Unleashing the power of junior doctors to deliver safer care.

junior-doctorsBy developing their capability through the BaSIS – Building Safety Improvement Skills- programme and empowering them to undertake their own quality improvement journey to enhance the care their patients receive.

In 2014 HEEM – Health Education East Midlands – commissioned the Quality Improvement Clinic to continue to develop and deliver the BaSIS programme with the Foundation School for Foundation Year 1 trainees. Based on the work of the NHS Institute for Innovation and Improvement, this quality improvement programme is designed around action learning with an intensely practical focus on improvement tools and techniques informed by improvement science.

During a two-day action learning event, FY1 trainees from across the East Midlands identify one small aspect of their service that they want to improve. Using the model for improvement to guide their approach to change they learn about setting a SMART aim, generating a baseline measure, using small scale PDSA test cycles and ways of engaging the support of their sponsor and team. Support in the form of coaching and mentoring is provided at the learning event and continues in their own organisations throughout their eight week improvement project.

The results are impressive. At the end of eight weeks, trainees present their QI projects and QI posters to a panel which includes representation from HEEM and The Quality Improvement Clinic. Improvement projects have ranged from subjects such as improving intravenous fluid prescribing; to interdisciplinary communication around catheterisation on a surgical ward; to appropriate assessment and prescribing of thromboprophylaxis.

By using measurement, trainees are able to identify what works and what doesn’t, with the greatest learning being achieved from the latter. Sachin Nagar, had just this experience and you can hear him talking about his improvement project Reducing Avoidable Time Delays in Stat Medication Administration here.

In his presentation Sachin reflects on the process of improvement, the importance of knowing when a change has failed, stopping the intervention and learning from it before taking the next step. Click to view his on-line publication in the BMJ Quality Report.

At the end of their quality improvement journey trainees feel well equipped to use a range of quality improvement tools and techniques and confident in their use of the Model for Improvement to articulate a project challenge and its aims. Just as importantly trainee’s mind-sets and behaviours around preconceived notions of “failure” had been challenged and changed by the programme. The junior doctors take away with them an understanding of the importance of learning from failure and embracing small tests of change.

The transformation from the original improvement idea to their own improvement project is fascinating and exciting. Each year I look forward to seeing the work that these trainees can take forward in their own organisations to further patient safety. This year our new trainees had the opportunity to hear and learn from last year’s project winners, providing evidence of how the next generation of doctors are helping to shape and grow improvement capability in the NHS.

Nicola Davey, Director of the Quality Improvement Clinic