Quality improvement activity is an important part of appraisal for revalidation but it can often be misunderstood, confused with other types of supporting information or difficult to evidence.
Here, Danny Keenan, medical director at the Healthcare Quality Improvement Partnership, shares his views and ideas to support doctors through the process.
Annual appraisals are something that everyone is now familiar with. Along with feedback from patients and significant events, quality improvement activity is one of the other types of supporting information doctors need to collect, discuss and reflect at their appraisals.
Quality improvement activity can take many forms depending on a doctor’s role and the nature of their practice. But one thing it doesn’t include is continuous professional development (CPD). CPD is a requirement for appraisal in its own right but having reviewed many colleagues’ appraisals I know they are often confused.
Why quality improvement is important
Quality improvement is essentially about doctors demonstrating that they regularly take part in activities to review and evaluate the quality of their work, with the aim of improving it.
Examples can include clinical audits, reviews of clinical outcomes, case reviews or discussions, monitoring and evaluation; and that’s just to name but a few.
So, if it’s that simple, why is it not better understood? Why do some doctors struggle when it comes to demonstrating their quality improvement? I believe there are several reasons.
Many doctors, including some of my colleagues, simply don’t understand that there are metrics they can use that relate to their areas of practice. Healthcare organisations measure metrics all the time of course, but the connections between corporate performance and individual practice aren’t always clear.
And, even when performance data is broken down to a more local level, it’s often still team-based. In fact, this applies to a vast amount of clinical information. Concentrating on the national clinical audit programme, these are mostly team-based programmes. Even those audits that are more focused on the work of interventional consultants have a large component of team-based metrics.
Keeping things simple
Appraisals, of course, are a personal affair. To include outcomes from these national audits in a personal appraisal, the key is to keep things simple.
For individual doctors who are part of an audit, keeping things simple means minimising the amount of data collection they need to do themselves.
Increasingly, this can be done by using routine data sources, such as reviewing national results and service recommendations, and discussing at a multidisciplinary meeting, including doctors in training, where a service can reflect on improvements needed in the year ahead. Similarly, GPs could meet and discuss and reflect on their Quality and Outcomes Framework (QOF) performance.
The minutes of such a meeting can be uploaded into an individual appraisal and, most importantly, individuals can also record what they want to do differently to contribute to achieving a better service for patients.
This can provide an excellent basis for reflection, and for developing an improvement plan. It is a method that can be applied to a range of information, in all sectors of care.
But I’d like to also suggest another idea to take this train of thought a step further. We work in scientific environments, and it is only right that we develop appropriate metrics along the lines of safety, effectiveness and patient responsiveness, and that these cover all areas of care.
Could all the members of a multidisciplinary team agree a single team-based objective that they can each include in their professional development plans?
I believe that with well-lead teams a single objective could be developed, and agreed by all, that would sit alongside team-based working. It would complement, rather than replace, individual appraisals and quality improvement data.
No doubt others will have views, but gathering quality improvement activity for an appraisal really shouldn’t be as daunting as it can sometimes appear.