Engaging trainee doctors in Quality Improvement Dr Anna Winfield

Contents What is QI? What are the benefits Ideas for involvement Contacts and further information

What is Quality Improvement? What does audit do? Measures what is actually happening Quality assurance process Quality Improvement? Understands why is it that we are not doing what we know we need to do Enables the possible to become reality in clinical practice Led by frontline teams Teams (not individuals) determine the outcomes for our patients

Model for Improvement Act Plan Study Do What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement Act Plan Study Do .

What are the benefit of junior doctors getting involved in QI? Ideas to improve patient care Don’t know how to put them into practice Junior doctors frequently rotate and often have seen a variety of different practices Patient care involves multi-disciplinary team – so should the team working to improve it! Patient safety is key to all specialties and practice Junior doctors are the “Eyes and ears of the NHS” Innovative and fun!

Examples of Junior Doctor involvement in QI QI forum at LTHT Safety huddles across Yorkshire and the Humber SAFE project in paediatrics Deteriorating patient project on J10 respiratory and L19 cardiology Screening for dementia in ophthalmology outpatient setting FY2 teaching in QI across Y&H International quality and safety forum

Improving escalation on Cardiology & MAU Plan Every patient NEWS of 5 to have a clear treatment plan Introduce a sticker to put in the notes highlighting to doctor that patient has high NEWS (alongside verbal prompt) Test this for the next 5 patients with NEWS >5 by sister Do Sister did this Study 5/5 patients had plan documented – but some missing vital elements e.g. blood glucose, escalation plan Act Adapt sicker to include these elements and re-test Wasn’t as simple as this as some drs didn’t fill them in – designed it will some – teaching session with drs

Patient Safety Checklist for NEWS ≥ 5 NURSE REVIEW NEWS Blood Glucose value………………………..………... Fluid balance monitoring Y / N Contact Outreach Y/ N Time .…….…….………... Nurse name …………………………………………... Date ………………………… Time …………….…… ------------------------------------------------------------------- DOCTOR REVIEW Obs Frequency: As per NEWS Other…………………………………………………… Need for sepsis bundle Y / N Escalation Plan reviewed Resus. Status reviewed Senior review needed Y / N Doctor name ……………............…Grade…………. Date………………………… Time ………………….. PLEASE DOCUMENT PLAN BELOW

Background to QI forum Survey to all trainee doctors in LTHT in November 2014 85 responses

Background Next steps Group of clinicians/ non clinicians QI knowledge Support from Medical Director Interactive presentations Publicise!

Establishing the forum Sessions were held after work Food and certificate of attendance provided Initial session to provide teaching/ develop QI knowledge Trainees given opportunity to present Attendance from Chief exec, CMO etc. INTERACTIVE!

How did it develop? Addition of trainee presentation – QI work in progress or example of work done Invitation to senior leaders in organisation Wider Trust involvement Provided food Invited medical students Multi-disciplinary

Attendee feedback

“Friendly presenters, interesting and informative talks” Word cloud “Friendly presenters, interesting and informative talks” “Really inspiring to see interesting projects going on in the Trust and how to get involved”

Next steps… Day-time session over lunch Email out slides Including role play Used to support QI teaching in Trust Continued engagement with Trust senior leaders Children’s Hospital QI forum QI surgery

Conclusion QI forum can lead to: Increased knowledge, networking, engagement “Collaboration - culture of innovation and safety” QI can assist junior doctors in the following: Developing skills such as: teamwork, organisation, time management, QI methodology, leadership skills Opportunity to try out and test new ideas Creative/innovative Feel empowered and boost morale!

For more information Improvement academy website: http://www.improvementacademy.org/ Consultant QI training 150 Improvement fellows across Y&H working with the improvement academy a.cracknell@nhs.net Alison.Lovatt@yhahsn.nhs.uk Please feel free to contact me for more information: Anna.winfield@nhs.net