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Making every moment count

In partnership with Health Education England, Royal Berkshire NHS Foundation Trust aimed to ‘Make Every Moment Count’ by providing a high standard of training in quality improvement (QI) practice for specialty trainee doctors to enhance patient care.


Related themes

  • Multi-professional teams
  • Change and empowering employees
  • Improving training programmes and pathways
  • Mental health

Background

To date, clinical audit has been the main route for doctors in training to become involved in quality improvement (QI). While clinical audit is quality improvement, it has not necessarily felt like it in practice due to the way it is carried out. This means that a potential opportunity for improvement is missed and often results in demotivating Trust’s doctors in this important area. The ‘Make Every Moment Count’ pilot project sought to address the apparent gap between learning opportunities from every day recognised problems and how these translate into effective action and improvement change in everyday practice. This presented an opportunity for focused and planned training.
The emphasis within this project was very much on learning, development and embedding new skills in QI methodology to start both trainees and members of the multi-professional team on a journey of lifelong learning along with the delivery of continuous service improvement. The project presented exciting opportunities for the trainees to base a QI project on their experiences of everyday practice or from their personal simulated learning incidents. This enabled the trainee to get involved not just in ‘being trained’ but inputting in how their training looks and is delivered.

How they did it

‘Make Every Moment Count’ identified a cohort of 30 cross-specialty trainees and provided them with QI training and mentoring. Half the participants derived their QI project from local area issues and half had QI project ideas generated from serious incidents or complaints.

Alongside this, Royal Berkshire developed QI resources and training for educational supervisors and consultants, including an e-learning module, who? provided support. A bespoke programme was also developed to teach essential debriefing skills (following an incident) to consultants, nurses, allied health professionals and doctors in training.

Who was involved

The project involved of a team of people, including a project manager, full time administrative support and a patient safety team consisting of: the clinical director for acute medicine, the head of clinical quality improvement and the head of patient safety who was responsible for coordinating the pilot. The Chief Medical Officer and the Director of Medical Education also provided supporting roles to the pilot.
Risks were fed into the Trust Risk Management Committee and added to the wider risk register. The project board reported into the patient safety council and hence into the trust clinical governance committee.

Outcomes

  • Participation of trainees in QI projects is now an expected practice by the Royal Berkshire NHS Foundation Trust
  • All project supervisors agreed the pilot project was a valuable practical learning exercise for the trainees and all agreed they would supervise another quality improvement project
  • 122 trainees registered an interest in participating in a project at the time of their August induction. 56 trainees subsequently registered to take part in a quality improvement project and 45 trainees completed a total of 27 projects
  • 20/27 projects achieved their stated aims
  • 93% of trainees faired above expectation for their stage of training in areas of change implementation
  • In the subject of quality indicator measures, 86% of trainees scored above their stage of training and 100% of trainees scored above their stage for future application of QIPP (Quality, Innovation Productivity and Prevention).

What they’ve said

“Being able to complete a QIP has been a very satisfying experience; having closed an audit loop and implemented a change in clinical practice within the space of a few months. This has been a very valuable learning experience into clinical quality improvement as well as being brilliant for my CV.” Trainee

“QIPs provide a nationally endorsed framework that allows junior doctors to institute change in areas they have identified as lacking. In doing so patient experience is directly improved whilst improving the skill-set of the doctors involved.” Trainee

“It is very satisfying to engage with trainees and to supervise a QIP as they have an enthusiasm and motivation which is a real joy to work with. I identified the role I played in this project in my own appraisal as the best thing I have done all year.” Consultant in Palliative Care and Consultant Supervisor

Toolkit

Please look at the toolkit materials in the documents section below. The top tips and business cases have been developed by the BTBC team to support organisations to implement these changes and the case studies and project resources have been developed and approved by the project teams.

The top tips include lessons learnt that have been identified throughout the project. The business case will guide you through the management principles and communications and engagement activities. The case studies provide a detailed overview of the project. Feel free to adapt these resources to suit your projects. Your organisation may have its own materials and templates that you can use or you may find the NHS Improving Quality (NHS IQ) learning handbook useful too.

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