A Team Based Quality Review (TBQR) is a dynamic process of proactive reviews and collective learning from everyday events, performed by teams, utilising Systems Thinking approach. TBQR is applicable and relevant to any teams working within health or care sectors (and beyond).
It recognises the importance of the role of teams and its relationship with its surrounding systems in contributing to the provision of safe and effective care. TBQR demonstrates the value of gaining different perspectives to provide insight to developing and sustaining systems safety. It recognises that in the delivery of safe and effective care, good or bad outcomes often start from the same point, involves interactions between systems and are rarely if ever the result of one individual.
TBQR can be described as having evolved from the traditional Mortality and Morbidity meetings, which has often struggled with lack of structure, inconsistencies in format, poor analysis and understanding of safety science, often resulting in poor learning outcomes or utilisation of “learning” to effect meaningful or system wide change.
The TBQR process starts from the moment an event has occurred or highlighted. It involves an active system that encourages and facilitates reporting which is translated to a process of team based analysis utilising updated safety sciences, collective learning and improvements. The entire process is open, transparent and with active patient or carer engagement at every step. TBQR puts a spotlight on the value and role of teams on outcomes but also recognizes that improvement in quality of care is very much dependent on active patient engagement, improving the environment staff works in and their well-being. An example of a TBQR process or pathway is noted below.
Key to success of a TBQR is active patient engagement at every level and seeking multiple perspectives from those working within the system. It is recommended that reviews and meetings with the team are held at least once a week, which allows prompt identification of strengths and weaknesses within the system, sharing of learning and appropriate improvements are executed and sustained.
Why do we need it?
TBQR when carried out appropriately not only provides vital insight into delivery of care in complex systems but also addresses key areas of improvement and learning within the team in a timely manner. It creates opportunities to actively engage service users or patients with the teams and systems, responsible for provision of care. It recognises that everyone can play a vital role in contributing relevant information, resources, knowledge and skills to achieve our common goal of safe and effective care.
TBQR also brings together relevant safety and quality work streams to support and sustain improvements where it matters most, closes to patient care or the service user and the teams delivering such care. By providing the appropriate resource and training, teams are better equipped to address, or highlight, day to day challenges including near-misses, as well as learn and reinforce strengths in the system.
Getting started:
Three key areas that are key to implementing a successful TBQR process are listed below.
1) Effective IT systems to capture relevant intelligence and to facilitate learning and improvement,
2) Training to support health and care staff in gaining the necessary skill set to lead and participate in effective team based quality reviews.
3) Learning Platform to share relevant output from team based quality reviews.
HIS, NES and stakeholders are continuing the development a structured training programme for TBQR.
Consider how your organisation or team could use the example of the pathway below to guide the development of your own local process – please see slide 1 TBQR Pathway and SEIPS
We encourage everyone to reflect and address these 5 questions when discussing a case at TBQR – please see slide 2 TBQR Pathway and SEIPS
One example of a framework to perform an analysis of why things worked well or not is the SEIPS model– please see slides 3&4 TBQR Pathway and SEIPS
Please get on touch with his.adverseevents@nhs.scot to learn more on TBQR or if you would like us to support the development on your organisation/ team.