Dr Mareeni Raymond is a GP in London, CCG lead for dementia in City and Hackney, and Managing Editor for BMJ Quality Improvement Reports.
Small and mighty. Good things come in small packages. From the tiny acorn comes the mighty oak tree. Small things, big wins. As a small person myself (I’m 5 foot – my partner tells me I’m actually shorter than that, but I’ve rounded up) I hear these sorts of statements a lot. We’ve just launched a campaign at BMJ Quality to highlight the wonders of all things small, because we are always struck by the projects that start with a small idea and make a huge difference to the care of people.
Take for example the #hellomynameis campaign. In Kate Granger’s blog last year she told us the story of how she has changed the way thousands of people introduce themselves to their patients, following her own experience as a patient. To introduce oneself by name is something so simple, but reminds us that we have a relationship with others as healthcare professionals that is much more powerful when personalised. She has inspired people around the world to change the way they see themselves, and change the way they present themselves to those people they are looking after.
At a talk I went to a few years ago, the speaker described a consultant in charge of a palliative care ward who was small and rather bedraggled looking, but who ran her ward with incredible passion, and whose junior medical staff were in awe of her for teaching them about compassion and how to deal with the sadness of families in distress when someone was dying. As a junior doctor, unsure of what career path to follow, I was inspired by that talk being rather of the same description (small – and bedraggled!); I really am a believer in #smallthingsbigwins! I manage the journal BMJ Quality Improvement Reports, and every week I’m lucky enough to read a new story of how a group of people got together, decided they wanted to fix something, and did it. Take for example the first report we have published this year, where junior doctors introduced a traffic light tool to categorise patients on the medical take as red, amber, or green according to their clinical status at time of admission to the acute admissions unit. Introducing this resulted in improved verbal handovers between doctors at the time of patient transfer. It’s simple idea, and one that any junior doctor could emulate in a new post. To find out how to run your own handover project, you could come to our next webinar and see how to start.
In the second article this year, a group of nursing students in Dundee, Scotland, did a small scale project to introduce a tool to screen for delirium in older people. The tool was a simple, short questionnaire that worked well, resulting in better identification of delirium by nursing staff and was then incorporated into nursing care ward round forms. From this small idea, a group of students have actually changed clinical practice, and their intervention will continue to be used even after their placement has finished – small things, big wins.
The beauty of the quality improvement reports we publish is that they don’t need to be complicated, filled with large numbers and lots of statistics. Take this project for example, where the authors introduced a patient information leaflet to dermatology clinics and used a small sample of 32 patients. They learned that new patients found the leaflet very helpful as it helped them to prepare for the consultation, whereas those who had been to the clinic before did not – and now all new patients receive this leaflet. Again, a small intervention based on a small study which has been embedded into the system long-term.
It isn’t just healthcare professionals who are doing quality improvement work. Caroline Dearson is a carer and volunteer who founded a Dementia Buddy Scheme after her own father’s experience of dementia. She knew that people with dementia needed a more tailored type of support, and set up the scheme from there. Now people with dementia on wards are better supported and she has a huge team of supporters and volunteers.
When BMJ Quality started, we’d identified that healthcare professionals were doing audits and other improvement work, but not getting a chance to publish their work. This meant that other people didn’t know that this work had been done, and it seemed such a waste. The idea was to make it easy for people to share their work, and introduce an online platform that could teach people every step of quality improvement, giving them the chance to share their work with “one click”. That is how BMJ Quality started – and again it was just a small idea that has now grown into one of the largest open access journals publishing quality improvement reports. There are over 5000 people working on projects using BMJ Quality right now, and so far 194 reports have been published. 1,658 reports are underway, and 180 new quality improvement mentors have joined us. People are working on quality improvement reports using BMJ Quality in over 35 countries, including over 2,000 healthcare professionals in the Kingdom of Saudi Arabia! And to date, improvement reports published by our community have been accessed just under 250,000 times in 2014 (QIR Report). A #smallthingbigwin indeed.
If you are interested in sharing your experience of quality improvement, please get in touch. You can email us at quality@bmj.com or use @BMJQuality and send us your ideas with #smallthingsbigwins.
To get your project started today, go to quality.bmj.com.