This is the 96th #WILTW

This week the Academy of Medical Royal Colleges published “Quality Improvement – Training for Better Outcomes” the output of a group set up to enhance quality improvement training for all doctors.

Quality Improvement could be considered a healthcare zeitgeist. When I was at medical school the zeitgeist was “Evidence Based Medicine”. I remember thinking at the time it seemed a bit odd that we weren’t already being taught about treatments that were based on evidence.

It now seems ridiculous that the terms ‘Quality’ and ‘Improvement’ were not part of my undergraduate curriculum. I wonder if current medical students listen to lecturers talking about delivering quality care and think, “errr…. of course?”

But changing practice and/or improving care is hard. It is especially hard as a junior doctor, not just because the NHS remains a hierarchical organisation but also as result of the frequent movement between different departments, and even hospitals within a region. However just because something is hard does not mean it is impossible and innovations can result from persistence and determination.

In the document I share my experience of working on the Paediatric Observation Priority Score (POPS) at the Leicester Royal Infirmary. I aim to demonstrate that you can successfully get involved in quality improvement work without having to be the Clinical Director or Chief Executive to make things happen!

My tips for success:

1) Find and support your first followers. If you are the only person promoting change then it will only happen when you are there (and even that will be hard!). As Derek Sivers explains “Followers of change tend to follow other followers not necessarily the leaders“. I focused on engaging a number of key nursing staff at the outset of the project. I listened and responded to their concerns and gave ownership to them. It wasn’t ‘my’ project it was ‘ours’

2) Use rewards sparingly but consistently. I wasn’t sure it was going to work but it was suggested to me that those who completed the POPS training package should receive a metal lapel badge. Such has been the success we have been through two large bags already. I am still not sure what the real motivations were behind having a badge but it worked.

(please click here is video fails to play)

3) Be prepared to fail. If you don’t take risks at trying different initiatives you will never know what works or doesn’t. The initial year of POPS was very hit and miss and my “Top of the Pops” campaign an utter failure. The more you try the more likely you are the something will succeed. Be prepared to quickly mobilise and run with the successes!

These are all pretty obvious but they probably wouldn’t make as much sense to me unless I had experienced undertaking them. Quality Improvement is very easy to teach. It is much harder to actually ‘do’. And in the same way that you will never diagnose a heart murmur from a lecture alone, it is only by doing improvement work in clinical environments you will ever be able to change practice for the better. So while students and juniors may think it is obvious it is only by real experience they will learn its true art.

What have you learnt this week? #WILTW

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