1. Engaging trainee doctors in Quality Improvement
Dr Anna Winfield

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

3. 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

4. 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 .

5. 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!

6. 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

7. 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

8. 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

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

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

12. 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!

13. 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

14. Attendee feedback

15. “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”

16. 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

17. 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!

18. For more information Improvement academy website:
Consultant QI training
150 Improvement fellows across Y&H working with the improvement academy
Please feel free to contact me for more information: