Jul 072016

Dr Gethin Pugh, Consultant in Anaesthesia & Intensive Care Medicine, Welsh School of Anaesthesia

What is Quality Improvement?Welsh Anaesthesia Seminar

Quality Improvement (QI), or Improvement Science, uses a systematic approach to design and implement changes in healthcare.  Knowledge of the methodology of QI is essential when considering improvements to the modern complex healthcare environment.  QI is also included as part of many postgraduate training curricula.

In March 2016, the AoMRC published its report: Quality Improvement – training for better outcomes, which sets out recommendations for quality improvement education and training.  The report has drawn together a wide range of organizations to align efforts to implement quality improvement training as a core competence in modern clinical practice, from undergraduate curricula through specialist curricula and beyond into Consultant practice.

The report represents a starting point for future development and aims to provide a structured framework to embed improvement methodology as a core competence for all doctors.

It is recognized that significant barriers remain, with a lack of parity in access to QI training and resources across organizations and specialties.  For many senior doctors and other members of the multi-professional team, the concept of QI remains a new idea.

The rotational nature of medical training means that doctors in training, working within multi-professional teams, are well placed to share areas of good practice and support QI development.

QI Training in Anaesthesia and Intensive Care Medicine in Wales

The Welsh School of Anaesthesia working in partnership with 1000 Lives Improvement have developed a QI Training programme for both doctors in training and trainers, to provide high quality training in the principles of QI and access to QI training resources to support innovation and excellence in healthcare.

This programme aims to provide high quality QI Training through the use of interactive workshops for trainees and support the development of QI networks of both trainers and trainees across Wales.  Furthermore, it is hoped that as part of the programme, access to high quality QI projects will be enhanced and individuals will be well supported in developing their own projects.  The programme includes the courses outlined below:

Quality Improvement in Anaesthetics – a 2 Day Interactive Workshop for Specialty Trainees

The Welsh School of Anaesthesia working in partnership with 1000 Lives Improvement offers an interactive workshop for trainees in Anaesthesia & Intensive Care Medicine in Wales.

The course provides the opportunity to learn from experts in quality improvement, who have experience of successful QI projects, to advance your own knowledge and skills in this area.

Candidates have the opportunity to develop their own QI project as part of the workshop, working in small groups to gain valuable hands on practical guidance.  Attendance at both days of the workshop and submission of a successfully completed project results in the award of IQT Silver Level Accreditation.

Feedback from delegates who attended the last workshop in 2015/2016:

‘Credible faculty full of useful information’

‘Really enthused me to do QI work’

‘Great reframing and moving on from audit, good interactive style’

Bronze Level Accreditation was completed via an e-learning package prior to attending the 2-day workshop.

As part of this programme, a further QI Training Workshop for specialty trainees in anaesthesia will be held this autumn.  Dates will be confirmed shortly and will be published on the Welsh School of Anaesthesia website.

Quality Improvement in Anaesthesia:  Introduction for Trainers (1 Day Course)

This 1-day introductory course for trainers focuses on the principles of Quality Improvement.

The course provides the opportunity for trainers in Anaesthesia in Wales to build on their knowledge of QI and its role as part of training in Anaesthesia and Intensive Care Medicine.

The course enables trainers to gain an understanding of the methodology and framework that underpins QI and its role in improving healthcare.  Participants will also have access to contacts with experience in this area that will be able to provide further support for QI initiatives locally.

Future areas for development:

As part of the ongoing development of the educational programme to support QI Training in Wales, there will be a number of new opportunities for trainers and trainees this autumn:

  • Welsh School of Anaesthesia Educational Supervisors Study Day, October 2016

The workshop will provide some background of the present scope of QI Training and provide the opportunity for trainers in Wales to gain an understanding of the methodology and framework of this developing area of postgraduate training, as part of an interactive workshop.

Society of Anaesthetists of Wales, Autumn Meeting, October 2016 will also include a presentation on QI Training in Anaesthesia in Wales by a member of the QI development programme, Dr. Katy Beard.

  • Working in partnership with other Specialty Schools to support QI Training in Wales

At present, members of the programme development team are working with the All Wales School of Emergency Medicine to develop a QI Training programme for Specialty trainees in Emergency Medicine.  This includes supporting trainers to develop a QI training network as well as mapping QI training areas against the requirements of postgraduate curricula.

Jan 082015
Dominique Bird

Dominique Bird

We have passed a significant milestone in Improving Quality Together (IQT). Over 10,000 NHS Wales staff have completed IQT Bronze, the introductory level of the training programme.

The total is actually 10,168 staff – which is around one in seven of the approximately 70,000 staff working in NHS Wales as a whole – who have completed the programme online, with more doing the training in local session organised by health boards.

This means IQT has become a common language of improvement spoken right across Wales, by staff in all disciplines and departments.

Continue reading »

Dec 182014
Sarah Puntoni

Sarah Puntoni

Like you, the title of this blog is a sentence I never thought I’d be saying, but, in a roundabout sort of way, it turns out that Mr Potato Head can teach us a thing or two about applying PDSA cycles.

Still not convinced? Let’s take a look at the reasons why, starting from the beginning.

I first came across the idea of using Mr Potato Head for PDSA cycles when discussing different exercises used by our Improving Quality Together (IQT) leads.

So, last week it was my turn to get Mr Potato Head out of his cardboard box for the session I was leading on person-centred care with Abdominal Aortic Aneurysm (AAA) screeners. The task? For groups to assemble him mirroring the image in front of them, which you can see below.

Continue reading »

Dec 022014


Emma Thomas

Emma Thomas

Emma Thomas shares her thoughts on Improving Quality Together, examining how we can all be inspired by some of the improvement projects already carried out across Wales.

The session at our 1000 Lives National Learning Event in Swansea asked delegates to share their Improving Quality Together (IQT) stories, hopefully inspiring and empowering others to take back learning from the projects to their teams and highlight the possibilities that IQT offers for improvements in the workplace. We had great representation from NHS Wales staff and students alike, which provided a recipe for interesting discussion.

Esther Philpott, from Aneurin Bevan University Health Board spoke about how she worked with her team to reduce the delay in discharge summaries process to GPs.  The CRT Rapid Response nursing team used the IQT Silver methodology to improve communication between themselves and the GPs they shared their patient care with. Discussion centred around how simple changes can be made with a team approach without a need for additional funding.

Continue reading »

Oct 282014

Where do I start? Experiential learning seems a good place to begin, and being a part of theAngela Williams Improving Quality Together (IQT) Silver workshop sessions for educators in improvement organised by 1000 Lives Improvement earlier this year made me realise how good it is to undertake an improvement project myself. For all attendees choosing an ‘improvement’ project, it wasn’t as simple as first envisaged. A familiar situation for many students!

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Aug 262014

All of our processes contain variation. Understanding variation is vital when deciding how to improve our processes and services.

David Williams

David Williams

Variation is the natural fluctuation that we see in our processes. For example, the number of times the phone rings at work a day is never constant. The differing number of times it rings a day is the variation we see in this process.There are two different types of variation, “common cause” variation and “special cause” variation.

An example of how variation works…

Every day I drive to work. It normally takes me about 55 minutes, if there are no unusual occurrences, but this does vary. It rarely takes exactly the same time to drive to work due to levels of traffic, weather, or the timing of traffic signals. These time differences are expected. It is common cause variation.

One day, there was an accident on the Motorway. My journey to work took 94 minutes. This is special cause variation. If this happened to you, would you change your route to work every other day just because of this single occurrence?

Continue reading »

Mar 032014
Dominique Bird

Dominique Bird

One year ago we launched Improving Quality Together, a training opportunity that gives staff ownership when it comes to quality improvement in NHS Wales.

A year on, 5752 NHS Wales Staff have completed the Bronze Level of the training, helping us all work towards a common language for quality improvement.

And why are we working towards an even higher staff uptake? Because a common language of quality improvement in NHS Wales benefits staff and patients alike. Continue reading »

Jan 132014
Jan Davies

Jan Davies

We know from international learning the value and importance of developing a common improvement language. This helps us to communicate within NHS Wales about how we can make real, worthwhile and lasting change happen.

And that’s the point of Improving Quality Together: making worthwhile changes. Often, changing the little niggles people have every day, which they feel is stopping them doing their job properly, can make a huge difference. It can free up staff time, and make the system we work in a lot more effective and efficient.

But we also need to know that the change we’re making is a worthwhile one, so Improving Quality Together helps us to think about how we test these ideas for change on a small scale before going bigger. Continue reading »

Jan 012014
Dr Alan Willson

Dr Alan Willson

Happy New Year! And welcome to #IQT2014. New Year’s Resolutions are often about small changes that make a big difference. That’s why we’re dedicating the first two weeks of 2014 to Improving Quality Together, to encourage NHS Wales staff to put “Make a start on IQT Bronze” on their New Year’s Resolutions list.

Improving Quality Together is the national learning programme for all NHS Wales staff and contractors. It provides a common language and consistent approach to improving the quality of services in NHS organisations across Wales.

Over 3,500 individuals completed IQT in 2013 – and if you haven’t taken part yet, over the next two weeks, we’ll be showing you the benefits IQT Bronze can make for you, your workload, and, most importantly, your patients. Continue reading »

Apr 292013
Dominique Bird

Dominique Bird

“I hear and I forget; I see and I remember; I do and I understand.” – Confucius

Obviously as the lead for Improving Quality Together, I would say those words ring true in the framework’s underpinning principles. Maureen Bisognano used them in her opening keynote address to set the tone for this year’s International Forum.

The importance of seeing the impact of the system on staff and patients was underlined with Maureen’s call for empathy. Until we truly see what is happening, we cannot even move to being able to ‘do’ something and therefore we need to ‘understand’ our role and our ability to make the improvements that will have an impact on patient care.  Continue reading »