Suggestions for setting up QI training scheme
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Workshop given at RCoA on ideas around setting up a QI training scheme in anaesthesia
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Suggestions for setting up QI training scheme
- 1. Delivering QI training John Colvin, Carolyn Johnston
- 2. In 45 mins… • What should be ‘delivered’ • Vehicles to deliver content • How it feels to be in/ run a scheme
- 3. In 45 mins… • What should be ‘delivered’ • Anatomy of a scheme • Physiology of a scheme
- 4. College QI curriculum • Development of new QI module • 3 levels (optional, not mandatory) • Nothing new – Compliments & completes – Familiar tools just different names
- 8. College QI curriculum QI training is a practical endeavor underpinned by improvement knowledge
- 9. Knowledge resources Wide range of sources- detailed in handouts Some ‘top picks’:
- 10. Knowledge resources • Raising the Standard: A compendium of audit recipes for continuous quality improvement in anaesthesia; Royal College of Anaesthetists
- 12. Knowledge resources • Improvement science in anaesthesia. Phillips J Rooney KD. RCoA Bulletin, July 2013; 80;29-32 • www.ihi.org- open school modules & videos
- 13. Structures of QI training
- 14. Structures of QI training Intrinsic motivation Spirit of continuous improvement Rewards individual effort Ideas flow up- self generated
- 15. Structures of QI training Fits with departmental/ hospital strategy Likely to get greater management support May fit with shorter rotation timescale Ideas flow down- provided by scheme
- 16. Structures of QI training • Support structures depend on resources
- 17. Structures of QI training • Support structures depend on resources • Action learning sets: • Meet as a group • Retell experiences for others • Learn from each others experience & reflection • Facilitated- could be outside specialty
- 18. Structures of QI training • Support structures depend on resources • Mentoring:
- 19. Structures of QI training • Support structures depend on resources • Mentoring: • Form semi autonomous groups with mentor • Mentor can be matched with subject area • Interested, senior mentor can ‘unblock’ sticking points • Infrequent catch up with lead to check progress
- 20. Structures of QI training • Support structures depend on resources • Mentoring plus- ‘paired learning’: • Paired with manager/ non clinician • Learning for both parties • Good to form contacts in organization • Complimentary skills to help project work
- 21. What do you have to work with? • Hospital wide improvement programmes • Pan specialty training- e.g. RCP initiative • Multidisciplinary working • Deanery facilitated networks
- 22. How a QI training scheme functions • Initial energy- but change is attritional! • Concentrate efforts on keeping momentum • Seek help from all over the hospital • Project completion takes longer than you think- esp if multiple PDSA cycles • Rewards are multiple- papers, case reports, posters
Notas do Editor
- Aim to cover the new syllabus, How you might set up a scheme to deliver that locally And how a Qi training scheme functions in practice
- The college has a new QI module of training which is optional- annex at the end of the main document. Many of the skills are transferrable, including teaching, leadership and analytical skills
- This is a synopsis of the syllabus- I don’t want to dwell on the details here, except point out 2 things:
- Curriculum is divided into 3 levels- progress may not be as per clinical progress- interested junior doctors can attain advanced level whilst still being very ‘junior’ and many highr trainees and consultnats may only be starting out with QI skills- and so be at a basic level
- The words participation and ‘takes an active role’ are circled. They occur frequently- showing that the new curriculum emphasizes practical conduct of quality improvement over theoretical knowledge.
- Many people worry about the knowledge resources needed to undertake a QI project- luckily as you can imagine, quality improvement enthusiasts have ensured there is a lot of high quality resources out there
- College compendium annex A written by Dr Peden is excellent and freely downloadable from the college website
- This is a similar document from the Health Foundation- who have a range of excellent resources, all freely downloadable. Their website is a wealth of knowledge about improvement and implementing change, and some of the latest research on quality improvement topics.
- Another article from the RCoA bulletin that is a good summary I particularly like the IHI stuff (Institute of Healthcare Improvement) which is a large charitable American organisation that promotes QI. You can enroll in the open school- which has a series of simple modules you can complete online to gain QI knowledge and certificates on completion. They also have ‘white board’ tutorials on individual topics like understanding run charts. They are short, easy to understand and freely available.
- So once you point your trainees in the direction of some basic knowledge, how do you get them to try using them in practice and delivering some improvements for you? The first thing to consider where their QI project will come from:
- Will this be a project they decide?
- Or will it be a project decided by the department- this has similar pros/cons to self motivated or allocating audit projects
- Once they have a project, and some basic plans they set out on measuring and perhaps improvement ideas, they will need some support to make this happen. Do not under value the importance of this- ideas are easy, implementation is hard! Quality improvement is an iterative process, actively measuring and changing depending on your results. It can be hard to come up against barriers- either in the organisation or more commonly individuals who don’t want to ‘play ball’ with proposed changes. Good support will help the trainee to navigate these as best they can, and this is where much of their learning happens. How you support them depends on the resources available
- The trainees can provide peer support in the form of action learning sets. These run as facilitated small groups, and members take a small amount fo time in the meeting to discuss their progress in their projects, and ask and learn from each other. As QI is not specialty specific, these could be cross specialty. I am in an action learning set with a surgein, GP and psychiatrist fro example! It is usually best if they are facilitated- at least at first. There are plenty of resources on how to run them on the internet, and your LETB may run action leanring set faciitation training
- Trainees could be set up with a mentor- a senior person with knowledge of the oragnication/ QI experience who can guide them and unblock some of the blocks the project may encounter
- Mentors can catch up with the programme lead as often as you see fit. I run our foundation year doctors programme in the hospital with this model, it depends on having a number of enthusiastic mentor volunteers. Benefits include involving skills outside your own (for example if a project is in ITU and you are mainly theatres) and if the mentors/ mentees are self sufficient, this is a relatively stress way to lead a scheme.
- Paired learning is a similar programme where clinicians are paired with managers to run QI projects. This is definitely more difficult to set up (and will need enthusiastic lead on the management side to find suitable candidates) but can be a really powerful way to improve trainee management knowledge, and management’s clinical knowledge! Imperial have run several successful schemes, and have an area on their website explaining the process. I also have a lot of details about how you might set this up, so you can email me (address at the end) and I will forward them on.
- It is also important to think about who else you can work with- at the moment the number of people ‘doing’ QI is small, but growing. Most hospitals have improvement or productivity schemes, and for example in St Georges everyone can enroll for free ‘Lean’ improvement methodology training. Other colleges are embarking on similar things, as are other professionals Deanery facilitated networks are growing too- in London PLAN is mainly audit based, but is looking to expand QI training and networks. QI networks are very helpful to share ideas and build enthusiasm, so please encourage one if you see it!
- In practice, trainees start with a lot of enthusiasm, but might meet barriers that quench that! A schemes clinical lead is therefore best deployed in maintaining momentum. Gentle badgering about deadlines and keeping projects moving (I send a lot of emails ‘just checking how your getting on, can I help?), social meet ups for improvement groups can help (action learning over a pizza?) It is really tough completing a project in 6 months. There are LOTS of places to present and publish this work: BMJ Quality improvement reports (case report journal), BMJ Quality (main journal), Conferences: International forum for quality & safety (annual, runs either in Paris or London), The Network, AQuA, FMLM, in London-Agents for Change, London deanery conference etc etc.