Billy Boland: Lessons from a Quality Improvement geek

billy_bolandI’ve become somewhat of a Quality Improvement #QI geek in the last year or so. Since first getting my head around the concept, I’m now an enthusiast and have witnessed first hand how useful it is as an approach to improve services and the quality of what we do. I still firmly believe it takes time to get under the skin of what it is all about. The best way to learn for me was to get involved and have a go at improving something. I’ve been through the process a few times now and better appreciate why it can fit so well into healthcare.

My colleague Eddie Short @eddieshort25 says that clinicians have a head start on getting this, as the process mirrors our approaches to managing patients. I totally get that and thought I’d stretch the analogy for you here:


Patient Management Continuous Improvement/ Quality Improvement
Presenting Complaint A pressing issue impairing quality, a problem in a system or an issue to be over come
History Asking questions to understand why things are as they are. Capturing the narrative of the issues in more detail. Getting to grips with how the situation has grown to be like it is.
Examination and Investigations Getting useful, meaningful data about the status quo. What can be measured that will tell us more about what is going on?
Diagnosis Defining the issue—with a better understanding of the cause and how circumstances may evolve if no action is taken.
Management (evidence based, in response to the diagnosis) Interventions aimed at improving quality/ taking down barriers that are informed by this better understanding. Solutions can be tailored to the situation or drawn from elsewhere based on evidence.
Review—take further history/ re-examine/ investigate as appropriate. A review of progress after a period of intervention. How are things now? What do the measures show? Do any changes need to be made to the plan? Has the situation (patient) improved or gotten worse? Do you need a second opinion?


I’ve found thinking about these things as transferable skills has helped me in surprising ways. I feel like I’m more able to problem solve and anticipate challenges using my clinical head, and then plan for these. And if things aren’t going to plan, I am less stymied by a sense of personal failure—sometimes patients deteriorate despite our best intentions. At those times it is important to reassess and consider what changes could be made. Is a new strategy now required, or is there a new problem all together?

I really encourage you to take the time to understand more about quality improvement and think about how it might apply to you work.

Billy Boland is a consultant psychiatrist and associate medical director for quality and safety at Hertfordshire Partnership University NHS Foundation Trust. You can follow him on Twitter @originalbboland

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.