Case Study: East Midlands Foundation School, Building Safety Improvement Skills (BaSIS)
The BaSIS Programme[i] is designed to enable Foundation Year 1 doctors like Rob Jackson to become an advocate for safe practice and quality improvement. It enables doctors to acquire skills they need to be safe, empowers them to make improvements within their own organisations and enables them to champion quality improvement within their cohort and with their Foundation Programme peers.
Rob initiated his quality improvement training in 2015, attending a 2 day QI workshop. By taking part in this training, Rob has become more analytical and critical of how things work. He has been empowered to believe that change can be instigated by anyone at any level in a system.
“The teaching we got from Quality Improvement Clinic and Health Education East Midlands Teaching Faculty provided a great foundation in quality improvement, but the real learning took place when we started making our own mistakes in the context of a real project. Teaching Faculty at Quality Improvement Clinic were always available to offer advice and help throughout this process, making it a really enjoyable and ultimately very useful experience.”
Rob worked with two other FY1 doctors to tackle the problem of managing constipation in patients on a general medical ward. Initially they felt that recognition was the key to appropriate and timely management and that they would need to work with the nurses to improve this. However, their diagnostic phase helped them identify that Nursing staff were already skilled at this, and that what they needed to work on was doctors’ monitoring of constipation.
After testing several ideas, the problem was addressed by making alterations to the continuation sheet in the medical notes.
The highlight for Rob was around the 3rd PDSA cycle when they realised that they’d come up with an idea that they could see was objectively working. “Importantly it was something that we could see ourselves using in practice and therefore we felt it was sustainable. I am told that the ward are still photocopying the sheets and using them that way.
Putting together the project in a poster has helped to consolidate all the work we carried out on our project and reflect on what went well and what we could have done smoother. It’s not until you actually start doing a project or writing up that you realise some of the logistical difficulties. These are lessons we can take forward our the next QI project”.
The measurable outcome was a process measure – how often do Doctors remember to check the patient’s stool chart on their daily ward rounds. Rob and his team took an entry in the ward round notes as evidence that they had done this. They also measured constipation in patients but because of the lack of a concrete definition and a small sample size this was less useful in their particular project.
Submitting work to BMJ Quality Improvement Reports Journal
Thanks to support and feedback, Rob and the team altered their QI project in the initial planning stages to something that was more feasible. Their project achieved a significant improvement in monitoring of constipation by doctors. “We were then supported by Nikki and the Quality Improvement Clinic to submit our work to the BMJ Quality Improvement Reports Journal, which we would not have been able to do without their help.” Rob describes his learning journey as immensely useful, enjoyable and a well-supported learning process that has led him to look at the systems he works from a completely fresh perspective.
“I would recommend the Quality Improvement Clinic firstly because of their knowledge and experience of the QI process, but more importantly their dedication to engaging people with Quality Improvement. I feel that the team get genuine enjoyment when they see what the people they have mentored have achieved, and this attitude is contagious.”
The yearbook charting the BaSIS journey for 2016, together with pictures of all the posters presented can now be downloaded via this link.
[i] The programme, initially developed by the NHS Institute for Innovation and Improvement, has been updated and is now delivered as a partnership between by Quality Improvement Clinic and Health Education East Midlands.