G101 Junior doctor led training to improve the quality of quality improvement. (12th March 2018) - Rees, P
Abstract : Aims: All junior doctors are expected to undertake quality improvement (QI). However formal coaching in QI methods, their theoretical underpinning and application, is sporadic. This combination of mandatory QI with a lack of training can result in projects lacking theoretical underpinning and correct use of established methodology that fail to measurably or sustainably improve care, further demoralising trainees. We hypothesised that improving trainees' QI capability would increase their use of formal QI methods and subsequently improve the quality of QI at our institution. A six-week training programme was delivered to junior doctors by a junior doctor. We aimed to increase junior doctors' confidence using and applying the model for improvement. Methods: Training was aimed at junior doctors at an inner-city District General Hospital but open to multi-disciplinary staff. Teaching mirrored the Cincinnati Children's Qi algorithm, underpinned by Deming's theory of profound knowledge. This covered the QI process using the Model for Improvement. Sessions were didactic, interactive and practical, using real-life examples and repetition. Training was evaluated using the Kirkpatrick model with: knowledge assessments, evaluation forms and follow-up surveys. Sessions were adapted according to feedback. On completion, participants received certificates for their portfolios, the option of further coaching, and access to a QI toolkit. Results: Training was attended by 83 multidisciplinary staff: largely junior doctors, pharmacists and paediatric nurses. Knowledge, mapped to session aims, demonstrably increased. Average knowledge scores increased from 48% to 72.5% in week 1: and from 27% to 62% in week 6. On completion, 81% felt confident using the Model for Improvement; 95% felt confident completing a QI project. We received positive feedback about training being junior doctor-led and about the training programme. After training: 95% felt they saw quality and safety issues differently, 95% felt they had acquired new knowledge or skills and 100% said they felt empowered to improve. Conclusion: Junior doctors appreciated and benefitted from formal QI training. Since training, there are several on-going QI projects at our institution using the Model for Improvement. We hope build on this success by integrating QI training into junior doctors' curriculum at our hospital to further improve QI capability within this cohort of future leaders.