27 Jan, 15 | by BMJ Quality
In our last blog, Dr William Calvert wrote about the importance of teaching quality improvement in medical school. BMJ Quality recently received a quest to share a school student’s experience of a quality improvement project, and it has got us thinking – should quality improvement be taught even earlier? Here’s Abhinav Bhatia’s view.
I’m a year 13 student at Altrincham Grammar School for Boys in Manchester and I plan to be an NHS doctor in future. While working as a volunteer in a district general hospital, I conducted a survey on smoking among hospital staff and started to think about ways to urge hospital policy makers to provide a better support system for staff smokers.
There are lots of support systems for patients who want to stop smoking. I’ve read many quality improvement projects focused on this, but I was really surprised to see so many staff smoking during my hospital placement and I wondered if they were accessing those same services – perhaps as medical staff they felt less inclined to attend a session where they might see their patients? The need for an opportunistic promotion of health when a patient is admitted into an acute hospital was highlighted by Sarah Cousins, who designed a checklist clerking document to enquire into four life style risk factors, including smoking, alcohol, obesity, and physical activity, so that appropriate support can be offered. Gary Bickerstaff in his recent Quality Improvement Reports publication entitled ‘Smoking cessation for hospital inpatients‘ introduced a pathway for identifying and supporting inpatient smokers. The key success factor was dependent on training large numbers of existing core healthcare staff to deliver an intermediate level of smoking intervention, rather than relying on a handful of “smoking nurses” to provide satellite services that leave a huge gap in opportunities outside their limited working hours.
Despite the quality improvement pathways that are being put into place for inpatient smokers, NICE recommends that smoking cessation is actively promoted among hospital staff who smoke. This is particularly important if we are to promote the health of the nation as a whole, and support the government’s Tobacco Control Plan.[3,4]
I designed a one-page questionnaire for my survey with guidance from a consultant physician and advice from research and development. I conducted five-minute face-to-face interviews with 103 hospital staff, chosen at random to ensure that I had included most staff groups.
My survey showed that 14.6% of hospital staff currently smoked as compared to 20% in HSCIC statistics (published August 2014). 24.3% of the participants were previous smokers, similar to HSCIC statistics (25%). Among current smokers, the non-clinical group (porters, security, domestics, catering staff, and volunteers) accounted for the highest percentage (46.7%), followed by nurses, health care assistants and other clinical (39.9%), then 6.7% administrative staff, 6.7% managerial and 0% doctors. None of the current smokers were in contact with hospital or community SSS.
46% of current smokers were non-clinical staff, followed by nearly 40% among nurses and other health care workers, as shown in other studies.[5,6] The latest national data (HSCIC) showed that the smoking rate was highest and rising among routine or manual workers (33%). My survey results are consistent with this, with a 35% current smoking rate among non-clinical staff such as porters, domestics, security staff, and caterers.
There is a need for an innovative approach with more proactive, friendly, and non- judgmental methods to identify and target those vulnerable staff groups who may find it intimidating to contact or attend hospital SSS. As many frontline clinical staff should be trained to provide brief interventions (5-10 minutes), making it more accessible to fellow staff smokers in all work areas, at all times. Those who decline referral should be offered prescription for licensed nicotine-containing products by trained health personnel within their work areas, along with other support advice. I’ve discussed these findings with my consultant supervisor, and I know that by engaging stakeholders by sharing my data and highlighting the NICE guidance, this is the beginnings of a quality improvement project.
Hospital policy makers need to do more to promote the health of more vulnerable hospital staff. It seems hypocritical not to do this in an environment that otherwise promotes health for patients themselves. Perhaps it is now time to include issues relating to staff health such as smoking, alcohol, and obesity in mandatory hospital training programs. I’ve shared my data with the hospital and I’m hoping that the next steps will be implementing some of my suggestions. It just proves that even before medical school, if you’re pro-active enough and understand the principles of quality improvement, then you really can start early!
- Sarah Cousins. Checklist clerking document improves health promotion among medical admissions. BMJ Quality Improvement Reports 2013; u202209.w1218 doi: 10.1136/bmjquality.u202209.w1218
- Gary Bickerstaffe. Smoking cessation for hospital inpatients. BMJ Quality Improvement Programme. BMJ Qual Improv Report 2014;3: doi:10.1136/bmjquality.u204964.w2110
- NICE Public Health Guideline PH5. Workplace interventions to promote smoking cessation. May 2007.
- NICE Public Health Guideline PH48. Smoking Cessation, Acute, Maternity & Mental Health Services. 2014.
- Davies PDO, Rajan K. Attitudes to smoking and smoking habit among the staff of a hospital. Thorax 1989; 44:378-81.
- Hussain SF, Tjeder-Burton S, Campbell I A, Davies PDO. Attitudes to smoking and smoking habit among the staff of a hospital. Thorax 1993; 48:174-5.
- Health and Social Care Information Centre. Statistics on Smoking, England 2014. www.hscic.gov.uk/pubs/smoking14
- Bloor RN, Meeson L, Crome IB. The effects of a non-smoking policy on nursing staff smoking behaviour and attitudes in a psychiatric hospital. J Psychiatr Ment Health Nurs 2006 Apr;13(2):188-96.
Declaration of competing interest:
“We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.”
Dr M. Aziz. Consultant Chest Physician. Tameside General Hospital, UK