Dr Marc Wittenberg

Dr Marc Wittenberg

Dr Marc Wittenberg gives us a personal view of what Quality Improvement is, ending with some top tips for those interested in starting a project. This blog is brought to you by BMJ Quality. For more quality improvement resources go to quality.bmj.com

I have recently, albeit temporarily, taken the leap from full-time clinical medicine, into a world of strategy, policy and thinking on a completely different level, and one which is not normally evident to a jobbing senior anaesthetic registrar. As one of the National Medical Director’s Clinical Fellows, I have joined the BMJ and NHS England on a one year secondment and will be spending a significant proportion of my time with the BMJ Quality team.

Prior to starting this post, my days (and nights) were filled with talk of service, examinations, audit, CV improvement, recounting individual clinical tales and the, occasionally dark, humour and banter that enables a hospital to churn on despite the challenges that face us. In sharp contrast, the conversation is now dominated by the latest concepts in Quality Improvement (QI), project management and change management.

Why so different? Well, it is actually not, but I now feel that I have the luxury to step back and look at the picture from a different perspective.

To illustrate this, I had an experience that made me realise that all it takes is a small adjustment in thinking: I still do the occasional shift in hospital in my own time to keep my feet on the ground, and one recent weekend, I was sitting in the intensive care unit coffee room, chatting with a consultant. He happened to remark that one of the trainee doctors had gone off to insert a central venous line into one of the patients, but had been gone a rather long time.

On his return, the consultant asked the trainee why it had taken him so long. He bashfully admitted that the actual procedure had not taken more than 15 minutes but that it was all the other tasks: finding the kit in the store-room, forgetting something then walking back up the corridor, having to ask the busy nurse to fetch something and having to rely on his memory to make sure all the items that he needed were there. “Wouldn’t it be great,” the consultant mused, “if we had a rapid access central line box, ready to go in the store-room?”. And there the conversation was left.

A few minutes later, it struck me that what the consultant was describing was Quality Improvement in its most usable form: they had identified a problem and a solution but had not yet made the connection between the two. It is all about the mindset, the shift from evidence-based medicine and audit where we now know what we should be doing, to guaranteeing that we are doing things right. This transition to the making the science of QI an everyday part of all healthcare workers’ lives is relatively new and sometimes requires its relevance to be realised.

For me, it was only through making the leap that I have done to realise the importance of QI to good patient care and it is vital that the message is spread: it does not just apply to large system changes or transformations, but QI is at its best at the coalface through often simple, usually cheap, and relevant projects that can make a big difference.

Through learning the relevant improvement skills and tools, all clinicians can, and should, be able to engage in Quality Improvement to ultimately improvement patient care.

So, here are my 5 top tips for quality improvement:

  1. Make the link: the ideas for QI projects often come from either things that you have noticed at work that you would like to change, or situations where someone’s answer to your question of ‘why do you do it like that?’ is ‘because that’s how we have always done it’.
  2. Keep it simple: often, the most effective QI projects are the simplest and cheapest.
  3. Get a mentor: think about who this should be – it could be a colleague, a supervisor or even someone that you have never worked with before.
  4. Keep talking: work out who is important to the success of your project and get in contact early, preferably in person. Buying someone a coffee never hurts!
  5. Publicise it: once you put the work in, get the message out in whatever you can. You will undoubtedly inspire other people and people will appreciate the hard graft that you have put in.

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