Quality Improvement Projects

The Quality Improvement & Evidence Based Practice Module is completed throughout year 4, with a team-based quality improvement project to be completed during the first three clinical placements of Stage 3.

This module will enable you to develop skills in healthcare quality improvement that few other British medical graduates possess. It is a substantial piece of work, amounting to 300 hours of learning, and will require regular engagement from you over the course of the academic year. A key feature of this module is that you will work in small groups enhancing your skills in team-based working. The module is designed to help you appreciate the limits of clinical freedom and the centrality of a scientific and quantitative and qualitative evidence base for medicine, as well as the role that societal and patient values play in clinical decision-making, and an appreciation of the value, but also the limitations of evidence. You will use and generate credible data to direct the improvement of clinical practice at both an individual and a population level. You will co-design, co-implement and co-evaluate health care, pathways and processes in your partnerships and create and lead innovation. In order to do this you will learn about and use the theories and methods of strategic and change management and quality improvement.

The module is comprised of three parts:

• a Quality Improvement Project with associated online learning;

• a Critical Appraisal of a published journal article with associated online learning;

• a Patient Shadowing Project with associated online learning.

The first placement that you are assigned to at the start of year 4 will be your 'project site' where you will undertake your QI project (unless you are assigned to a GP practice for your QI project). You will also be assigned to a team of between four and six students, as you will be undertaking a team based quality improvement project, which you will conduct as part of a Quality Improvement and Evidence Based Practice module in Stage 3, Year 4 of the MBBS curriculum.

You will have protected time every Wednesday morning to work on your QI project, but you may well need to undertake some project related activities at other times, such as data collection. Finally, you will be assigned to a QI Project Supervisor. Your supervisor may or may not be a clinician, but they will have experience in quality improvement.

If your project site is at a peripheral trust, you may rotate back to a central cluster site for the remainder of your clinical blocks; however your team mates will be rotating through the clinical blocks together, so even when not 'on site', you will have ample time and opportunity to work on your project together. You can take it in turns to return back to the project site, for example to collect data, and you will be able to claim for reasonable travel expenses.

The QI & EBP Module includes online e-learning lessons and recommended reading on quality improvement in healthcare, and provides you with the knowledge you need, but the QI project helps you apply what you've learned. This guide includes six lessons that walk you through the six steps involved in completing a QI project.

Online e-learning lessons ‘Improving the Quality of Healthcare’ and QI Project Guide for Students

These interactive e-learning compulsory courses provide an introduction to quality improvement and an overview of how to plan and undertake a quality improvement project, taking you step-by-step through the principles and processes involved, and introducing some effective tools that students can use for a successful QI project.

Optional: IHI Open School series of seven online courses on Improvement Capability

This series of seven online courses developed by the Institute of Healthcare Improvement, provides more in depth teaching to increase the capability of students to apply QI methods to improve patient care and the patient experience. The courses are not mandatory, and although they are highly recommended, you may elect to use the time allocated for self-directed independent study.

This one hour interactive e-learning course helps you to understand what critical appraisal means, how critical appraisal links to evidence based practice, and makes students aware of some of the most popular resources available to help the clinician critically appraise relevant evidence in their own area of clinical practice. It takes you step-by-step through the Critical Appraisal Skills Programme (CASP) tools. Each student will also critically review an epidemiological or clinical trial study selected by the QI project supervisor and present it to a ‘journal club’ facilitated by the QI project supervisor.

You will undertake two patient shadowing projects, in the clinical settings that you encounter during your quality improvement project (or during other year 4 integrated clinical practice attachments). The project will focus on asking and answering the question: “how can I improve the patient experience?” You may work together in the same team as your QI project to shadow multiple patients, or to shadow the same patient at different ‘touchpoints’ on the patient journey, but each student must complete at least two shadowing experience themselves. Each shadowing project involves the direct, real-time observation of patients and families as they move through each step of a care experience.

Each shadowing project includes five steps:

1. Establish purpose of the project. What care experience will be examined? What does the student hope to learn? Who will do the shadowing?;

2. Set up. Ensure all parties on both sides of the shadowing experience — including patients, families, providers, and staff — are well-informed and on board;

3. Follow, observe, and record. As the student(s) move through the care experience, document everything that occurs at every step of the process, including everyone with whom the patient and family come into contact;

4. Create a care experience flow map and observational summary. Organising the findings in a way that helps to identify opportunities for improvement and that helps share the findings with others;

5. Report project findings. Present the summary report and observations, in both a verbal and written report, to people in the organisation who can help make improvements. An online course ‘A guide to shadowing: seeing care through the eyes of patients and families’ provides guidance and templates to support the student through a case study.