Dr Archana Depala is an FY1 at UCLH, interested in anaesthetics and intensive care medicine. @archanadepala
Dr Liam Watson is an aspiring sailor, oarsman, and Arsenal Fan. He is also an FY1 at UCLH…hoping to do paediatrics. @liampjw
Be it a reflection of naivety, or time spent avoiding the wards, medical school painted a picture of efficiency within hospitals. Patients were admitted unwell and everything worked towards getting them better in as smooth and quick a manner as possible.
This dream rapidly eroded, starting August 5th 2014. Images of FY1-led clinical decision-making were replaced with monotonous paperwork, inefficient processes, and archaic algorithms. We may have familiarised ourselves with the minutiae of the “cheese and onion” but we were largely unfamiliar with the practicalities of how to go about our day-to-day tasks. Remind me exactly how do I go about ordering a plasma metanephrines? If only you could advise a younger you that the advanced anatomy module wouldn’t be as clinically relevant as “The beginners guide to faxing”. Annoyance at not taking this course (and that it probably doesn’t exist – a definite hole in the curriculum) was initially faced in isolation and then discussed amongst junior doctors at the pub after work. Here lay the crux of the problem: these issues were the domains of the juniors, and if changes were to happen, we had to lead it.
Annoyance had to be turned to productivity.
As fate would have it, early on in our FY1 year we were invited to be a part of a quality improvement programme. Perhaps somewhat ignorantly, 13 of us signed up. We spent the first two weeks learning about what quality improvement was: that it was not just a synonym for “audit”, and so began sharing anecdotes detailing irksome inefficiencies within our jobs in a more mild mannered and printable format than previously. However, this was not just a therapeutic talking group. By the end of the meetings we would leave feeling empowered to do something about our frustrations in the hope that we could optimise our time and that of future FY1s.
Ideas ranged from changing the whole IT system, deemed “out of scope”… what little faith our seniors have in us. An awareness campaign against the stigma of drinking mochas, which (while applicable to life) may not necessarily be applicable to hospitals lacking high end coffee shops.
After heated debate, we narrowed them down to two realistic projects. Both were inherently simple but could have a greater hospital-wide effect, in keeping with the #smallthingsbigwins message. Take phlebotomy for example: a routine procedure, carried out throughout the hospital and involving different members of the multidisciplinary team. A small intervention optimising this has the potential to have a significant institutional impact with a positive effect on staff, patients and hopefully saving the hospital money.
Will our quality improvement project save the NHS? Hubris perhaps. Can we improve things for our colleagues in the future? Now that’s achievable.
If you have any ideas or tips to help our FY1 QI team please tweet us with #UCLHQI at @UCLHmeded and @BMJQuality.