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What are the key ingredients of a good Quality Improvement Project and how do we make sure they are always available?

Dr Tricia Woodhead BM MBA

Quality Improvement Fellow and Advisor

Patient Safety and Person Centred Care Expert for the International Society for Quality in Healthcare (ISQUA)

Retired Consultant Radiologist and past Executive Medical Director (Weston Area Health Trust)

The most common question Educational Supervisors ask of me is ‘how do I make sure my trainees experience a great QUIP?’ As with all complex situations the answer is not straightforward and requires some forward thinking if your team, your colleagues and department are to be prepared.

We all learn in different ways and for many seeing something is more powerful than reading about it and doing it is always an experience of positives and perhaps negatives which will inform how we do things better next time. Having a clear idea in your department or hospital where the gaps in quality are and which ones need closing in the coming months is ideal, a recent audit or peer review process can spark off a suite of projects than can be undertaken by trainees in the period they are with you. These can then be handed over to their colleagues when they move on.

If these is one key ingredient it is the acceptance than high quality medical care is delivered by teams, in teams and is a shared responsibility. With this in mind, remember that shared ownership and shared responsibility go with shared authorship and publication or presentation. Acknowledging this in practice, in discussion and when asked in interview situations is vital if we are to build stronger and more resilient clinicians able to drive change in our rapidly evolving healthcare environment.

I have laid out an approach below in clear steps but there may be tremendous value to you to hear how a quality improvement projects have been undertaken and to see examples of good projects from trainees both in the South West and the UK more widely.

Here are some links to inform and encourage you before moving onto the guide below. The videos are prize winners and the advice encapsulates the essence of sharing QI successfully with others.

Step by Step

Few problems in healthcare are going to be fixed with a simple one step activity. Many challenges will require some further exploration and possibly new data and analysis before any possible solutions can be envisaged. Putting any ideas into practice requires energy, determination, creativity and often a degree of humility when what we thought would be an improvement turns out to be a change but not the improvement we have hoped for. In situations such as these having a standard approach to start with and that can be adapted over the life of the project is a sound and practical approach. Busy people in highly charged environments can then ground their ideas and their changes in the knowledge of a systems approach to the complexity of modern-day clinical care.

Step 1

What are we trying to achieve?

What is the symptom that is telling us the system is not working as it should

How do we define quality? Using the acronym STEEEPS helps organize an initial widening of perspective. What is safe, timely, effective, efficient, equitable, person centred and sustainable care with respect to the topic we are exploring.

Step 2

Who else should we discuss and involve in our considerations now we have explored as a small local group the problem is there more information or data we need to gather to ensure we are accurate in our identification of the underlying problems? Who would help us do this and how can we involve and inform them of why this work matters to patients, professionals, the wider system, and society?

Step 3

How would we know a change was an improvement. What would be different for the patient, the professional the wider system if we made the improvements we have identified. How would we identify and measure the improvement when it happens. What would great look and feel like for patient, professional and system?

Step 4

What ideas do we have, how might we test these out? Some will be straightforward and relatively simple to test tomorrow not least because this is about the work we individually do. Some may require some negotiation, resource, specific circumstances but none of these additional things need prevent an idea being tested they will just require some preparation.

Step 5

Testing our ideas gives us evidence of their impact, enables us to rehearse doing things in a new way so we improve at doing the work and provides evidence to persuade us and others the changes are having the impact we want to see.

Step 6

Refining and repeating the ideas in more challenging situations so we know how to do the work in a different way but also if any nuances to the approach are needed to ensure it remains safe, timely, effective, efficient, equitable, person- centred and sustainable for all patients.

Step 7

Discuss, share, explore and refine further using colleagues and patients feedback and the data you are collecting to evidence the improvement

Step 8

Return to the question at step 2, how did we think an improvement would show itself? Can we see that evidence starting to emerge.

Have a ‘systems thinking’ approach

There is a lot of value in thinking of complex system as a summation of new changed processes and new changed systems and cultures from which new changed outcomes arise. Avedis Donabedien made this into an equation it is worth keeping in mind  

Process + Structure= Outcome (

To compliment this approach a logic model diagram can be helpful. The purpose being to remind us that unless we change what we do, how and when we do it and know these changes are happening reliably then outputs by us and outcomes and impacts for patients will never change. Checking the measures (our inputs and activities) at the beginning of this logic model ensures that if our theory of what is an improvement is correct then we are on the road to achieving it and outputs, outcomes and eventually impacts will follow in due course


Hopefully a combination of videos, examples, guides on how and what as well as diagrams to show the relationship between what we each do in the day job and how these impact over time on the patient’s outcome and the impact on them of their disease will be useful.

There is a lot to improve and it is our job each day not just to do the work but to improve how we as individuals, teams and system combine our efforts for patients under our care.

The rest of this web site will support next steps for you and your trainees.

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