team deliver the educational component for QI (lunch and learn through to MSC in Quality improvement).
To address future demands and ensure the delivery of this Quality Improvement strategy we have aligned our teams to strengthen and capitalise on efficiency’s | to provide good patient care and drive better models of delivery.
All QI projects are logged on the QI project repository to ensure alignment with corporate objectives and aims projects are then supported by IQET if it is a service improvement project or the QI team if it has an inference on patient safety, patient outcomes, educational development or the clinical pathway.
Isn't QI just another name for cutting costs and saving money?
No. Everyone is aware that effectiveness and efficiency are a huge part of the NHS right now; but this not the priority of the QI team. Our principal objective is to make our patients safer . Sometimes there is a financial gain associated with a project, but this is not the focus for carrying out that project. Most of the QI projects in the Trust are led by you, as it is the individuals on the wards/areas that are most likely to notice a process/system that is in need of improvement. Because of this, finances are not usually the driver for change.
What is an SPC chart?
A Statistical Process Control (SPC) chart (example above) allows us to monitor the performance of a current metric. They allow us to observe any trends over time - which is particularly important when we want to see the effects caused by an intervention in a QI project.
NGH use process control charts for QI projects as they allow us to determine if a process is stable.
Learn more about SPC charts on our QI Resources page.
What is the Model for Improvement (MFI)? / What is a PDSA cycle?
The Model for Improvement is a simple and powerful tool for accelerating improvement. It has been used successfully in hundreds of healthcare organisations across the globe.
The model has two parts:
1. Three fundamental questions (aim, measure and change)
2. The PDSA Cycle
It is imperative that we follow the MFI as it allows for a complete, well established project every time.
You can read more on the MFI and PDSA cycles on the QI resources page.
How will I know if my improvement idea will be supported by the Trust?
We will tell you! If a project will truly improve the safety of patients at NGH then the project will be supported by the Trust and is aligned with corporate objectives and aims. Sometimes we have to make sure the projects align with the vision and values of the Trust - so we may have to tweak your ideas a little to make sure this remains true.
Send us an email if you are unsure - we will be more than happy to help!
Is it a lot of extra work if I agree to lead on a QI project?
Yes and No. It depends on the project you are undertaking and how many team members you have working on your project. There is a QI Project Manager and a QI Data Analyst within our team who can support you as much as you would like - helping you move the project forward at a pace that is suitable for both parties.
You do not need to worry about data analysis or even on PDSA cycles too much as we can fully support you on all of that!
If you have a very large project in mind that fits into the vision and values of NGH then we can fully support you on that, even if it is a more long term project. We understand QI is not your main job role - and we appreciate the efforts you are making to improve the care at NGH.
How do I start an improvement project?
The best thing to do once you have decided to undertake an improvement project is to get in touch. Before you send us an email, you should read the QI resources page, particularly the booklets and guides at hand.
Is there someone that can help with the project plan and data?
Yes! If you need support with a project plan, contact the project manager (firstname.lastname@example.org). If you need support with data, contact the data analyst (email@example.com). Read more on our team on our Meet Our Team page.
How do I submit my work to conferences and poster submissions?
If you would like to submit your work to a conference, please contact us and we can get the balling rolling on a submission. They will be able to support you in terms of the physical submission as well as preparing the documents for submission.
What if the change I make does not lead to an improvement?
Sometimes we make a change that does not lead to an improvement - and that is okay! Not every change will have a positive effect - it is very important that we collect data before and after an intervention just for this reason. It allows us to quantify a change.
If the change didn't work out how you planned, you can either adapt the idea - make some alterations to the process/system that you have changed and see if these give you the intended result, or you can discard the change and start again.
The most important thing is to be open and honest about the data you collect. Nobody will mind if the project hasn't worked out as planned, we can put our heads together to see if we can remedy the change to get a positive outcome. Please do not hide data if things don't work out!
If you need help on this, please contact us.
Is there a difference between Quality Assurance and Quality Improvement?
Quality assurance (QA) is a reactive, retrospective policing tool which allows you to monitor performance against required standards (compliance). It is used to look back at what happened and determine the cause. QA relies on inspections to identify errors over a determined period (e.g. a month).
Data collection for assurance can obtain baseline information. In recent years there has been a shift from this traditional approach to implementing real time measurable changes using Quality Improvement. Clinical audit combined with QI can allow us to prevent these errors in the future by implementing change after an unwanted event/incident. Examples of QA measures are the KPIs on the Trust Board Corporate Scorecard.
Quality Improvement (QI) is a proactive approach to improves processes and systems. It is about continuous improvement in order to be above the required standards. QI is for everyone, and not a select few decision makers. Examples of some QI projects can be found on the current projects page.
Why do you use the Model for Improvement (MFI) methodology and not any other QI methodologies instead?
The MFI methodology has a proven track record in improvement. It is a robust, powerful methodology with a large amount of resources to support an individual in their QI project. The methodology itself is well conceived and easy to understand - making QI accessible to all those who are interested in improvement.
Although there are other tools, we prefer to use a consistent approach in our QI projects, which hopefully will mean everyone is on the same page throughout the Trust when it comes to improving our care.
We teach MFI methodology in the Trust - please contact us if you would like to receive training on this and on general quality improvement. The team can teach on a one to one basis or attend your team meetings.