Bart's and The London - Quality Improvement Projects



What is Quality Improvement?


Quality Improvement uses a structured approach to change, and aims to improve reliability of healthcare delivery. Improvement will result in safer, more effective, efficient, equitable, timely and patient-centred care.


This short powerpoint presentation perfectly summarises why QI is so important within our school


How might a QI project involve you?


  • Identif y current practice


Draw a driver diagram to illustrate the aim and it to link the primary drivers (the key areas that can be worked on to ‘drive’ change) to achieve the desired outcomes. From the primary drivers, secondary drivers (more specific change concepts) can be considered to realise the desired outcome


  • Plan an intervention to improve practice


  • Carry out a PDSA cycle to improve the intervention and reach consensus

















  • Motivate others through networking, sharing, presenting evidence, collaboration


  • Document your improvement success through publication and presentation


  • Ensure sustainment and continued effectiveness of your work by handing the project on to another trainee identifying the area for Improvement?


  • Ask your department quality team or lead, what the quality aims are and what projects need doing?


  • Look online for known areas for QI projects and suggest them to your department.


  • Do you know of other units that have better outcomes – what is it that they do differently?


  • What guidelines, standards or research evidence is there that we could be doing something better?


  • Have you considered what it feels like to be a patient in the perioperative process at our trust– what would make their experience better? 



How do we measure QI?


Continuous outcome data collection (run charts) work best to track improvement.


We can measure against set standards defined through national standards (RCOA and AAGBI), accreditation standards (ACSA) and national audits (eg NAP).


There are 3 main types of QI measure; structure, process and outcome.

For example:


  • Structure


‘How many emergency operating theatres are available 24 hours a day?’

‘How many of our staff have received training in….?’


  • Process


‘What percentage of our patients receive harm free care?’

‘What percentage of incidents receive feedback?’

‘What is the time from admission to theatre?’

‘What percentage of patients have cardiac output monitor used during laparotomy?’

‘How often do we use intra-operative warming devices?’

‘What percentage of patients do we document appropriate antibiotic or thrombo-prophylactic medications?’


  • Outcome


‘What is our mortality rate for a ruptured AAA?’

'What is our post-operative thrombo-embolism rate?'

'What is our peri-operative central venous catheter infection rate?'



Can you give some examples of concepts that come from Improvement Science?


Bundles, process mapping and checklists all come from improvement science.



Safety and Quality


  • Safety and quality go hand and hand and a robust governance system to ensure that safety as an essential component of quality, is embedded into practice and assures action.

  • Trainees are essential to our QI!

  • Trainees are an essential to improvement; as QI fellows, as QI leaders, as project team members, as educators, as motivators/champions, as incident reporters, as M and M presenters, as journal club presenters, as data creators, collectors and analysers, to share ideas from other organisations, to present projects to the wider QI audience through meetings and publications.


We hope that trainees will pass a substantial QI project onto to an incoming trainee to ensure continuity. For ARCP, evidence of involvement in quality improvement will be essential and we hope during your time in our school you will be able to build your CV through getting involved. We want you to be involved in projects that MATTER: to you, to us and most importantly to the patient.


Royal London QI Team:


Matt Wikner, Davina Ross-Anderson, Alastair Mulcahy, Neil Macdonald, Toby Reynolds and Annie Hunningher


'Here is a PDSA Cycle!'