Clare van Hamel, Associate Postgraduate Dean and Director of Foundation School.

Severn Foundation School (FS) has embraced quality improvement (QI) as a highly effective means of achieving improvement in a wide variety of areas. Clare Van Hamel, Associate Postgraduate Dean and Director of Severn Foundation School believes QI empowers individuals, in a far more effective way than audit, helping staff to address the concerns which are directly affecting them. Here she describes ways that other Foundation Schools can follow their lead to enable foundation doctors to identify concerns and develop solutions using a multi-professional approach. This blog is brought to you by BMJ Quality. For more quality improvement resources go to

Severn FS has been fortunate in having quality Improvement leaders as part of the foundation faculty. They have really driven the enthusiasm to use QI tools supporting foundation doctors to identify concerns. Here are my top tips to facilitate quality improvement in a post-graduate medical education setting

1. Identify trainee leaders to enable near-peer championing of QI.

Severn FS have appointed Foundation School Quality Improvement Fellows. Following allocation via FPAS to the Severn Foundation School, all incoming F1s are invited to apply in open competition to be the QI Fellow for the school. The appointee is given financial support to attend an appropriate QI conference and also invited to attend relevant regional/foundation school meetings during their tenure. F1s do not have study leave but the Trusts are asked to be as supportive as possible to facilitate attendance at meetings.

The fellow is identified as a QI contact point for the other foundation trainees. The fellow is supported and mentored by the F2 QI fellow and QI faculty. There is a little more flexibility during the F2 year for the fellow to attend conferences during their study leave time supported financially by the Foundation school.

2. Identify trainer QI leads

Severn FS has been fortunate in having faculty who are committed QI champions within the region both at consultant and senior trainee level. The foundation school has recently set up a sub-group led by one of those champions to help to promote sharing of ideas and outcomes

3. Trusts need to engage and promote QI opportunities for their staff.

Many of our trusts really encourage their foundation doctors to participate in QI work as teams; with many achieving approximately 80% participation. The trusts have seen the specific benefits of the QI outcomes leading to change but also more subtly the benefits of multi-professional working leading to increased morale and respect between different professional groups. Many of the Trust’s executive teams are recognising the significance of the QI achievements and are keen to develop and endorse the work.

4. BMJ Quality subscriptions

These licences have been purchased by the Foundation school to help to facilitate sharing and publication of the QI work that has been completed by the trainees within the school.

5. Opportunities to share the QI outcomes

Severn Foundation School runs an annual regional presentation day providing opportunities for trainees to showcase their work. As a result of the positive feedback from the regional event..

6. Severn Foundation School organises the National Foundation Doctors Presentation Day

This annual event provides an opportunity for Foundation Doctors from any foundation school to present their work. The national day has attracted an increasing number of submissions >300/annum for the last two years. This year the event was supported by HEE, UKFPO, the GMC, HQIP, the BMA and others.

 7. Encourage and support your trainees to submit their work

A very large number of our trainees have presented their work at National and International meetings. We have been over-represented compared to the size of the school at meetings such as the NACT/UKFPO Sharing Best Practice Meetings. We try to provide financial support for trainees to attend to present their work when possible and encourage trusts to release trainees to present at national and international events.

 8. Highlight achievements

The trainee and faculty achievements are highlighted on our website. These are subdivided into presentations, publications and other projects.

In summary quality improvement has enabled our trainees to deliver change within their working environments, in a wide variety of fields. The work has delivered a huge number of changes including better patient care escalation policies;  improved handover; safer prescribing of drugs and fluids; induction to F1 and F2 programmes; improved access to rotas and access to protocols. Much of the work has centred on patient safety but also on efficacy and efficiency. Many of the projects have produced considerable cost saving whilst also improving patient safety. What could most concisely be described as a WIN- WIN for all involved.

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