Quality Improvement in the Emergency Department

So what is Quality Improvement?

Simply put, Quality Improvement is about making things better. Unfortunately this cannot happen without change, and nobody really likes to change.

https://www.torbenrick.eu/blog/change-management/change-management-comic-strips/

So Quality Improvement is really about managing change, and doing so such that it is the most positive experience for everyone involved.

Imagine a well. This is the well of good will. It is fed by a small trickling stream of good will but every time you make a change you take a great big bucket of good will out of the well. Do this too rashly and too often and the well of good will run dry. Manage your change and use of good will well and every one will remain sustained.

If we can learn to manage change so that it becomes a positive experience then we create an environment and culture that will embrace change and will constantly look to evolve and innovate.

 

So how does it work?

Quality Improvement is just about putting some rigour behind ‘Trial and Error’. The reason for this is that it gives us a structure to work from and allows us to learn as we go along so we know what works, what doesn’t, what is liked and what is not. It stops us from running down blind alleys and expending huge amounts of energy on ideas or projects that don’t have the results that we hoped for.

A Quality Improvement project asks 3 things from us:

  • To properly understand the system that we are trying to change
  • To know how any change we make gets the results we want
  • To start with a problem and not a solution

There are multiple methodologies that can be used for Quality Improvement but they all require and embrace these 3 points. The methodologies simply allow us to break down our problem and our thoughts so that we can examine them and act appropriately.

Isn’t it just audit?

No. An audit requires you to gather massive amounts of data. Traditionally you would then make a change or collection of changes and repeat the data collection to see if it differs.

Quality Improvement works differently. Firstly, you only collect the data that you need, often using sampling to reduce the burden, but you collect it continuously. This continuous data is where the power lies as you can use it to ensure that any change you observe is not due to random or normal activity. Secondly, you make changes in series, watching for the impact and evaluating each one in turn. This allows you to understand effective interventions and is more likely to result in sustainable change.

So where do I start?

Excellent. You can start by finding a problem that needs fixing. This needs to be a problem that exists and not one derived from anecdote. And whilst it may be tempting to try and fix the world, at first it is just as valid and important to try and fix those problems that bug and annoy us every day. Start small and get bigger. Alternatively, if you are enthused and eager but don’t know what you want to do then just get in touch.

Get in contact with the ED QI team at edward.james@nhslothian.scot.nhs.uk  and we can help you with or to become part of a project.

If you want to learn more then start with the NES e-learning modules below:

https://learn.nes.nhs.scot/3870/quality-improvement-zone/elearning

 

Good luck and we look forward to hearing from you