1. Learn home
  2. Advanced practice toolkit
  3. Pillars of practice
  4. Evidence, research and development pillar
  5. Audit and Quality Improvement

Audit and Quality Improvement

Add to favourites

Overview of audit and quality improvement and how to support in practice.

Audit and Quality Improvement (QI)

The term ‘Quality Improvement’ refers to the systematic use of methods and tools with the aim to try to continuously improve quality of care and outcomes for patients. As an advanced level practitioner, you will not only incorporate the principles of QI into your practice, but you will also provide leadership to the healthcare team in developing QI projects at work.

Dr Mareeni Raymong, a GP and editor of BMJ Quality Improvement Reports gives a short overview of QI in this video

If you are new to QI then the Turas Learn Quality Improvement Zone is a good place to get started and has a range of useful tools and resources.

This diagram provides a visual representation of the QI journey. For more information go to the QI Zone and watch the helpful animation.  

QI

 

Globally many countries have adopted the Institute of Medicine's (IOM) definition of quality (2001). An example of this can be seen in Scotland, where the IOM's six dimensions of quality have formed the basis of the 'Healthcare Quality Strategy for NHS Scotland' (Scottish Government, 2010). These dimensions form the basis of the three quality ambitions in Scotland and the plans for addressing them.

The three ambitions are:

  • Safe care: there will be no avoidable injury or harm to people from healthcare, advice or support they receive, and an appropriate, clean, and safe environment will be provided for the delivery of healthcare services at all times.
  • Effective care: the most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
  • Person-centred care: mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision-making.

Clinical audit is a way of reviewing patient care against a set of measurable outcomes with the aim of improving patient care, as part of quality improvement. The Audit Cycle is a process which can be followed to ensure a systematic and transparent approach. See diagram below:

QI Cycle

 

The need for audit may be triggered by a change in practice based on evidence, user views including complaints, near misses or local priorities.  The Effective Practitioner programme has further information about clinical audit. At a national level, Healthcare Improvement Scotland sets standards and monitors practice.

 

 

Watch this short video that highlights how an advanced practitioner has used audit to inform service development.

A transcript is available on request.

Tools to Support QI in Practice

There is a wide range of approaches and tools to support QI in practice:

  • Lean was developed by the Toyota Motor Company and was then adapted for healthcare. Six Sigma was developed by Motorola and used in healthcare. It uses a process called DMAIC - Define, Measure, Analyze, Improve and Control and is frequently used alongside Lean.
  • The Institute for Healthcare Improvement’s Model for Improvement uses the Plan-Do-Study-Act (PDSA) cycle to bring about change.
  • Information about other approaches can be found here

As an advanced level practitioner, you will be well positioned to identify changes in the evidence base for practice, near misses and adverse outcomes, as well as the need for change locally. Quality improvement activities are best undertaken as part of a team approach, and a multidisciplinary approach is advantageous as it ensures that all professional perspectives are represented, as well as having the appropriate clinical and technical expertise.

The QI team will identify aims of the project and agree the measures which the project intends to achieve. To find out more about how to establish measures, watch this video.

Implementing change can be challenging. The culture of an organisation can help or hinder changes in practice. Organisation culture is a complex set of ideals and principles which can either positively or negatively influence the performance of an organisation or the attitudes and practices of employees. Organisational culture can be explicitly stated (such as in strategy documents) or implicitly (as part of coffee room conversations). Much like the effect that culture can have on strategy, it can have a similar effect on your QI project (either positively or negatively). You can learn more about organisational culture in this video.  

Testing a change before implementing it across an organisation is a useful way of exploring if the intended benefits will be realised, as well as identifying challenges in adopting the proposed change. This can help reduce resistance to the change.

Based on the learning from the test of change, the change can then be spread across the organisation. The Institute for Healthcare Improvement (IHI) has resources which will help identify what needs to be considered before implementing the change widely and how to implement change successfully.

 

Please watch this short video for a practitioner’s perspective of QI in practice.

Training

There is a range of training on offer to suit a range of needs. Below is a list of some available.

Universities also offer masters programmes in quality improvement and patient safety. It is possible to access individual modules as continuing professional development.

Your NHS Board may also offer a range of training programmes and opportunities like this in NHS Lothian.

Useful Resources