EQUIP: Experience in Quality Improvement

Don Berwick’s 2013 report encouraged the NHS to “become a learning organisation” with an orientation towards implementing and sustaining improvement and the notion that everyone in healthcare has a role to take a lead on improvement. Batalden and Davidoff propose that “everyone in healthcare really has two jobs….: to do their work and to improve it”. QI is an attitude, a language and a set of techniques, tools and methods to help us meet the challenge of becoming a “learning organisation”.

In October 2015 the Royal College of General Practitioners published ‘Quality improvement for General Practice: A guide for GPs and the whole practice team’. In addition Quality Improvement is referred to within the ‘Professional Modules’ of the GP Training Curriculum and within guidance documentation for GP appraisal. General Practice already has an improvement culture; trainees witness a range of activities in which GPs are engaged in respect of quality and safety – collectively at a practice level and individually for appraisal and revalidation through clinical audit and significant event analysis. QI may be thought of as an augmented approach and a range of tools that builds on these firm foundations.

What are the challenges?

The GP Training programme is short with many competing demands on time. Added to this is the geographical dispersion of GP trainees where time spent together in locality groups is already filled with other aspects of the GP curriculum. So it is reasonable to wonder how we might weave training about QI into the curriculum for all GP Trainees.

How does EQUIP run?

During 2016-17 we used the ECHO platform (familiar to many of you from Dermatology) to learn together through the RCGP QI curriculum and to share the improvement journey by sharing challenges about how to set up and develop the QI projects. As many of you know ECHO harnesses the benefits of old and new – on the one hand the time-honoured approach of case-based learning and on the other the use of video-conferencing technology to bring geographically dispersed trainees together. ECHO helps to develop a virtual improvement ‘Community of Practice’.

EQUIP meets for 6*1.5hr ECHO sessions scattered throughout the year from September to April. Each ECHO will start with a short teaching presentation on an area of QI methodology. The topics for the presentations will include: The Model for Improvement, Driver Diagrams, Measurement and PDSAs, Process Mapping and the elimination of waste, Human Factors and Sustaining Change. The ‘cases’ in the EQUIP ECHOs are the QI Project plans and will be submitted in advance of each ahead of time and emailed to all participants in advance of the ECHO.

Choosing a QI Project

Trainees choose an improvement project relevant for their Training Practice. There is the option to do this in groups though few found that to be helpful as the individual context of each Practice is always unique. The emphasis for the projects will be on ‘small’ and ‘achievable’.

Day of Celebration – EQUIP Conference

EQUIP concludes with a ‘Day of Celebration’ Conference at which everyone gets to present their QI projects – some as an oral presentation (one from each Training locality) and the rest as Posters. Below are some photos from the EQUIP Day of Celebration for 2017:

Examples of the EQUIP Poster

Please find below the Poster versions for the Trainees who presented their work orally at the Day of Celebration:

Please see our new series of resources for EQUIP on the NIMDTA Website HERE