Ten step plan for a quality improvement project

Initiating and participating in quality improvement (QI) projects often allow you to achieve incremental and measurable changes which make a real difference to patients' experience in hospital. It's also a great way to enhance your eportfolio if you have one.

Dr Emma Vaux offers a few tips to get you started.

1.  Think differently

Ideas for change can come from a process or policy that you have come across that may affect patient safety or experience or appears to be no longer fit for purpose. Choose something you and others genuinely care about. Keep it simple; you are testing small scale change not trying to do ten things at the same time. You may decide to do a QI project against a known standard e.g. a clinical audit; but this will be a real-time, dynamic audit with the real possibility of making a difference in a short space of time rather than the traditional approach we have become used to.

2.  Use a simple, systematic approach to plan your QI approach

The Model for Improvement (MFI) helps you define:

• what you want to accomplish;
• what change(s) you are planning to make;
• and what you are going to measure to know that any change has led to an improvement.

You may then test changes on a small scale using Plan-Do-Study-Act (PDSA) cycles. Use the resources already available to help guide you in your planning.

3.  Be clear and focused

Have a clear vision and objectives so everyone understands what you are doing and why. Using SMART goals (which are specific, measurable, achievable, relevant, time-bound) should help you achieve this.

4.  Identify who you will ask to help you

You need supportive senior engagement, usually your supervisor (generally a consultant). It is a good idea to undertake the project as a group, particularly involving the wider multidisciplinary team.

5.  Think about how you might involve others

Articulate your vision and try to find the hook that makes them want to get involved as well. For example, what new skills they may acquire and the rewards for participating, such as team recognition, CV boosting and leadership.

6.  Organise your time

It is important to complete the project in a specified timeframe (usually over a 12-16 week training post) and maintain momentum. A project template should help chart your progress and keep you on track with regular check-ins with your supervisor. A team approach also helps with the data collection.

7.  Make a change and evaluate it to see if it worked

Use a straightforward measuring process so there is no doubting the improvements made. It's important to know the baseline activity before you start so you have a number of points of comparison and keep measuring little and often. Two data points are not enough. Record your results on a run chart so you can see the changes taking place over time.

8.  Document your project to show what you have learned

Using the PDSA cycle as the framework for your project, be clear about what was learnt, what worked and what didn't.

9.  Sustainability

Think right at the start about how this project will continue when you have moved on. It is important to be clear how your QI project fits with organisational aims and the benefits for staff as well as patients.  Identify a successor to take the project forward, working with continued senior support and ensure an established process for continued measurement is in place.

10.  Now take that first step and get started

All you need is a SMART aim, PDSA cycles of small scale changes and measure, measure, measure.

Dr Emma Vaux - Clinical Lead, Learning to Make a Difference, Royal College of Physicians & Joint Royal Colleges of Physicians Training Board

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