Lessons learnt: A junior doctor describes challenges to improving quality
‘Dr Jennifer Perry graduated from Birmingham Medical School in 2008 and moved to London for her foundation years as a junior doctor. She decided to specialise in Psychiatry and in 2010 joined the Royal Free Training Scheme. She is now currently working as a CT3 in Old Age Psychiatry at St Ann’s Hospital’.
Dr. Jennifer Perry describes the challenges to implementing a quality improvement project here.
We undertook a Quality Improvement Project (QIP) to create a workshop for patients with a diagnosis of schizophrenia within the Haringey Community Rehabilitation Team (HCRT). This was a result of the Barnet, Enfield and Haringey Mental Health Trust Patient Experience Questionnaire which highlighted that patients within the HCRT did not feel that information about their medication was explained to them in an understandable way.
Sustainability and Engagement of Staff
We faced a number of challenges to our QIP. One of the key issues was that of sustainability as I, as the project lead, was only part of the team for six months and so there was the worry that the project would be difficult to continue after I had left. There were a number ways we overcame this. The project engaged all HCRT members, as many of them helped to co-facilitate the workshop, and so this ensured that everyone was involved which made it a more sustainable project. A protocol was developed which offered a step by step account of how to plan and implement the workshops which would allow other people to run them. I liaised with the incoming junior doctor to ensure that she would be willing to continue running these workshops, which she was. The project was an agenda item at each team clinical governance meeting which again helped to ensure longevity. Therefore, to overcome the challenge of sustainability, my advice would be to engage all of the key stakeholders early on in the project (including future junior doctors), link the project in with local clinical governance and to formalise the process through writing a protocol.
Engagement of Service Users
A challenge we faced was how to engage service users in the workshops as it was felt that some patients might lack the motivation to attend. We developed a process whereby in advance of the workshop date we would contact the care home and speak with the manager; we would ask the manager to then speak with all of the residents in their care home to tell them about the workshop. We would then send out individual personalised invitations to each service user giving them information about the content of the workshop as well as details of the date, time and venue. Care co-ordinators who looked after clients in each care home where the workshops were being held were asked to speak with their clients to encourage them to attend. Where possible we tried to ensure that the group co-facilitator for each care home workshop was a care co-ordinator who looked after at least some of the service users living there. This highlighted that in order to engage other people in your QIP (this could be patients or staff members) you need to have a variety of methods to promote it and to be proactive in this.
Communication and Organisation
One difficulty we encountered was that there were on occasions miscommunications between our team and the care homes so that two of the workshops had to be cancelled. The lesson learnt from this was the importance of liaising with the care home well in advance of the workshop date and ensuring that this communication was via telephone as well as via email. In order to overcome difficulties such as this it would be advisable to prepare QIP interventions well in advance and maintain good communication with all those involved.
Designing an intervention to meet patient’s needs
Another challenge was that we implemented a workshop which we as mental health professionals had designed. We were uncertain as to whether or not this workshop would meet patients’ needs. To enable us to assess this we built in a section in the workshop introduction where service users introduced themselves and said what they would like to get out of the workshops. The workshops were then made as interactive as possible so that attendees could give their reflections, opinions and thoughts as well as ask their own questions. We distributed feedback questionnaires to the service users at the end of every workshop. As a result of the patients’ feedback and our own observations, modifications were made after each session so that we were able to develop a workshop that was tailored to the needs of the service users. The Plan-Do-Study-Act Cycle gave us a formal structure in which to implement and monitor changes. This highlighted the usefulness of PDSA cycles and the importance of obtaining service user feedback on QIP interventions where it is appropriate (as ultimately it is service users who should be benefiting from QIPs).
(One final piece of advice is that, where possible, your QIP intervention should be something that you enjoy doing, or that you feel passionately about, as this will help you, your colleagues and your patients to get the most out of it!)
